Back pain with bladder change
Neurological · Independent CANRA preparation
Clinical study scenario
A 46-year-old with worsening low back pain now reports difficulty initiating urination and numbness around the perineum. They ask whether a manipulation appointment can proceed.
Connect mechanism to the presentation
New bladder disturbance and saddle sensory change with back pain raise concern for cauda equina dysfunction.
Explain the next action
Immediate assessment is warranted for possible cauda equina syndrome. Explain the concern without claiming a confirmed diagnosis.
When the situation changes
Leg pain is only moderate. Does that reduce the urgency created by the bladder and sensory changes?
No. The red-flag functional changes drive the immediate assessment decision.
Safety and follow-up
- Do not manipulate before evaluation
- Record onset of bladder and sensory changes
- Use a direct emergency handover
Resume rehabilitation only after medical evaluation and an appropriate plan.
Practise actively
Choose an answer before viewing the reasoning, compare the alternatives, and explain your handover.
Practise this case Review the mechanismBackground source and limitations
NICE NG127 — Neurological recognition and referral
The reading supports background principles. The case and teaching synthesis require educator review, including Canadian scope and local pathway applicability.