There’s a collection of nerve roots at the bottom of your spinal cord that affect your legs and bladder. When an injury or herniated disk or other problem compresses those nerves, then that causes pain, weakness and incontinence. Cauda equina syndrome is a medical emergency. You should see a healthcare provider immediately if you have symptoms.
Cauda equina syndrome is the compression of a collection of nerve roots called the cauda equina. Nerves send and receive electrical signals all across your body. The collection of nerve roots, shaped like a horse’s tail, is located at the bottom of your spinal cord.
Because of the cauda equina nerves, you can move and feel sensations in your legs and urinary bladder. Compressed cauda equina nerves can cause pain, weakness, incontinence and other symptoms. This syndrome can cause permanent damage, including paralysis, if left untreated. Quick treatment might prevent permanent damage like paralysis.
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Cauda equina syndrome is not life-threatening. But it can permanently damage your body, affecting your health and quality of life. Symptoms may include leaking pee or poop and problems having sex. Surgery might treat several of the symptoms if performed immediately.
There are two types and two classifications of cauda equina syndrome. The syndrome is acute or chronic, and it’s either complete or incomplete.
Acute cauda equina syndrome
Severe symptoms start suddenly. You’ll likely need surgery within 24 to 48 hours.
Chronic cauda equina syndrome
This name means long-lasting cauda equina syndrome. It describes two scenarios:
Emergency surgery might stop permanent damage. See your healthcare provider if you have symptoms.
Complete cauda equina syndrome
Complete cauda equina syndrome causes urinary and/or bowel retention or incontinence. Retention means that you’re unable to pee or poop, and incontinence means that you can’t stop yourself from peeing or pooping. It affects about 60% of people with cauda equina syndrome.
Incomplete cauda equina syndrome
This affects the other 40% of people with cauda equina syndrome. Typical symptoms include loss of urgency or increased urgency sensation in the bladder and bowels without retention or incontinence. This means you can’t feel that you have to poop or pee, or you feel the sensation stronger than before.
Experts estimate the cauda equina syndrome affects around 1 in 65,000 people. It affects males as equally as females.
There are a number of reasons why the nerve roots that make up the cauda equina could get compressed, including:
There are several red flags that you might have cauda equina syndrome:
You might experience more symptoms in addition to the red flags. They include:
See your healthcare provider if you have these symptoms. You might be tested for cauda equina syndrome and sent to a neurosurgeon or orthopedic spine surgeon. Surgery may help you by stopping additional damage to your nerves.
Your healthcare provider will diagnose your cauda equina syndrome by interviewing you about your symptoms, assessing your physical abilities, performing tests and ordering imaging tests. They’ll assess your abilities by having you:
This information helps your healthcare provider assess your:
Your healthcare provider might then perform a rectal exam to check your anal muscles.
Finally, your healthcare provider might order the following tests:
Using these imaging tests should allow your provider to see your:
You’ll be diagnosed with cauda equina syndrome if you have two sets of symptoms:
Your healthcare provider will likely have many questions for you. They need to understand what’s happening to you so they can do the right tests, order the correct imaging tests and give you an accurate diagnosis. Questions might include:
New (acute) cauda equina syndrome is an emergency. If your healthcare provider determines that you have this condition, you’ll likely go into surgery within 24 hours. Surgery will move whatever is compressing your nerve roots so they can heal. The type of surgery is called a lumbar laminectomy.
Some medications can improve your bowel and bladder control. They include:
You may need to see a physical therapist and occupational therapist. Your physical therapist can help you regain your strength after surgery, and an occupational therapist can help you with everyday activities.
It may not be possible to prevent all of the causes of cauda equina syndrome. But, you might be able to reduce your risk of a herniated disk, the most common cause of the syndrome. Try the following tips:
Go to the emergency department if you have symptoms of cauda equina syndrome. You might need surgery right away. Your surgeon will move whatever is pressing down on your nerve roots so they can heal. But surgery doesn’t guarantee that you won’t have any long-term issues. Your nerves might not heal correctly or heal at all. You might have permanent damage. The best way to prevent that is to report to the emergency department and get surgery as soon as possible. The earlier the treatment, the better.
The faster you have surgery, the less time it will take your nerves to heal. If the surgery does help your nerves, it might take you a while to feel like yourself again. As the nerves heal over months or even years, you’ll slowly regain control over your bowels and bladder, the pain might lessen and the weakness might go away.
The best thing you can do for yourself if you have symptoms is to see a healthcare provider. Continue getting help from healthcare providers after you have surgery, including:
See if your family and friends are willing to help you as well. You’ll need support.
A note from Cleveland Clinic
Cauda equina syndrome affects about 1 out of 65,000 people. It’s uncommon, but it’s important to pay attention to the red flag symptoms because they might indicate various health issues. Be on the lookout for numbness in your saddle area, pain in your back and legs, problems with peeing or pooping, difficulties with sex and weakness in your extremities. See a healthcare provider immediately if you have these symptoms.
Learning that something is compressing the nerves in your back would frighten anyone. But don't hesitate to go to the emergency department if you experience symptoms. The faster you get treatment, the less likely you’ll have permanent damage to your body, including incontinence and paralysis.
Last reviewed by a Cleveland Clinic medical professional on 11/22/2021.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy