My mother has this problems Degenerative disc disease. At L4-L5 level: Circumferential disc bulge and bilateral flaval hypertrophy causing mild thecal sac indentation and bilateral partial lateral recess obliteration. Searching whole spine in T2 sagittal plane: a) Mild posterior disc bulge at C4-C5, C5-C6 & C6-C7 levels causing ventral subarachnoid space indentation without significant cord compression. b) Fatty marrow infiltration/haemangioma in D10 body. Now when she gots diarrhoea or another bowel problems..mainly diarrhoea.. Then she gots severe pain in hip-buttock-pelvic region.. Now you should explain that,,do bowel problems can make this severe pain? Search worldwise...in every books..epubmed..evety Where.. I need proper ans...think analytically,,and in a Most assured way..
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diarrhea AND pelvic pain
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irritable bowel syndrome AND low back pain
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NICE cauda equina syndrome red flags bowel bladder saddle numbness urgent assessment
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inflammatory bowel disease AND sacroiliitis
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diarrhea AND low back pain
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inflammatory bowel disease AND spondyloarthritis
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reactive arthritis AND diarrhea
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Crohn's Colitis Foundation IBD arthritis sacroiliac joints buttock pain diarrhea
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PMID: 35046098
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PMID: 36174478
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Short answer: yes, diarrhoea can make her hip-buttock-pelvic pain much worse, but it does not automatically mean that her L4-L5 disc problem is getting worse or that the bowel is pressing on a nerve. The repeatable connection needs medical assessment because there are several possible explanations, some spinal and some bowel/pelvic-related.
What the MRI does and does not show
L4-L5
Her MRI describes:
- a broad disc bulge
- thickening of the ligamentum flavum
- mild indentation of the thecal sac
- partial narrowing of both lateral recesses, where nerve roots travel
This can produce low-back pain and sometimes pain referred to the buttock, back of the hip, thigh, leg, numbness, tingling, or weakness. Lumbar disorders commonly refer pain to the posterior hip/buttock, while sacroiliac-joint disorders can do the same. Rheumatology, p. 729.
However, the report says mild thecal-sac indentation and does not report severe central canal compression or a large disc prolapse. Therefore, the scan alone does not prove that the L4-L5 finding is the cause of severe pelvic pain during every diarrhoea episode. Many adults have disc bulges on MRI that are not the main source of their symptoms.
Neck disc bulges at C4-C7
These are in the neck and have no likely direct explanation for hip, buttock, pelvic pain, or diarrhoea.
D10 vertebral haemangioma / fatty marrow change
A vertebral haemangioma is commonly an incidental benign vascular-fatty change in a vertebral body. At D10, it would not normally explain episodic low pelvic or buttock pain associated with diarrhoea, unless there were unusual aggressive features, which are not mentioned in the wording you shared.
Why diarrhoea can amplify this pain
There are three main categories to consider.
1. Mechanical pain flare from abdominal cramps, pelvic-floor activity, posture and muscle guarding
During diarrhoea, the bowel contracts strongly and often painfully. Repeated rushing to the toilet, sitting/standing, straining, abdominal muscle tightening, dehydration, and muscle guarding can all aggravate a sensitive lower back, sacroiliac area, gluteal muscles, or irritated nerve root.
This is a plausible explanation when:
- pain occurs only during the diarrhoea/cramping episode
- there is no new leg weakness or numbness
- there is no loss of bowel or bladder sensation/control
- the pain settles as the bowel illness settles
This would be a pain flare over an existing spine or pelvic musculoskeletal condition, not necessarily new structural injury to the disc.
2. The bowel or pelvic condition itself may refer pain to the back, buttock or pelvis
Diarrhoea accompanied by marked pelvic pain can arise from bowel inflammation/infection, irritable bowel syndrome, rectal inflammation, diverticular disease, urinary disorders, or gynecologic conditions, depending on her age and symptoms. Back pain can also have an extraspinal source, including abdominal or pelvic organs. Rosen's Emergency Medicine, p. 338.
So, if her severe pain is more in the lower abdomen/pelvis, rectum, deep buttock, groin, or perineum, the bowel/pelvis needs evaluation rather than assuming it is all from degenerative-disc disease.
Important accompanying clues:
- fever, vomiting, blood or mucus in stool
- persistent or recurrent diarrhoea
- abdominal swelling or tenderness
- weight loss, poor appetite, anemia, fatigue
- pain on passing stool, rectal urgency or tenesmus
- urinary burning, urgency, blood in urine
- vaginal bleeding, discharge, or a relation to menstrual cycles if applicable
3. Inflammatory bowel disease or post-infectious arthritis can affect the sacroiliac joints
This is less common than a simple mechanical flare, but it is important because it specifically links diarrhoea and buttock pain.
Inflammatory bowel disease, such as Crohn's disease or ulcerative colitis, can be associated with inflammatory arthritis and sacroiliitis, inflammation of the joints joining the spine to the pelvis. These joints can produce deep low-back, buttock, and posterior-hip pain. A major medical text lists sacroiliitis among systemic manifestations of inflammatory bowel disease. Goldman-Cecil Medicine, 2-volume edition.
