Cauda Equina Syndrome (CES)

Cauda equina syndrome (CES) is a rare but urgent medical condition. If it’s not treated quickly, it can cause permanent nerve damage, loss of bladder or bowel control and even paralysis. Knowing the warning signs can help you act fast and protect your long-term health.

At Banner Health, we know how serious spinal conditions like CES can be. Our neurosurgery team has the expertise and tools to diagnose and treat spinal disorders while safeguarding your neurological health.

What is cauda equina syndrome?

Cauda equina syndrome happens when a bundle of spinal nerve roots, called the cauda equina, becomes compressed (squeezed). These nerves sit at the lower end of your spinal cord in the lumbar spine, between your L1 and L5 vertebrae near your coccyx (tailbone). 

“Cauda equina” is Latin for “horse’s tail.” The name comes from the way these nerves look. They spread out at the base of your spine like a tail.

These nerve roots send and receive messages between your brain, pelvic organs and legs. They control important functions in your lower body, including:

• Movement and feeling in your legs
• Bladder and bowel control
• Sexual function

When these nerves are compressed, they can’t send signals the way they should. This can lead to loss of feeling, weakness and problems with bladder and bowel control. 

Why cauda equina syndrome is a medical emergency

Cauda equina syndrome is a medical emergency. The goal is to relieve pressure on the nerve roots as quickly as possible, ideally 24 to 48 hours after symptoms begin. The longer the nerves stay compressed, the greater the risk of permanent damage, including loss of bladder and bowel control, sexual dysfunction and even paralysis (loss of movement and sensation).

What causes cauda equina syndrome?

Cauda equina syndrome happens when something presses on the nerves in your lower spine. Several conditions can cause this pressure. 

• Herniated disk: A severe or large herniated disk is the most common cause. This happens when the soft center of a spinal disk pushes out and presses on nearby nerves. 
• Lumbar spinal stenosis: Spinal stenosis is a narrowing of the space in your spine. This can squeeze the nerves over time, especially in older adults. 
• Injury or trauma: Accidents, falls or sports injuries can damage the spine and put pressure on the nerves. 
• Tumors or infections: Growths or infections in the spine can also crowd the space and press on the nerve bundle.

Other less common causes include:

• Complications from spinal surgery
• Osteoporosis 
• Birth defect of the spinal cord (such as spina bifida)
• Arteriovenous malformation (an abnormal connection between arteries and veins)

What are the symptoms of cauda equina syndrome?

Symptoms of cauda equina syndrome can start suddenly or develop over time. They often affect both sides of your body and may get worse quickly. 

Key warning signs include:

• Severe lower back pain: Pain in your lower back that may spread to your legs.
• Leg weakness or numbness: You may feel weakness, tingling or loss of sensation in one or both legs.
• Saddle anesthesia: This is a key symptom of CES. It means numbness in the area that would touch a saddle, such as the inner thighs, buttocks (butt) and groin.
• Bladder or bowel problems: You may notice trouble starting or stopping urinating (peeing), loss of bladder control and constipation or loss of bowel control. 
• Sexual dysfunction: Changes in sexual function can also occur due to nerve damage.

Cauda equina syndrome vs. sciatica

Cauda equina syndrome and sciatica can both cause lower back and leg pain but they are not the same. While CES often affects both legs, sciatica usually affects one leg.

Sciatica causes pain, tingling or numbness that travels down the leg. While CES may cause severe weakness, saddle numbness or loss of bladder or bowel control.

Sciatica is common and often improves with time or treatment, whereas CES is rare and a medical emergency. If you experience back pain along with changes in bladder or bowel control or numbness in the groin area, seek emergency care immediately.

How is cauda equina syndrome diagnosed?

To diagnose cauda equina syndrome, your health care provider will perform a physical exam, review your medical history and order imaging tests. The exam may focus on your strength, reflexes, sensation and ability to move. 

Your provider may also order:

• Blood test
• Bladder test
• X-ray
• Magnetic resonance imaging (MRI)
• Myelogram, an X-ray or a CT scan of the spinal canal after injection of contrast dye
• Electromyography (EMG) checks muscle response to nerve stimulation
• Nerve conduction studies (NCS) that check nerve function and damage

If your provider suspects you have cauda equina syndrome, you will be immediately referred to a spine surgeon to confirm the diagnosis. 

