Cervical Spondylosis with Radiculopathy Does Not Cause Constipation
Moderate to severe cervical spondylosis with radiculopathy does not cause or exacerbate constipation, as the affected nerve roots (C5-C7) innervate only the upper extremity and have no role in bowel function.
Anatomical Basis for Why Constipation Cannot Occur
Cervical radiculopathy presents with arm pain in a dermatomal distribution, sensory dysfunction, motor weakness in corresponding myotomes, and neck pain that may radiate to the shoulder—but never affects bowel function 1.
The most commonly affected nerve roots in cervical spondylosis are C5-C6 and C7, which provide innervation exclusively to the upper extremity 1.
Bowel function is controlled by the sacral nerve roots (S2-S4) and the autonomic nervous system, which are anatomically distant from the cervical spine and cannot be affected by cervical pathology 1.
When Bowel Symptoms Indicate a Different Problem
If constipation or any bowel dysfunction occurs in a patient with cervical spine disease, this represents a red flag requiring urgent evaluation for cervical myelopathy (spinal cord compression) rather than simple radiculopathy 1.
New changes in bladder or bowel function require urgent evaluation and suggest possible cervical myelopathy with spinal cord compression 1.
Loss of perineal sensation is another red flag requiring urgent evaluation for myelopathy 1.
Cervical spondylotic myelopathy presents with gait disturbance and balance difficulties due to spinal cord compression, hand clumsiness, and fine motor deterioration—and in severe cases with long tract signs that can affect lower extremity function 2, 3.
Critical Clinical Pitfall to Avoid
Do not attribute constipation to cervical radiculopathy, as this represents a fundamental misunderstanding of neuroanatomy and may delay diagnosis of a more serious condition 1.
- If a patient with cervical radiculopathy develops bowel symptoms, consider alternative diagnoses including:
- Medication side effects (opioids, muscle relaxants commonly used for cervical pain) 4
- Concurrent lumbar spine pathology affecting sacral nerve roots 1
- Cervical myelopathy with spinal cord compression (requires urgent MRI and surgical evaluation) 1, 2
- Unrelated gastrointestinal or metabolic conditions 1
Diagnostic Approach When Symptoms Don't Match
MRI of the cervical spine is the preferred imaging modality to evaluate for cervical radiculopathy, but will not explain bowel symptoms 1.
When symptoms affect regions beyond the upper extremity, more comprehensive neurological workup is warranted, potentially including MRI of both cervical and lumbar spine 1.
Neurology consultation should be considered for atypical presentations that cannot be explained by the documented cervical pathology 1.