Peripheral Neuropathy and Sciatica in Elderly Patients

Peripheral neuropathy, sciatica?

Doctor, my father is in his eighties and has prostate cancer.
He experiences pain on both sides of his buttocks, and his legs feel sore and numb, making it difficult for him to walk.
He also has urinary and fecal incontinence.
He has seen a neurologist at a clinic and has undergone rehabilitation, but there has been no improvement.
The neurologist said there is nothing more that can be done.
What could be the cause of these symptoms, and how should we address this? Thank you.

Jay, 40~49 year old female. Ask Date: 2020/05/04

Dr. Shi Guozheng reply Orthopedics

As people age, it is common for the spine to undergo degenerative changes.
Some individuals may develop spinal stenosis or spondylolisthesis, which can lead to mobility issues (intermittent claudication) or bowel and bladder incontinence.
It is advisable to consult a neurosurgeon to determine if surgical intervention is necessary.
Minimally invasive decompression surgery may help alleviate some of the symptoms.

Reply Date: 2020/05/04

More Info

Peripheral neuropathy and sciatica are two conditions that can significantly affect the quality of life in elderly patients, particularly those with underlying health issues such as prostate cancer. In your father's case, the symptoms he is experiencing—bilateral buttock pain, leg discomfort, and urinary incontinence—could be attributed to a combination of factors related to his age, cancer diagnosis, and possibly the effects of treatment.

Understanding Peripheral Neuropathy:
Peripheral neuropathy refers to damage to the peripheral nerves, which can result from various causes, including diabetes, infections, toxins, and certain medications. In elderly patients, neuropathy can manifest as pain, tingling, numbness, or weakness in the limbs. Given your father's age and cancer diagnosis, it is possible that his neuropathy could be related to chemotherapy or other medications used to manage his prostate cancer. Additionally, cancer itself can lead to nerve compression or damage due to tumor growth or metastasis.

Understanding Sciatica:
Sciatica is characterized by pain that radiates along the path of the sciatic nerve, which runs from the lower back through the hips and buttocks and down each leg. It is often caused by a herniated disk, spinal stenosis, or other spinal issues that compress the sciatic nerve. In elderly patients, degenerative changes in the spine can lead to sciatica, resulting in pain, numbness, or weakness in the legs.

Symptoms and Diagnosis:
The symptoms your father is experiencing—pain in the buttocks, leg discomfort, and incontinence—could indicate a more complex issue. The combination of pain and urinary incontinence is particularly concerning, as it may suggest nerve involvement in the pelvic region. This could be due to a condition known as cauda equina syndrome, which is a medical emergency that requires immediate attention. It occurs when the nerve roots at the lower end of the spinal cord become compressed, leading to symptoms such as severe lower back pain, sciatica, and loss of bladder or bowel control.

Management and Treatment Options:
Given that your father has already seen a neurologist and undergone rehabilitation without improvement, it may be time to consider further evaluation. Here are some steps you can take:
1. Re-evaluation by a Specialist: Consider seeking a second opinion from a neurologist or a pain management specialist who has experience with cancer-related symptoms. They may recommend imaging studies, such as an MRI of the lumbar spine, to assess for any structural issues that could be contributing to his symptoms.

2. Pain Management: If neuropathy is confirmed, medications such as gabapentin or pregabalin may be prescribed to help manage nerve pain. For sciatica, anti-inflammatory medications or corticosteroids may provide relief.

3. Physical Therapy: A tailored physical therapy program can help improve mobility and strengthen the muscles around the affected areas. A physical therapist can also provide strategies to manage pain and improve function.

4. Palliative Care: Given your father's age and cancer diagnosis, involving a palliative care team may be beneficial. They can help manage symptoms, improve quality of life, and provide support for both your father and your family.

5. Addressing Incontinence: If urinary incontinence persists, it is essential to discuss this with his healthcare provider. There may be treatments available, including medications or pelvic floor exercises, that can help manage this symptom.

In summary, your father's symptoms are complex and may require a multidisciplinary approach for effective management. It is crucial to ensure that he receives comprehensive care that addresses both his cancer and the neurological symptoms he is experiencing. Don't hesitate to advocate for further evaluations and treatments that can improve his quality of life.

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