Treatment for cauda equina syndrome

Emergency surgery

If you truly have cauda equina syndrome, you may need emergency spinal surgery to relieve pressure on nerves. It is often done within 24 to 48 hours of the start of symptoms. Your surgeon will choose the best option based on what is causing the compression.

Types of surgery:

• Lumbar laminectomy (decompression surgery): Removes a small section of bone called the lamina to relieve pressure on the spinal cord or nerves
• Lumbar discectomy: Removes part of a herniated disk in the lower back that is pressing on a nerve root
• Tumor removal surgery: Removes growths that are pressing on the nerves
• Spinal fusion: Stabilizes the spine by joining two or more vertebrae

Medications used in treatment

Medications are not a replacement for surgery in most cases but they can help manage symptoms and support recovery.

Common medications include:

• Pain relievers: Over-the-counter (OTC) options like acetaminophen or ibuprofen or prescription pain medications
• Muscle relaxants: Help reduce muscle spasms
• Corticosteroids: Help reduce inflammation and swelling around the nerves
• Antibiotics: Used if an infection is causing the compression
• Medications for nerve pain: Such as gabapentin or pregabalin to help manage nerve-related pain
• Bladder medications: May help improve bladder control during recovery 

Recovery and long-term outcomes

Recovery from cauda equina syndrome varies from person to person. Some people recover fully, while others may have lasting symptoms. 

What to expect:

• Gradual improvement in strength and sensation
• Possible long-term bladder or bowel changes
• Ongoing nerve pain in some cases

To support your recovery, your health care provider may suggest:

• Physical therapy to restore strength and mobility
• Occupational therapy to assist with daily activities
• Pelvic floor therapy for bladder and bowel control
• A continence counselor to address bladder and bowel issues
• Therapy, counseling and support groups for emotional support

If you have loss of bladder and bowel function, the following tips may help:

• Use a catheter to empty your bladder
• Drink plenty of fluids 
• Use good personal hygiene
• Use glycerin suppositories or enemas
• Wear protective pads and pants to prevent leaks

When to seek emergency care

Do not wait if you notice symptoms of cauda equina syndrome. Quick action can help prevent permanent changes. 

Go to the emergency room right away if you have:

• Loss of bladder or bowel control
• Trouble urinating
• Numbness in the groin or saddle area
• Severe weakness in your legs
• Sudden, severe back pain with leg symptoms

Can I prevent cauda equina syndrome?

There is no guaranteed way to prevent cauda equina syndrome. However, there are steps you can take to reduce your risk:

• Use proper body mechanics and lifting techniques
• Strengthen core muscles
• Avoid smoking
• Treat herniated disks and spinal issues
• Watch for changes in bladder and bowel habits

Frequently asked questions

Is cauda equina syndrome rare? 

Yes, it is rare. CES is uncommon but requires urgent treatment. 

Can a herniated disk cause cauda equina syndrome? 

Yes. A herniated disk is the most common cause of CES. 

Can a herniated disk cause bladder problems?

Yes. A severe herniated disk can cause bladder problems but this is not common. In most cases, a herniated disk causes back pain or sciatica symptoms. These symptoms usually do not affect bladder or bowel control. But if the disk presses on the nerves at the base of the spine, it can lead to CES.

Can you walk with cauda equina syndrome?

Some people can still walk but they may have weakness or numbness. Walking ability may worsen without treatment. 

Is cauda equina syndrome permanent? 

Early treatment improves recovery but nerve damage may be permanent. 

How quickly should CES be treated? 

Surgery is often recommended within 24-48 hours. 

Can cauda equina syndrome be prevented? 

Treating other spinal conditions early may reduce the risk. 

Get expert spine care at Banner Health. 

Cauda equina syndrome is a serious condition that can alter your life if left untreated. Prompt diagnosis and treatment are important for preserving your bowel, bladder, mobility and sexual health.

Banner Health is nationally recognized for excellence in spine care. Our multidisciplinary spinal team provides both non-surgical and surgical treatments for a full range of spinal disorders. Schedule an appointment today with a Banner Health specialist.