What Are the First Signs of Cauda Equina?

Cauda equina is an emergency condition in which the roots of the spinal cord are compressed where they exit the tailbone. This is an emergency condition, and if you notice problems with leg weakness, new urinary or fecal incontinence, and/or severe lower back pain, you should see a doctor immediately.

The collection of nerves at the end of the spinal cord is called the cauda equina because it resembles a horse's tail. Cauda equina syndrome (CES) occurs when the nerve roots of the cauda equina are squeezed and disrupt motor and sensory function to the lower extremities and bladder. 

Cauda equina syndrome is a medical emergency and should be treated promptly to reduce or avoid permanent problems such as paralysis or incontinence.

What Are Symptoms of Cauda Equina?

The severity of symptoms of cauda equina syndrome depends which nerves are squeezed, and much they are compressed. 

Cauda equina syndrome is a medical emergency and should be treated promptly to avoid permanent problems such as paralysis or incontinence. 

Early symptoms of cauda equina syndrome should be considered “red flags” and include: 

• Severe low back pain
• Pain, numbness, or tingling in one or both legs
• Leg weakness
• Inability to hold the foot up, such as while walking (“foot drop”)
• Inability to feel anything in the body parts that sit on a saddle (“saddle anesthesia”)
• Recent onset of bladder problems
  • Urinary retention 
  • Urinary incontinence
• Recent onset of bowel incontinence
• Sensory abnormalities in the bladder or rectum
• Recent onset of sexual dysfunction
• Loss of or reduction of reflexes in the extremities

See a doctor right away if you experience any symptoms of cauda equina syndrome. Prompt treatment may minimize complications and reduce the chance of permanent disability.

The most common cause of cauda equina syndrome is a massive herniated disc in the lower back (lumbar region), which may be a result of strain, injury, or even natural disc degeneration due to aging. 

Other causes of cauda equina syndrome may include: 

• Spinal lesions and tumors
• Spinal infections or inflammation
• Lumbar spinal stenosis
• Forceful injuries to the lower back (gunshots, falls, motor vehicle accidents)
• Birth defects
• Spinal arteriovenous malformations (AVMs)
• Spinal hemorrhages (subarachnoid, subdural, epidural)
• Postoperative lumbar spine surgery complications
• Spinal anesthesia

Cauda equina syndrome is diagnosed with a physical examination and patient history, along with imaging tests such as: 

• Magnetic resonance imaging (MRI)
• Myleogram

Treatment for cauda equina syndrome usually involves surgery. Surgery may be performed to remove bits of bone or discs, or tumors. Prompt surgery within the first 48 hours of onset of symptoms can minimize complications and reduce the chance of permanent disability. 

Following surgery, muscle function may return sooner than bladder or bowel function. Drug therapy along with intermittent self-catheterization can help lead to a slow but steady recovery of bladder and bowel function.

Other treatments for cauda equina syndrome may include: 

• Radiation to shrink a tumor 
• Physical or occupational therapy
• Assistive devices such as braces
• Medications
  • Medications to treat infection 
  • Corticosteroids for inflammation: methylprednisolone (DepoMedrol, Medrol, Medrol Dosepak)
  • Anticoagulants to prevent blood clots: heparin
  • Skeletal muscle relaxants: baclofen (Lioresal, Gablofen) and dantrolene (Dantrium, Revonto)
  • Benzodiazepines to help induce muscle relaxation: diazepam (Diastat, Valium)
  • Alpha 2-adrenergic agonist agents to help reduce muscle tone: clonidine (Catapres) and tizanidine (Zanaflex)
  • Neuromuscular blocker agent, toxin, to inhibit transmission of impulses in neuromuscular tissue: onabotulinumtoxinA (BOTOX)
  • Bisphosphonate derivatives for patients with bony lesions: etidronate disodium, alendronate (Fosamax, Binosto), and ibandronate (Boniva)
  • Phosphodiesterase (type 5) enzyme inhibitors to help with erectile dysfunction: sildenafil (Viagra), vardenafil (Levitra, Staxyn), and tadalafil (Cialis)

Cauda equina syndrome can lead to a number of complications, such as: 

• Loss of bladder and bowel control (incontinence)
• Frequent or Recurrent urinary tract infections
• Permanent paralysis
• Severe pain
• Motor weakness 
• Sensory loss 
• Problems walking
• Sexual dysfunction
• Blood clots
• Pressure ulcers
• Growth of bone where it is not supposed to be (heterotopic ossification)
• Osteoporosis
• Spasticity/contractures
• Urethral stricture
• Bladder stones
• Negative impact on social life
• Relationship difficulties
• Depression