A systematic review found that axial spondyloarthritis, which includes sacroiliac/spinal inflammatory disease, occurs in a meaningful minority of people with IBD, though reported rates vary substantially across studies: Schwartzman et al., 2022, systematic review, PMID 35046098.
Another possibility is reactive arthritis, in which arthritis occurs after some gastrointestinal infections. It more often follows diarrhoea by days to weeks rather than starting simultaneously with each loose stool, and may involve swollen painful joints, heel pain, eye redness/pain, or urinary symptoms. Evidence includes a systematic review of post-Giardia reactive arthritis: Mahdavi et al., 2022, systematic review, PMID 36174478.
Features that make sacroiliac/inflammatory disease more likely:
- pain deep in one or both buttocks, sometimes alternating sides
- pain/stiffness worst in the early morning or after rest
- improvement with gentle movement, rather than rest
- repeated/chronic diarrhoea, blood/mucus in stool, weight loss
- eye inflammation, psoriasis, heel pain, swollen joints
- family history of psoriasis, inflammatory bowel disease, or ankylosing spondylitis
The bowel-red-flag distinction that matters most
Having diarrhoea is not the same as neurologic bowel dysfunction.
With simple diarrhoea, she feels the urge, knows stool is coming, and can generally control it, although urgency may be severe.
Possible nerve compression affecting the cauda equina is different. It can cause:
- new inability to start urinating, poor urine stream, urinary retention, or urine leakage
- new loss of sensation of bladder filling or when passing urine
- inability to feel stool passing, or new fecal incontinence that is not simply diarrhoeal urgency
- numbness/tingling around the genitals, anus, inner thighs, or the area touching a saddle
- new or worsening weakness in one or both legs, foot drop, or rapidly increasing bilateral sciatica
- severe back/buttock pain with these neurological changes
If any of these occur, take her to an emergency department immediately, today. Cauda equina syndrome is uncommon but time-sensitive. Large L4-L5 or L5-S1 disc herniations are a typical cause, and urgent MRI plus spinal specialist assessment is indicated when suspected. Goldman-Cecil Medicine, 2-volume edition. Recent guidance also emphasizes urgent same-day assessment for new bladder symptoms or altered saddle sensation in a person with back pain/sciatica, as summarized in this cauda equina clinical review.
Her written MRI sounds less suggestive of cauda equina compression, but symptoms always override an old MRI report. A scan can change, and a report cannot assess her current neurological function.
What I think is most likely, and what should happen next
Based only on the information given, the most likely explanation is:
- She has pre-existing lumbar/SI-region sensitivity from degenerative changes.
- Diarrhoea causes bowel cramps, pelvic-floor and abdominal muscle tightening, altered posture, and repeated movement.
- Those factors trigger or magnify pain in the buttock-pelvic region.
But this is only a working explanation. Because the pain is severe and repeatedly linked to diarrhoea, she should be evaluated by her doctor rather than treated as “just disc disease.”
Ask her clinician to assess
- a focused neurological exam: leg strength, reflexes, sensation, straight-leg raise, gait
- hip and sacroiliac-joint examination
- whether the pain follows a nerve pattern below the knee or is more pelvic/abdominal
- diarrhoea history: duration, frequency, blood/mucus, nocturnal diarrhoea, fever, weight loss, medication/antibiotic history
- stool tests and blood tests when clinically appropriate, especially if diarrhoea is recurrent
- gastroenterology referral if recurrent diarrhoea, blood/mucus, weight loss, anemia, or inflammatory markers
- rheumatology assessment and possibly sacroiliac-joint imaging if she has inflammatory-pattern buttock pain plus bowel symptoms
Until she is assessed, avoid assuming repeated severe pain is safe to manage with painkillers alone. In particular, if she has possible inflammatory bowel disease, do not regularly use ibuprofen, naproxen, or similar anti-inflammatory medicines without her clinician’s advice, because they can worsen gastrointestinal symptoms in some people.
Bottom line: diarrhoea can very plausibly trigger severe pain in an already vulnerable lower-back/buttock/pelvic region. But the MRI changes do not by themselves fully explain the bowel-linked pattern. The priority is to distinguish a mechanical flare from bowel/pelvic disease, sacroiliac inflammation, and the rare but urgent signs of cauda equina nerve compression.
Give the ans of follow up suggestions
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chronic diarrhea AND guideline
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NHS diarrhoea adults when to seek urgent medical advice blood fever severe abdominal pain dehydration
Follow-up suggestions for your mother
1. Book a doctor visit soon
Arrange an appointment with her primary doctor or a spine/orthopedic doctor within the next few days, especially because the pain is severe and happens repeatedly with bowel episodes.
