Cauda equina syndrome

The term relates to the lower end of the spinal cord, where the nerves fan out into a bundle of fibres that looks like a horse’s tail (‘cauda equina’ is Latin for ‘horse tail’). These nerve fibres leave the spinal canal through holes between each vertebra (the bones in your back).

Some of the nerves join to form the sciatic nerve or nerves controlling the legs. Some also provide the sensation and control for the bladder, anal and genital regions.

What has happened to these nerves?

The cauda equina lies behind the lumbar discs, in the spinal canal. These discs sit between the vertebrae (bones of the back) but can sometimes rupture (known as a large disc prolapse or ‘slipped disc’). This can happen quite suddenly, usually in younger people. When this happens, the nerves of the cauda equina can become trapped and squashed. In older people, it may happen gradually and be combined with other arthritic changes within the spine. The effects may be noticed more slowly, and even regarded as simply ‘part of getting old’.

Many patients have a combination of back pain, leg pain, leg numbness  and  weakness. These symptoms can be distressing for you but don't necessarily require emergency medical attention. A rare but serious back condition, Cauda Equina Syndrome, can lead to permanent damage or disability and will need to be seen by an Emergency Specialist Spinal Team. 

Cauda Equina Syndrome presents as one or a combination of the following symptoms. Most commonly these symptoms develop suddenly and may worsen rapidly, within hours or days. However some people develop symptoms gradually.

Saddle Anaesthesia

• Loss of feeling/pins or needles between your inner thighs or genitals
• Numbness in or around the back passage and/or buttocks
• Inability to feel the toilet paper when wiping

Bladder disturbance

• Inability to urinate (pass water)
• Difficulty initiating urination (urinary hesitancy)
• Loss of sensation when you pass urine. Leaking urine or recent need to use pad
• Inability/ difficulty to stop or control urination (incontinence)
• Loss of the full bladder sensation/ not knowing when your bladder is full or empty

Bowel disturbance

• Inability to stop a bowel movement or leaking (incontinence)
• Constipation
• Loss of sensation when passing a bowel motion.

Sexual problems

• Change in ability to achieve an erection or ejaculate (Males)
• Loss of sensation in genitals during intercourse

It is very important that you attend your local Accident and Emergency Department immediately if you have any of the above symptoms to enable the medical team to assess for cauda equina symptoms.

The main risk of not having this assessed and treated include

• Permanent loss of bowel or bladder and /or Bowel function i.e. incontinence
• Permanent loss of sexual function

If investigations confirm compression of cauda equina and you are experiencing cauda equina symptoms mentioned above consistently then you may require urgent surgery to reduce compression on the cauda equina. Therefore, you need to be prepared for possible surgery when attending accident and emergency with cauda equina symptoms.