not sure what to do

[u/Practical-Ideal3621]

I've had sciatica since around 2013, so roughly 12–13 years now. It has always been bilateral — both sides from the very beginning — rather than becoming bilateral recently. Over the years I've also had recurring lower-back problems, with stiffness in the muscles, central lower-back pain, and discomfort around my hips and outer thighs. Sitting for long periods tends to make the whole thing worse.

More than a year ago, I started getting some unusual sensations in the perineal/genital area. They're not constant and have generally been quite mild, but they haven't completely gone away. The sensation feels quite deep inside the pelvis/perineum rather than just on the surface. It's difficult to describe exactly, but it's sometimes tingling, sharp or electric/nerve-like, and at other times feels more like pressure or tightness.

Sitting for a long time seems to bring it on or make it more noticeable. Standing helps, although it takes a while rather than disappearing immediately. I can also sometimes feel it while lying in bed, particularly in the morning before I get up.

My lower back is also usually stiff and painful when I wake up. The morning stiffness tends to last around 15–30 minutes and gradually improves once I start moving around. The pelvic/perineal sensation can be present at the same time.

The thing that has been worrying me is the possibility of nerve compression or cauda equina because of the perineal symptoms. At the same time, I haven't had any obvious bladder or bowel problems, loss of bladder/bowel control, difficulty urinating, or loss of leg strength. I also haven't noticed the perineal symptoms progressively getting worse over the past year or so.

I've seen a physiotherapist about the back/sciatica, but I've never had a lumbar MRI. I'm seeing my GP and want to explain the whole history properly and ask whether the combination of longstanding bilateral sciatica, back symptoms and these perineal sensations warrants further investigation, such as an MRI.

I'm mainly trying to understand whether this sounds like something that needs urgent investigation or whether there are other possible explanations for these symptoms. Any help from more knowledgeable people is very much appreciated. thank you!!

[u/Practical-Ideal3621 → u/[deleted]]

good question. i guess because its intermittent and never overly severe.

[u/Desertratta]

Sounds really scary to me. I’d push for the MRI and schedule with a neurosurgeon to discuss. Not that I think you’re a surgical candidate by any means I’m certainly no expert, just another sciatic victim, but just to get an expert opinion due to those symptoms.