The name ‘cauda equina’ describes the collection of nerve roots at the end of the spinal cord. These nerves are responsible for helping to control our bladder and bowel function, sexual function and lower limbs. If they are compressed, it can result in serious problems for sufferers. This is referred to as cauda equina syndrome, or CES. 

There are a number of symptoms that occur when these nerves are compressed, which are referred to as ‘red flags’. The cauda equina red flag signs include bowel and bladder disturbance (e.g. altered flow, sensation or urgency), altered sensation in the lower part of the body, pain and/or altered sensation in both legs and loss of sexual sensation.

In this blog post, we will explain what causes cauda equina syndrome, what the cauda equina red flags are and what happens if somebody presents with these red flags.

What are the causes of cauda equina syndrome?

Cauda equina syndrome has numerous potential causes. The most common is when a large central disc herniation (slipped disc) in the lower back causes damage to the nerve roots in the spinal cord.

Cauda equina syndrome can affect anyone of any age and is considered a medical emergency. Relieving the condition requires urgent surgery usually within 48 hours or sooner, and if healthcare professionals don’t recognise the signs, or there is a delay in treatment, the condition can become permanent.

What are the cauda equina red flags?

The following red flags, or warning signs, can suggest you have cauda equina syndrome. It is vital that you seek urgent advice from a medical professional if you spot these early symptoms of cauda equina syndrome, to try to avoid permanent damage to your body. 

These cauda equina syndrome red flags can be broken down into five categories:

Bladder disturbance

• Inability to urinate or difficulty urinating
• Loss of sensation when passing urine
• Inability to control urination
• Loss of full sensation of the bladder
• Incontinence

Bowel disturbance

• Inability to stop a bowel movement
• Loss of sensation when passing a bowel motion
• Incontinence
• Not feeling any urge to open bowels 

If you are usually able to control your trips to the toilet but find that you are suddenly unable to control when you need to go, these may be cauda equina syndrome red flags. The damage caused by compression of the cauda equina nerves can cause you to have issues when going to the toilet.

Pain and weakness

• Leg pain in both legs
• Leg weakness or numbness in both legs
• Tingling or pins and needles in both legs

Pain in the legs is often referred to as sciatica. Sciatica usually comes from the pain caused by a slipped disc. This can cause extreme discomfort and create unnecessary pressure on the spine. The bulging disc can press on surrounding nerves, causing pain in the legs. 

The pain may bring with it tingling, pins and needles, numbness, or weakness in your legs. 

The most common characteristic of sciatica is pain that stems from the lower back, down into the buttocks and into the legs, often right down to the ankle. The pain can vary from tolerable to unbearable. Sciatica in both legs and buttocks can be considered to be a cauda equina red flag, so it is important that you seek urgent medical attention if you experience this. 

Sexual problems

• Inability to achieve an erection or ejaculate
• Loss of sensation during intercourse
• Loss of clitoral sensation

Saddle numbness

• Loss of feeling between the legs
• Numbness in or around the genitals
• Inability to feel the toilet paper when wiping

If your legs, genitals or anus feel weak or numb, this can be a sign of cauda equina syndrome. As the space around your cauda equina nerves narrows and compresses a section of nerve tissue, this can lead to nerve damage and leave you without the ability to feel or control your lower body. 

The compression around your cauda equina nerves affects your legs and can leave you with numbness. If you feel that your legs are weak, or that you have lost feeling in areas of your legs, you should speak to a medical professional about testing for cauda equina syndrome. 

As with the compression around the spinal nerves, the nerve damage may also be felt around or under your genitals, or around your anus. Again, this could be a sign that you have cauda equina syndrome.

What should I do if I think I have cauda equina syndrome?

If you suspect that you are experiencing any of these potential red flags for cauda equina syndrome, it is crucial to seek immediate medical attention. The condition can progress rapidly, leading to permanent nerve damage, paralysis and other severe complications. The first step is to go to the nearest accident & emergency department as soon as possible for an evaluation. You should not wait for a GP appointment, as the condition requires prompt diagnosis and treatment - often within 48 hours of the onset of red flag symptoms - to prevent irreversible damage.

Upon arrival at the hospital, you should undergo a series of tests, including MRI scans, to confirm the diagnosis; however, we often see people with CES who were sent away from hospital without an MRI scan when they had red flags. If cauda equina syndrome is confirmed, emergency surgery is usually required within 24 hours to relieve the pressure on the nerves. The sooner this is done, the better the outcome is likely to be. Every hour counts, so do not delay in seeking medical help when you spot cauda equina red flags.

What medical care is required for signs of cauda equina syndrome?

The primary treatment for cauda equina syndrome is emergency surgical intervention, specifically a procedure called a laminectomy. This surgery aims to relieve pressure on the spinal nerves by removing a portion of the vertebrae. The surgery is generally followed by a course of antibiotics to prevent infection and steroids to reduce inflammation. The sooner this surgery is performed after the onset of symptoms, the better the chances of a full recovery.

In addition to surgery, postoperative care is crucial for recovery, and may include physical therapy to improve mobility and strength. Pain management is also an important aspect of care, often involving medications to control pain and inflammation. Depending on the severity of the condition and the timeliness of the treatment, some patients may require assistive devices like catheters or mobility aids. Long-term follow-up care, including regular check-ups and imaging tests, will be necessary to monitor recovery and prevent complications.

What happens if cauda equina syndrome is not treated?

Untreated cauda equina syndrome can lead to severe, life-altering complications. The condition involves compression of the nerves at the base of the spinal cord, which can result in permanent nerve damage if not promptly addressed. This can lead to chronic pain, incontinence, sexual dysfunction, and even paralysis in extreme cases. The longer the condition goes untreated, the higher the risk of these symptoms becoming irreversible.

Additionally, untreated cauda equina syndrome can have a significant emotional and psychological impact. The loss of basic bodily functions like bladder control can lead to a decreased quality of life, affecting your self-esteem and mental wellbeing. Therefore, immediate treatment is not just recommended, but essential to prevent these devastating outcomes.

If you have experienced delays or below-standard treatment for cauda equina syndrome, and it was the result of negligence by a GP, hospital doctor, nurse, or even a physiotherapist, you may be entitled to medical negligence compensation.

JMW Solicitors has helped countless people get the compensation they deserve following cauda equina clinical negligence. If you or a loved one has been affected by cauda equina syndrome that was caused or exacerbated by negligence, our team of specialist solicitors is here to help. 

Contact us today on 0345 872 6666, or fill out our online contact form, and we will get in touch with you about making a cauda equina syndrome claim.