How to Recognize Cauda Equina Syndrome

Shot of an unrecognizable man standing alone outside and suffering from backache during his run

Cauda equina syndrome is a serious nerve disorder. It often has a rapid onset, and if it is not promptly diagnosed and treated, it can have permanent, life-changing effects. Those include limited mobility, sexual dysfunction, and bowel and bladder incontinence—conditions that can affect your ability to work, care for yourself and your family, and enjoy social activities.

Some good news is that cauda equina syndrome is relatively rare, occurring in only about one in 65,000 people. The condition’s infrequency is little comfort to those who must live with its effects, however. Cauda equina syndrome is not life-threatening, but it can seriously damage quality of life.

The more quickly cauda equina is diagnosed and surgically treated, the better the chances for a full or near-total recovery. Unfortunately, because the condition is not common, many doctors in an emergency room setting fail to diagnose it. That’s why it is critically important to know how to recognize signs of cauda equina syndrome and to advocate for prompt testing for yourself or a loved one experiencing symptoms.

What are Early Signs of Cauda Equina Syndrome?

The cauda equina is the bundle of nerves at the base of the spinal cord which is said to resemble a horse’s tail (“cauda equina” means horse’s tail in Latin). When there is pressure on these nerves, a person may experience several symptoms, including lower back pain and sciatica. These symptoms are common and may also be caused by a number of other, less serious conditions.

Some people self-medicate with over-the-counter drugs and hope the discomfort will go away. Others go to a doctor, who may prescribe medication or other treatment but may not treat the situation as an emergency. Most of the time, this isn’t a problem—but with cauda equina syndrome, it could be a disaster.

How do you know whether you should be concerned about cauda equina syndrome? It’s not always obvious, and you should never try to self-diagnose. However, if you have any of the following red flags for cauda equina syndrome you should seek immediate medical attention and be explicit about your concerns:

  • Saddle anesthesia. While this is not always present in cauda equina syndrome, it is one of the more common symptoms and is considered a hallmark of the syndrome. “Saddle anesthesia” refers to numbness in the inner thighs, buttocks, and other body parts that would be in contact with a saddle if you were riding a horse.
  • Changes in sensation in the lower body. If you have changes in sensation or lose sensation altogether in your feet or legs, that could be a red flag for cauda equina syndrome—especially if the loss of sensation gets worse.
  • Sudden sexual dysfunction. Sexual dysfunction that is sudden in onset is a warning sign that should not be ignored.
  • Recent changes to bowel or bladder function. Another warning sign of cauda equina syndrome is sudden urinary or fecal incontinence, or inability to pass urine or stool. Often a patient’s bladder will fill up, but they will not feel the usual need to urinate. This is called “urinary retention,” and is one of the most common symptoms of this syndrome.
  • Sudden, severe lower back pain.
  • Pain in one or both legs.
  • Weakness or numbness in one or both legs.

If you experience any combination of these symptoms, especially if they are severe or have a sudden onset, don’t assume that your doctor will think of cauda equina syndrome and perform the appropriate diagnostic tests. Don’t feel foolish about saying, “Given my symptoms, I’m really concerned about cauda equina syndrome. Could you please screen for it?”

It’s better to risk seeming pushy than to risk permanent disability, and that could be the choice you are making. Immediate surgery may be necessary to prevent irreparable nerve damage. If it really is cauda equina syndrome, you just don’t have time to wait for a second opinion.

Diagnostic Testing for Cauda Equina Syndrome

Unfortunately, there is no simple lab test to conclusively test for cauda equina syndrome. The first diagnostic tool a doctor will use is the most simple: a patient history and physical exam. It is important to be as thorough as possible in describing the symptoms you are experiencing and when they first began. The most common (though not the only) cause of cauda equina syndrome is a herniated lumbar disk, so be sure to tell your doctor if you are aware of any injury or damage to your lumbar spine.

Magnetic resonance imaging (MRI). This test creates three-dimensional images of body parts including the spinal cord and nerve roots. It is perhaps the most important tool for confirming a suspected diagnosis of cauda equina syndrome.

Other possible tests may include a computerized tomography (CT) scan, which is an X-ray of the spinal canal, and a myelogram, an X-ray of the spinal canal using contrast dye. CT scans and myelograms may be especially helpful if the compression of the nerve root was caused by cancer or trauma to the spine.

While you should advocate for yourself with a physician who is treating you, it is ultimately your physician’s responsibility to diagnose and treat you properly. Unfortunately, many physicians fail to diagnose cauda equina syndrome in a timely fashion. This may constitute medical malpractice, especially if the patient suffers serious or permanent injury.

If you have questions about recognizing cauda equina syndrome or what to do if a doctor or medical facility failed to give you appropriate care, contact Huegli Fraser to schedule a consultation with one of our experienced medical malpractice physicians. We have experience with cauda equina cases and can advise you of your rights and options.