Can Cauda Equina Symptoms Come and Go? 

Cauda equina syndrome (CES) is a serious and highly debilitating form of spinal injury, which can lead to long-term disability if left untreated. In some cases, the symptoms of this condition will develop rapidly, but in other cases, the patient may experience a more gradual onset.

If a person's cauda equina symptoms come and go, it may be harder for them to recognise the condition for what it is. However, because cauda equina syndrome is such a serious issue, it is always best to seek immediate medical attention if you are experiencing any of the red flag symptoms.

Here, we explain the most important symptoms of this rare but serious condition, as well as what it means if you are feeling these symptoms coming and going.

What are the main symptoms of cauda equina syndrome?

Cauda equina syndrome is a condition in which the cauda equina nerves are compressed, putting pressure on the nerve tissue in a way that causes long-term damage to them.

The cauda equina nerves play a key role in many of the most important functions in the pelvis and lower limbs, as well as the body's urinary, sexual and bowel functions. As such, people with cauda equina syndrome may experience the following symptoms:

• Severe low back pain
• Loss of bladder and bowel function, including bowel incontinence or a loss of urge to use the bathroom
• Problems with motor and sensory function, such as a loss of feeling or movement in the lower limbs - for example, a persistent tingling (pins and needles)
• Sexual dysfunction, such as impotence or a loss of sensation

There are several causes of cauda equina syndrome, such as a slipped disc placing pressure on the nerve roots, or spinal infections/tumours in the region of the lumbar spine. Complications during spinal surgery can also be a cause.

Many of the typical symptoms of cauda equina syndrome are similar to those of other conditions affecting the spinal cord, which is why they need to be assessed and properly diagnosed by a medical specialist as soon as possible.

What does it mean if your cauda equina symptoms come and go?

Cauda equina syndrome can develop in different ways, which will affect the way that the initial symptoms of the condition manifest.

In many cases, the individual will experience an acute onset of cauda equina symptoms, in which they will experience a sudden and rapid development of sensory and motor issues, or functional changes to their bowel or bladder function, over a period of 24 to 48 hours. These symptoms can become severe and lasting, and will not change without immediate surgical treatment.

In other instances, the patient will experience a gradual onset - for example, they may observe a fluctuation in their bowel and bladder function, or they may feel pain or numbness in their lower body that seems to get better and then worse. This can take place over a matter of weeks, or even months.

This is known as incomplete cauda equina syndrome, and should not be taken lightly. Even though the symptoms may seem to come and go, this is usually because the condition is progressing gradually, and must be treated immediately to prevent further damage.

What to do if you have symptoms of cauda equina syndrome

If a person is experiencing any cauda equina syndrome symptoms - whether a gradual onset or an acute onset - it is essential that they attend A&E to have them assessed as soon as possible. This may include a neurological examination or an emergency MRI (magnetic resonance imaging) scan to check the condition of the spinal nerves.

By paying attention to these red flag symptoms, it will be possible for your doctors to diagnose cauda equina syndrome as early as possible, allowing you to undergo surgery to prevent the life-changing injuries that untreated cauda equina syndrome can cause.