What symptoms of a herniated disc require immediate hospital attention?

Emergency Symptoms of Herniated Disc Requiring Immediate Hospital Attention

Go to the hospital immediately if you develop urinary retention, loss of bowel control, or numbness in the "saddle area" (groin/buttocks), as these indicate cauda equina syndrome—a surgical emergency requiring decompression within 24-48 hours to prevent permanent nerve damage. 1, 2

Absolute Emergency ("Red Flag") Symptoms

Cauda Equina Syndrome - Requires Emergency Room Within Hours

• Urinary retention (inability to urinate or painless retention) - this is the most frequent finding with 90% sensitivity for established cauda equina syndrome 1
• Loss of bowel control or fecal incontinence 1, 2
• Saddle anesthesia - complete numbness in the groin, buttocks, and inner thighs where you would sit on a saddle 1, 3
• Bilateral leg weakness affecting both legs simultaneously 1

Critical timing: Surgery must occur within 24-48 hours of symptom onset for cauda equina syndrome to maximize chances of recovery 2. Waiting for complete urinary retention is a dangerous pitfall—early bladder changes warrant immediate evaluation 1.

Urgent Symptoms - Seek Emergency Evaluation Within Days

Severe Motor Weakness

• Significant leg weakness (unable to stand on toes, lift foot, or walk normally) with muscle strength ≤3/5 requires surgery within 3 days for best recovery outcomes 2
• Progressive neurological deficits - weakness that is getting worse over hours to days 1, 4
• New foot drop - inability to lift the front of your foot 4

Warning Signs of Developing Cauda Equina

• Bilateral radiculopathy - pain, numbness, or weakness radiating down BOTH legs (not just one) 1
• New difficulties with urination - hesitancy, weak stream, or any change in bladder function even if you can still urinate 1
• Subjective perineal numbness - any new numbness or tingling in the groin/buttock area, even if subtle 1

Non-Emergency Symptoms - Outpatient Management Appropriate

Standard Herniated Disc Symptoms (Do NOT Require Hospital)

• Sciatica - pain radiating down one leg below the knee 4, 3
• Mild to moderate leg weakness (can still walk and perform daily activities) 2
• Back pain with or without leg pain 4
• Numbness or tingling in one leg or foot (not the saddle area) 4

These symptoms warrant outpatient evaluation but not emergency room visits. Most patients (60-80%) improve within 6-12 weeks with conservative treatment 2, 5.

Common Pitfalls to Avoid

• Don't wait for complete urinary retention - any new bladder symptoms require immediate evaluation, as complete retention indicates irreversible damage has already occurred 1
• Don't dismiss bilateral leg symptoms - this is fundamentally different from typical one-sided sciatica and requires urgent imaging 1
• Don't delay if symptoms are rapidly worsening - progressive neurological decline over hours to days requires immediate evaluation 1, 4
• Don't confuse typical sciatica with cauda equina - isolated leg pain without bladder/bowel/saddle symptoms does not require emergency care 4, 3

When to Call 911 vs. Drive to ER

Call 911 if:

• Unable to urinate with severe pain 1
• Complete loss of bowel control 1
• Sudden paralysis of both legs 1

Drive to ER (or have someone drive you) if:

• New bladder hesitancy or changes 1
• Numbness developing in groin/buttocks area 1
• Rapidly progressive leg weakness over 24-48 hours 2
• Bilateral leg pain/weakness 1