Disturbances of rectal and genital innervation

1. Big picture

Rectal and genital dysfunctions are important neurological symptoms because they help localize lesions to the spinal cord, conus medullaris, cauda equina, sacral roots, pudendal nerve, autonomic nervous system, or frontal control systems.

For the exam, always connect rectal and genital symptoms with bladder symptoms, because they share the same sacral and autonomic control.

The most important emergency pattern is:

Low back pain or sciatica + saddle anesthesia + urinary retention + fecal incontinence/constipation + sexual dysfunction = conus or cauda equina syndrome until proven otherwise.

Rectal and genital symptoms are often not volunteered by the patient. You must ask directly and respectfully.

---