Take:
- the complete MRI report and images/CD
- a list of all medicines, including painkillers, antibiotics taken recently, diabetes medicines, supplements, and laxatives
- a written record of her diarrhoea and pain episodes
2. Ask the doctor to assess these specific possibilities
Do not let the visit focus only on the MRI. Ask for examination of:
-
Lumbar nerve irritation / sciatica
- leg strength, reflexes, sensation
- pain radiating down either leg
- walking and foot weakness
-
Sacroiliac joint and hip
- SI-joint pain commonly feels deep in the buttock/posterior hip
- the doctor should distinguish spine pain, SI-joint pain, true hip-joint pain, and pelvic-organ pain
-
The cause of recurring diarrhoea
- repeated diarrhoea needs its own assessment, particularly when paired with severe pelvic pain
- diarrhoea persisting beyond 4 weeks warrants evaluation for underlying causes. Harrison's Principles of Internal Medicine, 22nd ed.
- inflammatory bowel disease can have joint/SI-joint inflammation as an associated feature. Goldman-Cecil Medicine, 2-volume edition.
3. Discuss useful tests, based on her symptoms
The clinician decides which are appropriate, but reasonable questions include:
- Blood tests: complete blood count, kidney function/electrolytes, liver tests, CRP/ESR for inflammation, and possibly iron/B12 depending on history.
- Stool tests: stool culture or PCR for infection, parasites if relevant, and fecal calprotectin if inflammatory bowel disease is suspected.
- Urine test if urinary pain, frequency, fever, or flank/pelvic pain is present.
- MRI of the lumbar spine again only if there are new neurological symptoms, a change since the old scan, or clinical concern.
- X-ray or MRI of sacroiliac joints if she has deep alternating buttock pain, morning stiffness, pain improving with movement, or recurrent diarrhoea/inflammatory markers.
- Gastroenterology referral if diarrhoea recurs, lasts more than 2-4 weeks, occurs at night, or includes blood/mucus, weight loss, fever, or anemia.
- Rheumatology referral if bowel inflammation plus sacroiliac/back/joint symptoms appears likely. A systematic review supports the recognized overlap between inflammatory bowel disease and axial/peripheral spondyloarthritis: Schwartzman et al., 2022, PMID 35046098.
4. Keep a simple symptom diary for 2-4 weeks
This can make the diagnosis much clearer. Record:
| What to record | Details |
|---|---|
| Stool episodes | Number/day, watery or not, blood, mucus, urgency, night-time stools |
| Pain | Exact site: low back, one/both buttocks, groin, lower abdomen, anus/perineum; severity 0-10 |
| Timing | Does pain start before, during, or after diarrhoea? Does it continue after diarrhoea stops? |
| Nerve symptoms | Tingling, numbness, leg weakness, pain below knee, foot dragging |
| Other symptoms | Fever, vomiting, appetite/weight change, eye redness/pain, heel pain, swollen joints |
| Triggers | Foods, recent antibiotics, travel, new medicines, stress, physical activity |
| Relief | Rest, passing stool, heat, position, hydration, medicines |
5. Safe measures while waiting for review
- Encourage fluids. During frequent watery stools, oral rehydration solution is preferable to plain water alone.
- Use gentle movement and avoid prolonged bed rest. Avoid lifting, twisting, or repeatedly bending during a flare.
- A heat pack over the lower back/buttock area may help muscular spasm if she finds it soothing.
- Avoid self-starting antibiotics or strong anti-diarrhoeal medicines without medical advice.
- Avoid frequent ibuprofen, naproxen, diclofenac, or similar anti-inflammatory tablets unless her clinician says they are safe, particularly if she has gastritis, kidney disease, blood thinners, high blood pressure, or possible bowel inflammation.
- Use only pain medicines already known to be safe for her, following the label or her clinician's instructions.
Go to emergency care immediately if she develops any of these
- New inability to pass urine, difficulty starting urine, loss of bladder sensation, urine leakage, or new loss of bowel control
- Numbness around the anus, genitals, inner thighs, or “saddle” area
- New leg weakness, difficulty walking, foot drop, or rapidly worsening pain/numbness in both legs
- Severe abdominal pain with a rigid/swollen abdomen
- Blood in stool, black stool, high fever, persistent vomiting, fainting, confusion, or signs of dehydration
- Diarrhoea with severe weakness, very little urine, dizziness on standing, dry mouth, or inability to keep fluids down
New bladder symptoms or saddle-area sensory changes with back/sciatic pain require urgent same-day assessment for cauda equina syndrome, even if a previous MRI described only mild compression. Current clinical guidance summary supports urgent investigation in that situation.
Most practical next step: arrange a doctor visit for both the recurrent diarrhoea and the buttock-pelvic pain together, bring the MRI report, and use the symptom diary to show whether the pain is mechanical, bowel-related, sacroiliac inflammatory pain, or nerve-related.
Anss 3,4 no follow up suggestion
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Do you mean:
- Answer point 3 and point 4 only, with no further suggestions, or
- Your mother has no symptoms from items 3 and 4 in the symptom diary?
Please clarify which one you mean.
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