3-month genital numbness, NEW urinary retention after lifting injury

Hi,

I’m posting on behalf of my partner.

• Age 29 • Sex F • Height 170 cm (5′7″) • Weight 76 kg (167 lb)
• Existing conditions polycystic ovary syndrome
• Meds combined oral contraceptive, ibuprofen
• Alcohol: no • Smoke: no

1. How it started
05 May 2025 – while lifting a heavy bed I felt a sudden “witch’s-blow” low-back pain, bilateral leg tingling, and genital numbness. I could still pee and have bowel movements, though the sensations felt odd.

2. Imaging & specialist visits so far
20 May – Lumbar X-ray: transitional L5, mild L5–S1 narrowing.
29 May – Lumbar MRI w/o contrast:
• dehydrated L4-L5 disc with broad median herniation + small L4-L5 left foraminal protrusion
• no significant dural-sac compression; conus & cauda “normal” per radiologist

30 May – Neurosurgeon #1
• hyper-reflexia legs, genital hypoesthesia; no motor loss
• said the disc is “small, not touching sacral roots”
• ordered full-spine MRI + contrast

June–early July – leg symptoms faded; genital numbness persisted; bladder/bowel still manageable.

15–24 July – sudden worsening:
• very small urine volumes most voids (only drops) with rare larger void (maximum ~350 ml at once, in a day)
• almost no urge to defecate, must strain abdominally
• occasional sharp twinges in anus/pelvic floor

21 July – Neurologist
• noticed “possible signal change” at L1-L2 on MRI
• exam: initial anal-sphincter spasm + absent anal cough reflex, brisk knee jerks; no motor loss
• dx “cauda equina syndrome due to possible micro-spinal-infarct”

25 July – Urologist
• Based on current symptoms, agrees on neurogenic bladder; wants bladder ultrasound with post-void residual (PVR), still pending

3. Current symptoms (27 July)
• genital/perineal numbness
• tiny urine flows most times, rare normal voids
• need to strain for stool
• brisk knee reflexes but full leg strength; can heel/toe walk
• occasional pain in the right buttock
• within ~1 h after lying down to sleep I often get a numb/tingly feeling in the left arm and both legs; not sure if positional (pillow under knees) or related to the main problem

4. Conflicting opinions
• Neurosurgeon (June): “disc minimal; unlikely sacral-root damage. Has doubt on this being cauda equina syndrome”
• Neurologist (21 July): “suspects a micro-spinal-stroke at L1-L2; cauda equina syndrome”

5. My questions:
1) Does a cauda equina syndrome ever show bladder problems this late (≈11 weeks) after the initial injury?

2) Could a micro-spinal-infarct present with a nearly normal lumbar MRI and only now produce retention?

3) What other diagnoses should be ruled out first?

4) Could the new numb/tingly feeling in my left arm and both legs shortly after lying down simply be positional, or is it something relevant?

Thank you for any insight or shared experiences while we chase the next tests. I'm worried this might still be evolving and could worsen before we get answers.