A spinal cord injury can happen anywhere along the spinal cord.
The location of an injury has a great impact on what parts and how much of the body is affected by the injury. If an injury is lower on the spinal cord it will affect less of the body. Alternately, if a spinal cord injury is higher up on the cord it will affect a greater part of the body.
For example, my injury is in my neck so, my entire body except for my neck and head are affected by my spinal cord injury. Someone with an injury much lower on the spinal cord may have their body affected from the waist down but have normal torso and arm function.
Below is what I would call a ‘textbook’ description and explanation of a sacral or lumbar spinal cord injury.
Spinal cord injuries are truly different for everyone. I hope those with lumbar or sacral injuries will comment below this post and let others know about their experiences. Also, please comment if there is additional information you feel is important to mention.
Sacral Cord and Vertebrae
The lowest spinal cord injury occurs in the sacral vertebrae (indicated in red in the picture to the right). There are five sacral vertebrae (S1-S5) which are fused together to make one segment called the sacrum. Below the sacrum is a tiny little piece called the coccyx.
Injury to this part of the cord is uncommon and results most often from a traumatic injury.
Nerves in the sacral area of the spine control messages to and from the feet, lower legs, thighs, and genitals.
Injuries to the sacral nerves often cause some loss of function in the legs and hips as well as sexual dysfunction.
There is very little, if any, voluntary bladder and bowel control, but most often these folks can manage bladder and bowel functions without assistance.
Injury to the sacral vertebrae often does not result in paralysis. People with this level injury often retain the ability to walk.
Lumbar Cord and Vertebrae
Located above the sacrum are the five lumbar vertebrae (L1-L5) which are indicated in green in the image above. They are the largest of our vertebra and support the most weight.
Nerves in the lumbar area control messages to and from parts of the legs, the buttocks, lower parts of the back and abdomen, and some parts of the genitals.
Injuries in this area of the spine can result in:
- paralysis or decreased function of the legs and hips
- loss of sexual function
- decrease or loss of skin sensation
- loss of voluntary bladder and bowel control
Depending on where the injury is and on leg strength, injury to the lumbar nerves can necessitate the use of a wheelchair and/or braces to walk.
The Christopher & Dana Reeve Foundation (2014) indicates this level of injury often requires surgery and external stabilization.
What Does This Mean?
We all pretty much know what paralysis means – the inability to move, but what does the rest of it mean.
Sexual dysfunction by definition means the inability to have and/or enjoy sex; a sexual response is absent or abnormal.
The loss of touch and sensation may make you unable to feel anything during intercourse. Men may be unable to have an erection and/or achieve orgasm. Women may lack lubrication, experience discomfort or pain, and/or be unable to achieve orgasm.
Loss of Bladder Control
Inability to control the bladder means some or all bladder muscle tone is lost. This means the bladder muscles cannot contract and empty or the muscles may only contract a little bit so the bladder only partially empties.
Arms and hands are not affected by a sacral or lumbar spinal cord injury, so you can use a catheter to empty the bladder when needed. A tube (catheter) is inserted into the urethra to allow urine to drain out of the bladder.
For some, catheterization must be done on a schedule since you may not feel when your bladder is full.
Loss of bladder control also means an increased likelihood of urinary tract infections.
Loss of Bowel Control
With the loss of bowel control, a voluntary bowel movement cannot happen … but one cannot control when one will occur, either.
People with loss of bowel control schedule bowel movements on a routine schedule so the body can get used to when it needs to go and for convenience.
Bowel programs often include using a stool softener, suppository, mini-enema, and/or stimulation with a finger to trigger a bowel movement. Sometimes stool will then come out on its own otherwise manual removal of the stool is necessary. With this level of spinal cord injury, most people do their bowel program sitting on the toilet.
My Injury Isn’t Like That
All spinal cord injuries are truly different. I know people with a spinal cord injury at the same location as mine but our abilities are dramatically different. There are so many nerves running through the spinal cord the likelihood of two injuries being exactly the same are very small.
The amount of sexual dysfunction, loss of bladder control, and loss of bowel control are dependent on where on the injury is on the spinal cord and also if the injury is “complete” or “incomplete”.
You can read more about the functions of the spinal cord in my blog post: Spinal Cord Function | What Does Your Spinal Cord do as well as about spinal cord injury classifications in my post: Types of Spinal Cord Injury | Levels and Classifications.
Share Your Experience with Others
Do you have a sacral or lumbar spinal cord injury? We all remember what it’s like to be newly injured and searching for as much information as we can find. Share your experiences below in the comments to help others. Have questions? Share them here so others can lend a hand.