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What is cauda equina syndrome?

Cauda equina syndrome (CES) is the dysfunction of the nerves supplying the bladder, bowel, genitals and saddle area (were contact would be made if riding a bike).

What causes cauda equina syndrome?

CES is a rare condition, with the commonest cause being a large central disc prolapse in the lower spine. Other much rarer causes of CES are tumours, infection, trauma or haematomas. CES is an emergency, because there is the possibility that timely surgery can salvage function of the nerves supplying the bladder, bowel, genitals and saddle area. Where treatment is delayed, function will be lost permanently.

What are symptoms or signs of cauda equina syndrome?

There are a group of symptoms or signs, known as ‘red flags’ for CES, whereby the diagnosis should be suspected, if they are present. Usually severe low back pain with sciatica (very rarely, CES can occur in the absence of either) is present. However, the red flag features are:

1. Sciatica affecting both legs;
2. Altered function of both legs;
3. Reduced sensation in the saddle/peri-anal/genital region/urethra;
4. Reduced/loss of bladder control/bowel function, altered sexual function.

Typical bowel symptoms in CES are constipation, reduced sensation and difficulties with bowel emptying.

The progression of CES differs. In some patients it can occur within a few hours, while in other patients’ progress slowly over days or weeks.

What action should be taken?

CES is an emergency therefore urgent medical assistance should be sought. Patients with a new diagnosis of CES should be treated as soon as possible, and there is a risk that delay could result in a worse outcome.

Because persistent cauda equina compression causes a worse outcome, reports of the red flag features should result in an emergency referral to A&E (for example, where a patient complains to their GP). Once in attendance at hospital, an emergency MRI scan, and surgical decompression within 24 hours, is mandatory.

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