Understanding Cauda Equina Syndrome: Symptoms and Effective Treatments

What is Cauda Equina Syndrome?

Cauda equina syndrome occurs when the nerve roots in the lumbar spine are compressed, usually within the spinal canal. These nerve roots control both motor and sensory functions in the lower body. Because they serve vital areas—including the legs, bladder, bowel, and sexual organs—compression can cause rapid and irreversible damage.

When cauda equina syndrome occurs, immediate action is required. CES is considered a surgical emergency, and early treatment is key to preventing permanent paralysis, bladder and bowel dysfunction, and sexual dysfunction.

Symptoms of Cauda Equina Syndrome

The symptoms of cauda equina syndrome can vary from subtle to severe, but often develop quickly. Early symptoms may resemble those of common back problems, making CES difficult to identify without proper medical evaluation.

CES symptoms vary but can include the following:

• Severe lower back pain
• Leg pain
• An altered sensation in the lower extremities
• Numbness or tingling in the saddle area (buttocks, inner thighs, and perineum), known as saddle anesthesia
• Weakness in the legs or lower limbs
• Difficulty walking or standing
• Sudden onset of bladder and bowel incontinence or
• Inability to empty the bladder completely
• Inability to feel when the bladder is completely full
• Loss of sensation around the genitals
• Sexual dysfunction

If you or someone you know experiences red flag symptoms like urinary retention, loss of bowel control, or altered sensation in the saddle region, seek immediate care. Delaying treatment can result in permanent nerve damage.

Diagnosing Cauda Equina Syndrome

To diagnose cauda equina syndrome, doctors will conduct a physical exam, review your medical history, and order imaging tests. An MRI scan (magnetic resonance imaging) is the preferred method to detect compression in the spinal canal. If MRI isn’t available, a CT myelogram may be used. Additional tests may include blood tests to rule out infection or inflammation.

Doctors may also evaluate whether the patient can stand from a seated position using armrests or control bladder and bowel function. In some cases, a urodynamic study helps assess the severity of urinary retention.

Risk Factors and Causes

Several spinal disorders and injuries can lead to CES. Common causes include:

• Herniated disk in the lumbar spine
• Spinal tumors or lesions
• Lumbar spinal stenosis (narrowing of the spinal canal)
• Severe lower back injuries
• Infections, inflammation, or hemorrhaging in the spinal area
• Complications following lumbar spine surgery
• Congenital spinal abnormalities

Though cauda equina syndrome occurs more frequently in adults, children are not exempt, especially if they suffer from trauma or developmental spine conditions.

Treatment Options

Once diagnosed, immediate surgery is often necessary. The goal is to relieve pressure on the nerve roots as quickly as possible, ideally within 24 to 48 hours after symptoms begin. Delays can reduce the chance of recovery and increase the risk of permanent nerve damage.

Surgical decompression, commonly via lumbar laminectomy, involves removing bone or tissue that’s compressing the nerves. In some cases, a lumbar microdiscectomy is performed if the cause is a herniated disk.

Post-surgical recovery includes physical therapy, pain management, and ongoing assessment of bladder and bowel control. Emotional support is also vital, as some individuals may experience lasting symptoms or complications.

Managing Bladder and Bowel Function

Cauda equina syndrome can impair the voluntary control of the bladder and bowel, leading to issues such as urinary retention, incontinence, or the inability to sense when it’s time to go. This occurs when the nerve roots responsible for controlling these pelvic organs are compressed, thereby affecting the signals between the brain and the lower body.

To manage these complications, patients often follow a structured routine:

• Use a catheter multiple times a day to ensure the bladder empties fully.
• Stay hydrated and maintain good hygiene to reduce the risk of urinary tract infections.
• Monitor bowel activity and assist elimination manually if needed.
• Glycerin suppositories or enemas may help stimulate bowel movements.
• Wear absorbent pads or garments for added protection and comfort.

How Can I Prevent Cauda Equina Disorder?

There is currently no guaranteed way to prevent CES. However, taking steps to maintain spinal health may reduce risk:

• Use proper body mechanics and lifting techniques
• Strengthen core muscles through regular exercise
• Avoid smoking, which affects spine health
• Treat herniated disks and spinal issues early
• Monitor changes in bladder and bowel habits

If you’re managing chronic back issues, regular checkups with a spine specialist can help detect problems before they become emergencies.

Living with Cauda Equina Syndrome

Recovery from cauda equina syndrome varies widely. While some nerve function may return over time, other damage could be long-lasting. Even if full recovery isn’t possible, many people find ways to adapt and lead fulfilling lives with the right support and strategies.

You might consider building a care team that includes not only your doctor but also specialists like occupational therapists, continence advisors, or sex therapists. Including your family in your care journey can also provide emotional strength. Joining a CES support group offers connection, practical advice, and shared experiences from others who truly understand what you’re going through.

Schedule a Consultation 

Cauda equina syndrome is not just another back problem; it’s a condition that can alter your life dramatically if ignored. Timely diagnosis and treatment are critical to restoring bowel function, preventing sexual dysfunction, and protecting mobility.

At OrthoNeuro, we have the tools, expertise, and compassion to help you navigate CES, from diagnosing CES to life-changing surgical care. Contact one of our multiple Columbus, OH, locations today to consult with one of our skilled orthopaedic surgeons.

Medically reviewed by Braden J. Passias, DO