Saddle Area Sensory Loss: Causes and Concerns

Saddle area sensory loss or numbness?

Hello, doctor.
A few months ago, I strained my lower back, and since then, I've been experiencing pain in my lower back when sitting.
About a month ago, I suddenly noticed a decrease in the urge to urinate and defecate, and my ability to pass urine and stool has significantly worsened, especially urination.
I feel no sensation in my urethra while urinating, and there is reduced sensation in the glans penis and the frenulum, with no sensation at the base of the penis, leading to an inability to achieve an erection.
Additionally, the pain on the right side of my lower back extends to the area near the tailbone in the right buttock.
I discovered that if I lie on my right side for a few minutes, I experience numbness and lack of sensation in my buttocks, perineum, genitals, and the adjacent thigh, which do not hurt even when pinched.
Lying on my left side seems to alleviate the symptoms.
The next day, I immediately went to a major hospital and consulted the urology department.
After undergoing a bladder ultrasound and urinary tract imaging, no issues were found.
The doctor referred me to the neurology department, stating that he couldn't address the lack of sensation.
I then saw a neurosurgeon, who performed nerve conduction velocity (NCV) tests on my calves and X-rays and MRI of my lower abdomen.
The neurosurgeon mentioned that I have a mild herniated disc but not severe enough to cause saddle anesthesia.
He also stated that he couldn't determine the cause and referred me to the neurology department.
After reviewing the MRI, the neurologist gave a similar assessment, stating that my symptoms only involve sensory reduction and numbness, with no other symptoms resembling cauda equina syndrome.
He suggested that it might be due to prolonged sitting causing nerve compression.
He couldn't diagnose a specific condition and prescribed anti-inflammatory and neuropathy treatment medications for two months, indicating that I would have to wait another two months.
Doctor, I have two questions: 1.
After a month of symptoms, is there a risk of permanent nerve damage? 2.
In your experience, what could this condition possibly be? It seems unusual that three specialists couldn't identify the cause; it feels too rare and fortunate, doesn't it?

Mr. Cheng, 30~39 year old female. Ask Date: 2022/09/10

Dr. Jiang Junyi reply Neurology

Hello Mr.
Cheng,
You mentioned that "lying on my right side for a few minutes causes numbness and loss of sensation in my buttocks, perineum, genitals, and adjacent thigh, with no pain even when pinched, while lying on my left side feels more normal." This may indicate peripheral nerve compression.
The mechanism could be due to structural abnormalities that exert external pressure on the peripheral nerves.
When peripheral nerves are compressed, sensory nerves typically exhibit symptoms first.
Common causes of peripheral nerve injury include acute direct trauma: nerve traction, tearing, and direct compression, as well as chronic overuse: sustained muscle contraction and tightness, hypertrophy, and edema causing nerve compression.
Symptoms of peripheral nerve compression include:
1.
Pain characterized by burning or tingling sensations.
2.
Symptoms that follow a specific dermatomal distribution, which can be triggered by touch or pressure.
3.
Accompanied by muscle weakness or atrophy.
Examinations for peripheral nerve issues typically involve electrophysiological studies to assist in diagnosis.
Nerve conduction studies assess the conduction velocity and waveform of large fiber nerves, while electromyography evaluates muscle responses in the affected nerve distribution areas.
I recommend consulting a neurologist specializing in peripheral nerves, as they have more experience with electromyography diagnostics.
Thank you for your inquiry.
If you have further questions, feel free to discuss them!
Wishing you good health, peace, and happiness.
Dr.
Jiang Junyi, Neurology, Taoyuan Hospital

Reply Date: 2022/09/10

More Info

Saddle area sensory loss, characterized by numbness or loss of sensation in the areas that would come into contact with a saddle (the inner thighs, perineum, and buttocks), can be a concerning symptom that warrants thorough investigation. Your symptoms, including reduced bladder and bowel sensation, erectile dysfunction, and pain radiating from the lower back to the buttocks, suggest a potential neurological issue that could be related to nerve compression or injury.

1. Potential for Permanent Nerve Damage: The concern about permanent nerve damage is valid, especially with symptoms persisting for an extended period. Nerves can be sensitive to prolonged compression, and while some nerve injuries can heal over time, others may lead to lasting deficits if not addressed promptly. The duration of symptoms is critical; the longer the nerve is compressed, the higher the risk of irreversible damage. However, the exact timeline for potential nerve recovery varies widely among individuals and depends on the nature and severity of the underlying issue.

2. Possible Conditions: Given your symptoms and the investigations you've undergone, several conditions could be considered:
- Herniated Disc: While your MRI indicated a mild herniation, it may not be severe enough to cause saddle area sensory loss directly. However, it could still contribute to nerve root irritation or compression, leading to your symptoms.

- Cauda Equina Syndrome: This is a serious condition resulting from compression of the cauda equina nerves at the lower end of the spinal cord. Symptoms can include saddle anesthesia, bladder and bowel dysfunction, and lower extremity weakness. While your doctors have ruled out this diagnosis, it is essential to remain vigilant for any worsening of symptoms, as this condition requires immediate surgical intervention.

- Peripheral Neuropathy: This condition can result from various causes, including diabetes, vitamin deficiencies, or prolonged pressure on nerves. If your symptoms are due to peripheral nerve issues, they may improve with appropriate treatment.

- Sacroiliac Joint Dysfunction: This can cause referred pain to the buttocks and lower back, potentially affecting sensation in the saddle area.

- Prolonged Sitting or Compression: As suggested by your neurologist, prolonged sitting can lead to nerve compression, particularly if there are underlying anatomical issues.

3. Next Steps: Given the complexity of your symptoms and the lack of a definitive diagnosis, it may be beneficial to seek a second opinion from a specialist in neurology or a pain management clinic. They may recommend additional imaging studies, such as a more detailed MRI or nerve conduction studies, to assess for any subtle changes that may have been missed.

4. Management: In the meantime, conservative management strategies may help alleviate your symptoms. This could include physical therapy focused on strengthening the core and pelvic floor muscles, which can help relieve pressure on the nerves. Medications such as non-steroidal anti-inflammatory drugs (NSAIDs) or neuropathic pain agents (like gabapentin) may also provide relief.

In summary, while the symptoms you are experiencing are concerning, there are various potential explanations. It is crucial to continue working with your healthcare providers to monitor your condition closely and explore further diagnostic options. If your symptoms worsen or new symptoms arise, seek immediate medical attention.

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