Intermittent Burning Sensation in Buttocks with Bladder Spasms and Genital Numbness

Case at a Glance

A 24-year-old female presents with a 2-3 week history of intermittent burning sensation in the buttocks, bladder spasms when lying on her left side, and episodic genital numbness triggered by squatting. She has a medical history of stage 2 endometriosis and IBS-C.

Patient's Story

The patient reports that approximately 2-3 weeks ago, she began experiencing a burning sensation in both buttocks that persisted for about one week before resolving. The symptoms recently recurred, but this time isolated to the upper left buttock. She also describes associated soreness in her lower back just above the left buttock that worsens with forward bending or awkward sitting positions. Additionally, she experiences occasional bladder spasms described as uncomfortable, shock-like sensations that occur primarily when lying on her left side at bedtime. These spasms are non-painful but cause her to startle. She also reports brief episodes of genital numbness that have been occurring for several months, typically triggered by squatting movements and resolving quickly.

Initial Assessment

The patient appears to have neurological symptoms consistent with possible lower spinal cord or sacral nerve involvement. Her symptoms include unilateral buttock burning, positional bladder spasms, and transient genital numbness. Given her history of endometriosis and suspected pelvic floor dysfunction, a comprehensive neurological evaluation was warranted.

The Diagnostic Journey

Initial consultation focused on ruling out spinal cord pathology given the constellation of symptoms affecting the lower back, buttocks, bladder, and genital region. The patient's medical history of stage 2 endometriosis diagnosed via laparoscopy one year prior, along with IBS-C and suspected pelvic floor dysfunction, was considered in the differential. Current medications include combined oral contraceptives (norethindrone/ethinyl estradiol), venlafaxine, and dicyclomine as needed.

Final Diagnosis

Pending neurological evaluation for suspected lower spinal cord or sacral nerve dysfunction, with consideration of pelvic floor dysfunction as a contributing factor.

Treatment Plan

Referral to neurology for comprehensive evaluation including possible MRI of the lumbosacral spine. Consideration of pelvic floor physical therapy evaluation. Symptom monitoring and documentation of triggers and patterns.

Outcome and Follow-up

Patient scheduled for neurological consultation. Advised to monitor symptoms and seek immediate care if symptoms worsen or new neurological deficits develop. Follow-up appointment scheduled in 2 weeks to review specialist recommendations and symptom progression.