Cauda Equina Syndrome is a spinal surgical emergency where nerves in the lower back compressed. This can lead to lower limb paralysis and loss of bowel, bladder and sexual function.
The Syndrome occurs when the nerve roots that emerge from the end of the spinal cord at L2/L3 are compressed to such a degree that function and sensation to the parts of the body they serve become compromised.
This can happen for many reasons – the most common is a herniated or prolapsed disc, but it can also occur due to other reasons such as:
- Spinal lesions, cyst or tumours
- Spinal infections or inflammation
- Spinal stenosis
- Major injuries to the lower back (e.g. car accidents, assault etc)
- Spinal arteriovenous deformities
- Spinal haemorrhages
- Spinal surgery complications
- Spinal anaesthesia
- Scar tissue development
There are a number of key Red flag symptoms that would point to a Cauda Equina Syndrome diagnosis. Depending on the degree of nerve damage, these could include:
- Severe lower back pain
- Weakness or numbness in the lower limbs
- Sciatica-like pain in one or both legs
- Difficulty walking, leg weakness
- Alteration in urinary function, such as difficulty urinating or reduced flow
- Inability to know when you need to empty your bladder, loss of bladder or bowel control
- Numbness around the ‘saddle’ area (buttocks, anus and genitals)
- Sexual dysfunction
- Other neurological deficits
Cauda Equina Syndrome is not a life-threatening condition however, for some people the red flag symptoms can become permanent issues, leaving them with chronic Cauda Equina Syndrome.
If your GP suspects you have Cauda Equina Syndrome they should refer you for an emergency MRI scan.
Cauda Equina Syndrome is a medical emergency and requires immediate action within 24 hours. This is the time to advocate for yourself.
Positive recovery from Cauda Equina Syndrome is significantly increased, if surgery takes place within 24 hours of the onset of symptoms. A delay in treatment can lead to permanent damage to the root nerves and worsen or prolong symptoms.
The only way to treat Cauda Equina Syndrome is through surgery. This usually involves a laminectomy or micro discectomy to relieve the pressure on the cauda equina root nerves and remove disc fragments.
Recovery from Cauda Equina Syndrome depends on many factors including the degree and length of time of the compression before surgery. In some cases however, outcomes will not be changed regardless of timing of surgery.
Surgery can be deemed successful if it prevents further deterioration but you may be left with permanent issues, such as bladder and bowel problems, mobility issues and chronic pain.
Recovery for some can be relatively quick whereas for others recovery can take many years.
Recovery from CES is different for everyone and best described as a spectrum of functional and psychological recovery.
Cauda Equina Syndrome can cause permanent damage to the bladder and bowels, sexual function and sensation, chronic pain and fatigue and permanent lower body paralysis.
The Cauda Equina Champions Charity is here to help you and your family with every stage of your journey to recovery.
https://championscharity.dev.icgonline.co.uk/cauda-equina-syndrome/treatment-and-recovery/
Recovery varies for each person. Some see improvement within weeks, while others progress gradually over months or years. Nerve healing is slow, and some symptoms may remain long term, even with good rehabilitation
Ask your GP or spinal consultant for a referral to a neuro-physiotherapist or spinal rehabilitation service. You can also search through professional directories or patient groups for CES-aware specialists.
Keep a regular bowel and bladder regime, stay hydrated, and seek support from a continence nurses or urology clinics.
A tailored plan can help, it might include medication, catheters, or bowel care techniques and or devices which can improve comfort, confidence and quality of life.
Are there treatments or devices that can help?
Yes as your GP, urology or continence team. Intermittent catheters, bowel irrigation systems, and nerve stimulation devices can support function. A specialist nurse or clinic can help you find what fits your situation best.
CES may reduce genital sensation or make sexual response more difficult. Sexual health clinics and physiotherapists can offer practical advice, aids, and counselling. Honest communication with your partner helps too.
We offer mental health psychotherapy and psychosexual therapy which you may find useful.
Psychological Therapy Service – Cauda Equina Champions Charity
Psychosexual Therapy – Cauda Equina Champions Charity
Pain may result from nerve damage or muscle strain. Combine medication with gentle movement, pacing, and relaxation techniques.
Ask your GP about a referral to a pain management clinic for specialist input and explore sacral cord stimulation devices with you healthcare professional.
Emotional recovery takes time. Talking therapies, mindfulness, and peer support can help you adjust and rebuild confidence.
Don’t hesitate to ask your care team for a mental health referral or follow the link for charity funded therapy. You can call the Champions Connect line (03335 777 113) to talk about other support we offer.
Keep detailed records of your symptoms and bring written notes or questions to every appointment.
Don’t hesitate to ask for clarification if something isn’t clear. It can help to bring a friend, partner, or parent with you for support and to help remember information.
Use the CaudaEquina app to log your symptoms and CES download the healthcare passport from the website or app. If you still feel your concerns aren’t being addressed, make another appointment, request a second opinion
Early surgery, ideally within 24 hours of the onset of Cauda Equina Syndrome symptoms, offers the best chance of nerve recovery. However, improvement is still possible even when surgery happens later.
If you feel you experienced delays in diagnosis or treatment for CES you are entitled to ask your care provider for an explanation.
If you believe your treatment was unreasonably delayed or handled incorrectly, you may wish to seek independent advice about medical negligence.
Champions Charity have an approved panel of legal firms who have demonstrated to us their extensive knowledge and experience in CES claims. CES claims are notoriously difficult to litigate, we recommend that you research your options before committing to one firm.
If you suspect Cauda Equina Syndrome, act immediately. It is a medical emergency. Call NHS 111 for quick guidance and explain your symptoms in detail so they can assess the situation. You may be advised to go straight to A&E (Accident & Emergency) for an urgent MRI scan to check for nerve compression.
It’s always better to be proactive. CES is a time-dependent condition, and the sooner it’s diagnosed and treated, the better the chances of recovery and preventing long-term damage.
If you have been discharged and you suspect you have Cauda Equina Syndrome but no MRI was taken, keep a detailed record of their reasons for discharging you and the symptoms that you presented with at the time.
Even though you may not have Cauda Equina Syndrome at the time you entered A&E, it will evidence any deterioration later down the line.
If your symptoms get worse, call 111 and ask for the most appropriate A&E to attend, or call 999 for an ambulance, if you are unable to get to hospital.
Yes, while medication can help, many people find that combining other approaches makes pain easier to live with. Gentle movement, stretching, and relaxation techniques can reduce stiffness and tension. Activities such as swimming, yoga, mindfulness, art, music, or other hobbies can also distract from pain and improve mood.
Keeping a regular routine, pacing yourself, and focusing on things you enjoy can make a real difference. If you’re unsure which activities are safe, ask your physiotherapist or pain clinic for guidance tailored to you.
