When there are minimal outward signs of SA/CRS and differences at birth are not significant enough to indicate this condition, functional issues may lead to further and more extensive evaluation later in life. Some of the issues in these cases may not become concerning enough until well into adulthood, particularly when a small portion of the lower sacrum is absent.

These functional characteristics include:

• Delay in development of lower limbs
• Fatigue in walking or running
• Delay in toilet training
• Frequent urinary tract infections
• Frequent constipation
• Pain in the lower back
• Difficulties associated with carrying a fetus or with pregnancy
• Difficulties after a fall (spinal x-ray examination reveals structural issues with the sacrum)

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