Cauda Equina Syndrome (CES) is a VERY serious medical condition.

If you think you have any this problem after reading the symptoms listed on this page you should contact NHS 111 or go to your local A&E department immediately.  If you DO have it, it is classed as a medical emergency and requires surgery within 24-48 hours.

What is the Cauda Equina?

Cauda equina means horse's tail. The spinal cord in your back finishes about 6 inches up from your belt line. From that point onward the remaining nerves hang down like  a horse's tail.   These lower nerves give your legs, bladder and bowels their ability to function.

If the nerves are compressed you can lose the ability to control your bladder, bowels or legs.   CES can result in permanent consequences of paralysis, bladder/bowel incontinence, and altered sexual function if not treated promptly.

Low back pain is common, CES is rare. Subjective examination is critical. All patients presenting with low back pain should have a detailed examination of their clinical history. CES cannot be confirmed without appropriate imaging examination that identifies nerve root compression. 

Signs to look out for

• Increased difficulty trying to urinate
• Loss of sensation when you pass urine
• Increasing difficulty when you try to stop or control your flow of urine
• Leaking urine or recent need to use pads
• Not knowing when your bladder is either full or empty
• Loss of feeling/pins and needles between your inner thighs or genitals
• Numbness in or around your back passage or buttocks
• Altered feeling when you use toilet paper to wipe yourself
• Inability to stop a bowel movement or leaking
• Loss of sensation when you pass a bowel motion
• Change in ability to achieve an erection or ejaculate
• Loss of sensation in genitals during sexual intercourse

Other Possible Reasons for Symptoms in BOTH legs

• Large circumferential disc herniation with bilateral exit nerve foraminal nerve root compression (with no CES symptoms)
• Spinal Stenosis
• Cancer- Metastatic disease
• Myelopathy (higher spinal cord lesion)

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