Family Nurse Practitioner Exam

A 62-year-old female presents with chronic low back pain and fecal incontinence. What condition should be suspected?

1. Fracture of the lower spine

2. A herniated disc

3. Cauda equina syndrome

4. ankylosing spondylitis

The correct answer is: Cauda equina syndrome

The presentation of chronic low back pain accompanied by fecal incontinence strongly suggests the potential involvement of cauda equina syndrome. This syndrome occurs when the cauda equina, a bundle of nerve roots at the lower end of the spinal cord, becomes compressed. The resulting symptoms can include severe lower back pain, motor and sensory deficits in the legs, as well as bowel and bladder dysfunction, which in this case manifests as fecal incontinence. Recognizing the significance of these symptoms is critical, as cauda equina syndrome is a medical emergency that requires prompt diagnosis and intervention to prevent permanent neurological damage. The combination of chronic back pain and changes in bowel function raises concern for serious underlying pathology affecting nerve function. While fractures of the lower spine and herniated discs can also lead to back pain, they are less likely to present with fecal incontinence unless there is significant neurological compromise. Ankylosing spondylitis primarily affects the spine and sacroiliac joints, leading to pain and stiffness but typically does not cause bowel or bladder dysfunction as a direct consequence. Therefore, the presence of both chronic low back pain and fecal incontinence points toward cauda equina syndrome as the most probable condition to consider in this scenario.