What is it?
Cauda Equina means ‘Horse’s Tail’ in Latin. At the lower end of the spine is a bundle of nerve roots called the cauda equina, so named as it resembles a Horse’s Tail. The nerves running out of the cauda equina control the bladder, bowel, sexual and lower limb function.
Cauda Equina Syndrome is a collection of symptoms which occur due to compression or damage to the cauda equina. It can happen for several reasons, such as disc prolapse, narrowing of the spinal canal, surgical complications, tumours, infection or trauma. It is a form of spinal cord injury. This in turn can lead to a variety of symptoms that must be faced and managed correctly.
Cauda Equina Syndrome is a relatively rare condition, and it is estimated to affect between 1 and 3 people in every 100,000 of the population. However, symptoms should not be ignored. Cauda Equina is usually an acute condition but occasionally it can be chronic with the slow progression of symptoms such as:
- Bladder problems e.g., urinary retention or urinary incontinence
- Bowel problems
- Changes in sexual function
- Searing lower back pain that can travel down the legs
- Saddle Anaesthesia – numbness & tingling in the buttocks, genitalia and inner thighs
- Weakness or paralysis in the legs and/or feet
Bladder Function:
- Alteration in sensation of the need to pass urine
- Difficulty controlling or stopping urination leading to incontinence
- Difficulty initiating passing urine
- Incomplete bladder emptying leading to urinary retention
- Poor urinary stream
- Straining to pass urine
Bowel Function:
- Can include an alteration or loss in sensation of the need to pass wind or stool (liquid or solid).
- May lose the ability to stop a bowel motion resulting in faecal incontinence
- Changes in stool consistency – increased frequency or constipation
- Lack of regularity
Changes in Sexual Function:
Men:
- Altered or absent sensation in the penis
- Erectile dysfunction
- Difficulty in ejaculating or achieving orgasm
Women:
- Absent or altered genital sensation
- Difficulty in arousal and/or achieving orgasm
- Reduced lubrication
- Reduced pelvic floor function
- Difficulties using certain feminine hygiene products
Back pain:
- May be caused by nerve damage (neuropathic pain)
- May be because of damage to muscles or joints
- There are often several causes
- Neuropathic pain in particular, may not go away, even long after injury
- Sciatica type pain
Saddle Anaesthesia:
- May present as partial loss, such as pins and needles, or complete absence and numbness in your “saddle” area or legs
- Weakness in legs or feet, especially when rising from a sitting position
- The skin should be checked regularly to ensure problems such as pressure sores aren’t developing
Diagnosis of Cauda Equina is accomplished with full medical and physical examination, plus tests such as an MRI scan, CT scan and Myelogram. The earlier the diagnosis the better!
Treatments:
The main aim of any treatment is to relieve the pressure on the spinal nerves to restore sensation and muscle function to the bladder, bowel, and legs. Surgery is often required and may be in the form of a discectomy for a herniated disc (removes the portion of the disc that is compressing the nerves) or spinal decompression for stenosis (removes the bone spurs and ligaments compressing the nerves).
Do not suffer in silence
Suffering any form of spinal cord injury, including cauda equina, can be an extremely traumatic and emotional experience. It is important that the sufferer gets to talk to someone about their problems and feelings, and it may also help to chat with a fellow sufferer.
Mobility and everyday activities:
- Difficulties with walking is common due to muscle weakness and pain
- Everyday tasks may be more difficult due to pain, numbness and weakness
- Physiotherapy can be a benefit and an exercise programme may help to alleviate certain problems
- Some hospitals will have a specialist neurological physiotherapist who can be accessed via a GP referral
- Occupational Therapy can also help, with assessment for equipment such as shower chairs, stools, grab rails and so on
- A RADAR key can enable access to hundreds of disabled toilets across the country. These can be purchased but most prescription delivery services offer them free of charge as does Manfred Sauer Care
- Driving – once diagnosed, anyone wishing to return to driving must undergo an assessment through their local driving assessment centre
- drivingmobility.org.uk may be of use
- The DVLA and insurance company must be informed prior to returning to driving
- If a Blue badge is required, it can be applied for via the local council and they will carry out the necessary assessments
Further support:
https://caudaequinauk.org.uk – A voice for those affected by Cauda Equina Syndrome in the UK
https://www.spinal.co.uk – Spinal Injuries Association