Cauda Equina Syndrome

Overview

Cauda equina syndrome is a rare but serious condition that happens when the bundle of nerves at the very bottom of your spinal cord becomes squeezed or damaged. These nerves control your bladder, bowels, and legs. If the pressure is not relieved quickly, it can cause permanent damage.

No, cauda equina syndrome is quite rare. It affects roughly 1 in 70,000 people each year.

It can affect anyone, but it is most often seen in adults who have a slipped (prolapsed) disc in the lower back. Other spinal problems can also raise the risk.

Symptoms

Common symptoms

• Severe lower back pain
• Pain spreading down one or both legs (sciatica)
• Numbness or tingling in the legs or feet
• Numbness in the area between your legs (the 'saddle area')
• New problems with passing urine or stool
• Weakness in your legs that makes it harder to stand

Symptoms in children

• Cauda equina syndrome is very rare in children, but the symptoms are similar to adults. A child may complain of leg weakness or lose control of their bladder suddenly.

Symptoms in older adults

• Older adults may be more likely to notice falls, unsteadiness, or difficulty starting to pass urine. They may also have a history of arthritis in the spine.

Causes

Main causes

• A herniated or slipped disc in the lower back pressing on the cauda equina nerves
• Narrowing of the spinal canal (spinal stenosis)
• Injury to the lower back, such as a fall or car accident
• A tumour or infection near the spinal cord

Risk factors

• Heavy lifting or repetitive strain on the lower back
• A previous back injury or spinal operation
• Conditions like arthritis that affect the spine
• In rare cases, complications from a spinal procedure

When to see a doctor

See a doctor urgently if:

• If you have any of the 'call emergency' symptoms, call your local emergency number right away.
• If you have the urgent symptoms, go to the nearest emergency department the same day.

Book a routine appointment if:

• If you have persistent back pain or leg pain that is getting worse, make an appointment to see your GP.

Diagnosis

A doctor will ask about your symptoms and do a physical examination. They will check your leg strength, reflexes, and the feeling in your saddle area. You will also normally have an urgent MRI scan to look at the nerves in your lower back.

Tests that may be done

• Physical examination of your legs, feet, and saddle area
• Urgent MRI scan of your lower spine
• Sometimes, a CT scan or other imaging if MRI is not available

What to expect at your appointment

If your doctor suspects cauda equina syndrome, you will usually be sent to hospital immediately. Once there, the care team will work quickly to reduce pressure on your nerves.

Treatment

Cauda equina syndrome is treated with urgent surgery to take the pressure off the nerves. The sooner surgery happens, the better the chances of recovery. Most people need surgery within 24 to 48 hours of symptoms starting.

Self-care at home

• Do not wait to see if symptoms improve on their own.
• While waiting for help, avoid sitting up straight or straining your back too much.
• Do not drive yourself to hospital if you have weakness in your legs or numbness in your saddle area.

Medical treatments

Surgery is the main treatment. The surgeon removes whatever is pressing on the nerves, such as part of a slipped disc or bone. You may also be given medicines to control pain and reduce inflammation around the nerves. Your healthcare team will explain what is right for you.

When is surgery considered?

Surgery is almost always needed, and it is most effective when done as early as possible.

Living with this condition

Recovery takes time. You may need physiotherapy to help you regain strength and balance. Some people need to use a walking aid or wheel chair for a while. It is important to follow your rehabilitation plan and not push yourself too hard too soon.

Lifestyle tips

• Use mobility aids as needed to stay safe.
• Do pelvic floor exercises if your bladder or bowel control has been affected.
• Give yourself rest, but try to stay as active as your medical team advises.

Diet and exercise

A healthy, balanced diet with plenty of fibre can help with bowel function. Gentle exercises, such as walking, may help your recovery once your doctor says it is safe. Always check with your physiotherapist before starting new exercises.

Mental health and emotional wellbeing

Living with cauda equina syndrome can be stressful and frightening. You may feel anxious, low, or frustrated. This is completely understandable, and you should not face it alone. Talk to your GP about ways to cope, or ask about local counselling services.

Prevention

It is not always possible to prevent cauda equina syndrome. But you can reduce your risk of back problems by keeping your back strong, lifting heavy objects safely, and maintaining a healthy weight.

Complications

If left untreated

• Permanent bladder and bowel incontinence
• Loss of sensation in the saddle area
• Weakness or paralysis in both legs
• Sexual dysfunction

Long-term outlook

With early diagnosis and surgery, many people make a good recovery. Some people may have lasting problems, but rehabilitation can make a real difference. Even if recovery is slow, there is always hope, and support is available.

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