2 Sciatica Symptoms That Require Immediate Medical Attention

While your sciatica pain can be severe and cause your leg to feel weak, the symptoms typically do not produce any long-term complications. ¹ Davis D, Vasudevan A. Sciatica. [Updated 2019 Feb 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507908/ Rarely, if the underlying cause of your sciatica becomes severe, it may produce troubling symptoms when your spinal nerve roots and/or spinal cord get compressed, sometimes triggering a medical emergency.

Below are the descriptions of two serious sciatica symptoms that must be urgently evaluated and treated:

1. Changes in bowel and/or bladder control

Consult your doctor immediately if you have any sudden, unexplained changes in your bowel and/or bladder control. These changes may include:

• An inability to control your bowel and/or bladder movements. ² Kim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28. doi:10.1016/b978-0-7020-2913-4.00001-x
• Difficulty in passing urine, a reduced urinary sensation, a loss of desire to pass urine, or a poor stream. ² Kim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28. doi:10.1016/b978-0-7020-2913-4.00001-x ^{, 3} Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. doi:10.3399/bjgp14X676988

These symptoms indicate a rare, but serious medical condition called cauda equina syndrome. In addition to incontinence problems, cauda equina syndrome may also cause:

• Sudden pain and weakness in both your legs ⁴ Verdugo RJ, Campero M, Castillo JL, Cea G. Pain and Temperature. In: Textbook of Clinical Neurology. Elsevier; 2007:363-381. doi:10.1016/b978-141603618-0.10020-7
• Numbness in your groin, buttocks, genitals and/or inner thighs (saddle numbness). ² Kim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28. doi:10.1016/b978-0-7020-2913-4.00001-x
• Sexual dysfunction ³ Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. doi:10.3399/bjgp14X676988 ^{, 4} Verdugo RJ, Campero M, Castillo JL, Cea G. Pain and Temperature. In: Textbook of Clinical Neurology. Elsevier; 2007:363-381. doi:10.1016/b978-141603618-0.10020-7

Read more about Cauda Equina Syndrome Symptoms

Cauda equina syndrome can occur suddenly or gradually and typically requires immediate surgery to control the symptoms. ³ Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. doi:10.3399/bjgp14X676988 If patients with cauda equina syndrome do not receive prompt treatment, it can result in difficulty in walking and/or other neurological problems, including lower-body paralysis. Doctors advise treating this condition within 24 to 48 hours of symptom occurrence in order to preserve lower limb function. ² Kim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28. doi:10.1016/b978-0-7020-2913-4.00001-x ^{, 3} Fairbank J, Mallen C. Cauda equina syndrome: implications for primary care. Br J Gen Pract. 2014;64(619):67–68. doi:10.3399/bjgp14X676988 ^{, 5} Petr O, Glodny B, Brawanski K, et al. Immediate Versus Delayed Surgical Treatment of Lumbar Disc Herniation for Acute Motor Deficits. SPINE. 2019;44(7):454-463. doi:10.1097/brs.0000000000002295

See Treatments for Cauda Equina Syndrome

While rare, sciatica caused due to severe disc herniation(s) in the lower spine may progress into cauda equina syndrome.

2. Worsening neurological symptoms

Severe damage to your sciatic nerve roots can cause progressive neurological symptoms and requires immediate treatment. ⁵ Petr O, Glodny B, Brawanski K, et al. Immediate Versus Delayed Surgical Treatment of Lumbar Disc Herniation for Acute Motor Deficits. SPINE. 2019;44(7):454-463. doi:10.1097/brs.0000000000002295 ^{, 6} Selz AF, Morard M, Buchard PA, Frochaux V. [When should a patient with low back pain/sciatica be referred to the emergency ward?]. Rev Med Suisse. 2010;6(259):1540-2, 1544-5. The symptoms may affect one or both legs and typically include the following:

• Numbness
• Weakness
• Tingling
• Abnormal sensations, such as crawling
• An abnormally increased sensitivity to pain (hyperalgesia)

It is also possible for the symptoms to occur only below the knee without involving the entire limb. ² Kim K-H, Kim DH. Diagnosis and Treatment of Spinal Pain. In: Minimally Invasive Percutaneous Spinal Techniques. Elsevier; 2010:1-28. doi:10.1016/b978-0-7020-2913-4.00001-x While these symptoms may not warrant surgery, some form of immediate medical treatment is usually needed. ⁵ Petr O, Glodny B, Brawanski K, et al. Immediate Versus Delayed Surgical Treatment of Lumbar Disc Herniation for Acute Motor Deficits. SPINE. 2019;44(7):454-463. doi:10.1097/brs.0000000000002295 Your doctor may recommend pain management procedures, such as epidural steroid injections or radiofrequency ablation. If your symptoms are severe, do not improve with these treatments, and/or continue to worsen, surgery may be advocated. ⁵ Petr O, Glodny B, Brawanski K, et al. Immediate Versus Delayed Surgical Treatment of Lumbar Disc Herniation for Acute Motor Deficits. SPINE. 2019;44(7):454-463. doi:10.1097/brs.0000000000002295

See Sciatica Surgery

Failure to treat severe or progressive neurological symptoms can cause irreversible nerve damage over time. These symptoms may also indicate slow-onset cauda equina syndrome and must not be ignored.

More red-flag symptoms to watch out for

You should also consult a doctor if your sciatica symptoms:

• Started after an accident or injury
• Are accompanied by fever, nausea, and/or loss of appetite
• Include unrelenting night pain or pain at rest

These symptoms may indicate serious medical conditions such as an infection or spinal tumor.

Talk to your doctor if you have troubling symptoms related to sciatica. A doctor can accurately diagnose the underlying cause and recommend a specific treatment plan for your symptoms.

See When Sciatica Pain Is a Medical Emergency

Learn more:

Is My Pain Sciatica or Something Else?

Causes of Cauda Equina Syndrome