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Cauda Equina Syndrome

Cauda equina syndrome is a rare but serious condition that requires urgent medical assessment. Early diagnosis and treatment are important to reduce the risk of permanent nerve damage. It affects the bundle of nerves at the bottom of the spine, known as the cauda equina. It is usually (but not always) associated with low back pain.

Cauda equina syndrome can have several causes, including a large slipped (herniated) disc, spinal stenosis and, less commonly, other conditions affecting the spine. It requires immediate medical attention to prevent permanent nerve damage and long-term complications.

Know When to Seek Help
Seek emergency medical assessment immediately (attend A&E) if you have:

  • Bladder problems
    • New (within the last two weeks) difficulty passing urine
    • Not knowing when your bladder is full
    • Loss of sensation when your bladder is full
    • Episodes of incontinence
    • Loss of bladder control e.g. difficulty stopping or controlling the flow of urine
  • Bowel problems - incontinence (leaking) or loss of sensation during bowel movements
  • Loss of feeling or pins and needles around the inner thighs, genitals, buttocks or anus ("saddle area")
  • New sexual dysfunction, such as erectile dysfunction or reduced genital sensation

If you develop symptoms that could suggest cauda equina syndrome, do not wait to see if they improve. Attend your nearest Emergency Department as soon as possible. Early assessment is important because delaying treatment can increase the risk of permanent problems affecting the legs, bladder, bowel or sexual function.

You can download a cauda equina syndrome information card for further information and watch a Cauda Equina Syndrome Video for further information. 

Most episodes of back pain are not caused by cauda equina syndrome and improve with time. However, if you experience any of the following symptoms, contact NHS 111 or your GP promptly:

  • New weakness in one or both legs or increasing difficulty walking or coordinating your legs
  • Severe pain that is worse at night and not relieved by changing position
  • Fever (temperature above 38 degrees) and severe back pain
  • Pain that started after a serious accident, such as after a car accident
  • Back pain and a history of previous cancer
  • Back pain after a minor fall or lifting injury if you have osteoporosis

When to seek further advice

Call 111 / Go to A&E immediately if you experience:

Bladder problems

  • New (within the last two weeks) difficulty passing urine
  • Not knowing when your bladder is full
  • Loss of sensation when passing urine
  • Episodes of incontinence
  • Loss of bladder control e.g. difficulty stopping or controlling the flow of urine

Bowel problems

  • Incontinence (leaking) or loss of sensation during bowel movements

Numbness in the "saddle" area

  • Loss of feeling/pins and needles between your inner thighs, genitals and/or anus
  • Sexual dysfunction i.e. erectile dysfunction or reduced sensation during intercourse

These symptoms could suggest cauda equina syndrome. If you have these symptoms please seek urgent medical assessment. This is usually through A&E because early assessment is important.