Cauda Equina Syndrome
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What is cauda equina syndrome?
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.
Is cauda equina syndrome life-threatening?
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.
What are the types of cauda equina syndrome?
There are two types and two classifications of cauda equina syndrome. The syndrome is acute or chronic, and it’s either complete or incomplete.
Types of cauda equina syndrome
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:
- If you’ve had symptoms of cauda equina syndrome for a period of time before you see a healthcare provider, it’s labeled chronic.
- If the surgery doesn’t fix your nerves and there is permanent damage, you’ll likely have symptoms for the remainder of your life. Your healthcare provider calls these symptoms chronic.
Emergency surgery might stop permanent damage. See your healthcare provider if you have symptoms.
Classifications of cauda equina syndrome
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.
How rare is cauda equina syndrome?
Experts estimate the cauda equina syndrome affects around 1 in 65,000 people. It affects males as equally as females.
Symptoms and Causes
How do I get cauda equina syndrome?
There are a number of reasons why the nerve roots that make up the cauda equina could get compressed, including:
- Birth anomalies.
- Lumbar spinal stenosis.
- Injuries to the lower back like from a car accident or gunshot wound.
- Herniated disk in the lumbar region. This is the most common cause.
- Postoperative lumbar spine surgery complications.
- Spinal arteriovenous malformations (AVMs).
- Spinal hemorrhages.
- Spinal infections (such as meningitis) or inflammation.
- Spinal lesions or tumors.
What are the symptoms of cauda equina syndrome?
There are several red flags that you might have cauda equina syndrome:
- Numbness or different sensations in the backs of your legs, butt, hip and inner thighs (your saddle area, as in the parts of your body that would touch the saddle if you were on a saddled horse).
- Pain in your back and/or legs (sciatica).
- Problems having sex.
- Urinary and/or fecal incontinence.
- Urinary retention.
- Weakness or paralysis in your lower extremities.
You might experience more symptoms in addition to the red flags. They include:
- Lower back pain.
- Burning, prickling, tingling or numbness in the lower limbs (paresthesia).
- Reflexes issues.
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.
Diagnosis and Tests
How is cauda equina syndrome diagnosed?
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:
- Walk on your heels.
- Walk on your toes.
- Bend forward.
- Bend backward.
- Bend to the sides.
- Lie down and lift your legs.
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:
- Nerve roots.
- Spinal cord.
- Displaced spinal cord or nerves because of herniated disks, bone spurs and tumors.
You’ll be diagnosed with cauda equina syndrome if you have two sets of symptoms:
- Bowel, bladder and/or sexual problems.
- Paresthesia of the backs of your legs, butt, hip and inner thighs.
What questions might a healthcare provider ask me to diagnose cauda equina syndrome?
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:
- What are your symptoms?
- How long have you had these symptoms?
- What medications do you take?
- Have you ever injured your spine?
- Which symptom is worse?
- Have you ever had a herniated disk?
Management and Treatment
How do you fix cauda equina syndrome?
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:
- Hyoscyamine (Levsin®).
- Oxybutynin (Ditropan®).
- Tolterodine (Detrol®).
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.
How can I prevent cauda equina syndrome?
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:
- Avoid wearing high-heeled shoes. These types of shoes can misalign your spine.
- Stop smoking. Avoid using other tobacco products as well because they can weaken your disks.
- Exercise. Try exercises that strengthen your back and abdominal muscles.
- Lift properly. Bend your knees and keep your back straight when you lift something instead of bending at your waist.
- Maintain a healthy weight. Extra weight adds extra pressure to your lower back.
- Practice good posture. That will reduce strain on your spine.
- Stretch. Stretch your body periodically, especially after you’ve been sitting for a long time.
Outlook / Prognosis
What are the long-term effects of cauda equina syndrome?
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.
How do I take care of myself?
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:
- Physical therapists.
- Occupational therapists.
- Sex therapists.
- Primary care healthcare providers.
See if your family and friends are willing to help you as well. You’ll need support.
What questions should I ask my healthcare provider about cauda equina syndrome?
- What type of cauda equina syndrome do I have?
- What classification of cauda equina syndrome do I have?
- How quickly do I need surgery?
- How long will the surgery take?
- How long will I be in the hospital after surgery?
- Do I have a herniated disk?
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.
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