Cauda Equina Syndrome
Cauda Equina Syndrome
This is a 'Spinal Emergency'. It occurs when the nerves below the spinal cord are compressed. The nerves that supply the bladder and bowels also supply sensation to the skin around the bottom and back passage.
The syndrome is a complex spectrum of symptom and signs. If the clinical index of suspicion is even moderate the diagnosis is confirmed with MRI scan
SYMPTOMS Perineal numbness Unilateral or bilateral
Disturbance of bladder function
Sphincter dysfunction Bowel or bladder
Back pain Severe
Sciatica Unilateral or bilateral
SIGNS Perineal numbness Unilateral or bilateral
Retention of urine
Incomplete emptying of bladder (post micturition residual or bladder ultrasound greater than 50ml)
Loss of sensation of passing urine
Motor loss or reflex loss
Loss of voluntary anal sphincter contraction
Perineal numbness and any other symptom or sign requires specialist referral
The exclusion of a surgically treatable cause can often only be made with specialist imaging, most commonly an MRI scan.
Many patients delay in presentation to health care professionals as they do not recognise the significance of their symptoms. Further delay in obtaining specialist spinal care can result in devastating disability which can lead to medical negligence litigation.
Timely referral after thorough assessment may result in better outcomes for patients.
Spinal Pain alone can produce pain inhibition of bladder function and so early adequate analgesia is important and aids assessment.
The literature currently suggests the outcome of surgical decompression is better if decompression occurs WITHIN 48 HOURS OF THE ONSET OF SYMPTOMS. Most surgeons would prefer to carry out surgery as soon as it is safe to do so , if surgery is required.
This condition requires emergency referral to the secondary care specialist that can confirm the diagnosis and treat the condition.
If you have significant back pain or sciatica, and numbness around the bottom area or back passage you are at risk of developing cauda equine syndrome. It is rare, between 6-10 per million population. It is a diagnosis that doctors are happy to see and assess if only to re-assure.
If you have numbness around the anus or back passage and any alteration of control of bladder function or bowel function you should be assessed urgently by some one of suitable training and experience to reassure you or to arrange suitable urgent tests such as an MRI scan.
CAUDA EQUINA WEBSITES