Cauda equina syndrome

Cauda equina syndrome (CES) is a rare but serious condition that affects the bundle of nerve roots at the lower end of the spinal cord.

Within your spine, the spinal cord extends from the brain down through a canal inside the vertebral column. At each level of the spine, there are nerves branching off from your spinal cord. These are called nerve roots. They are responsible for sending signals to and from the muscles and other structures throughout the body.

The area which we need to concentrate on is the area of the spine which is approximately just above the waist. This area of the spine is where the spinal cord finishes. Below this is the group of nerves which are called the cauda equina. This is known as the “cauda equina,” a Latin term that means “horse’s tail,” which is what these nerves resemble.

The nerves of the cauda equina are responsible for the supply of nerves to the bladder, bowels, lower limbs and also supply sensation to the skin around the bottom and back passage.

Cauda equina syndrome (CES) occurs when there is dysfunction of multiple lumbar and sacral nerve roots of the cauda equina. This syndrome has a complex spectrum of signs and symptoms. If your doctor has suspicions of CES, then in some causes it can be confirmed with a MRI scan.

Established by the Champions Charity, CES Awareness Day has been held annually on 1 October since its inception in 2020.

CAUDA EQUINA AWARENESS DAY 2025

What are the causes of CES?

Whilst the cauda equina are protected by the vertebrae (the bones that make up the spine). It is still vulnerable to damage.

These are the main causes:

Intra-vertebral disc herniated (slipped or prolapsed disc)
Tumours of the cauda equina
Spinal injury fracture/trauma
Secondary to medical procedure
Vascular problems of cauda equina
Infections of the cauda equina

Red Flag Signs & Symptoms

Patients should be aware of the following “red flag” symptoms that may indicate CES:

Saddle Anaesthesia

Loss of feeling between the legs
Numbness in or around the back passage and / or genitals
Inability to feel the toilet paper when wiping

Bladder Disturbance

Inability to urinate
Difficulty initiating urination
Loss of sensation when you pass urine
Inability to stop or control urination
Loss of the full bladder sensation

Bowel Disturbance

Inability to stop a bowel movement
Constipation
Loss of sensation when passing a bowel motion

Sexual Problems

Inability to achieve an erection or ejaculate
Loss of sensation during intercourse

Nerve Root Pain

It is quite common to have a combination of back pain, leg pain, leg numbness or weakness. These symptoms however are also common in people who have a history of back problems but do not have cauda equina syndrome.

DOWNLOAD INFORMATION ABOUT THE RED FLAGS

Poster: © Ruth Eaves, Medical Artists, Bolton NHS Foundation Trust 2023.

Cauda equina syndrome IS a medical emergency!

If you are visiting this page and have any of the red flags listed above, this should be treated as a medical emergency. Urgent treatment leads to better outcomes. This would mean being assessed at your local Accident and Emergency Department.

There is a recognised Suspected cauda equina syndrome pathway for healthcare professionals to follow, to ensure you get the right treatment at the right time.

ACCESS THE PATHWAY HERE

Wheelchair provision

Cauda Equina Syndrome is a condition where many are still able to walk, either independently, or with the use of walking aids. Walking any distance may be limited and could cause significant fatigue, pain and limit independence. A wheelchair may help in many ways, but it is vital that the wheelchair fits the needs of the individual.

SIA , CESCI and The Wheelchair Alliance, have produced a template letter which can be downloaded and given to the GP to support them to outline the more specific information that can help to make the referral to the wheelchair services more effective. This should ensure that the most appropriate equipment is provided.

download template letter

More information

Download our leaflet about CES

For further information, you can contact our support line on 0800 980 0501 or contact our specialist clinicians. We have a range of services providing support and advice to help you live a fulfilled life.

Our SCI knowledge hub will also equip you with information on everything from bowel and bladder management and skin care to mental health and your right to accessibility. We also have information about CES aimed specifically at healthcare professionals.

information for healthcare professionals

Partnerships

Cauda Equina Spinal Cord Injury (CESCI) is a support group dedicated to helping people living with CES find resources and support. We are a community of individuals who understand the challenges of living with CES and strive to help one another. Our website is a great place to find information about the condition and connect with others who are going through similar experiences. We offer blogs, events, and links to helpful resources.

“Our goal is to provide a safe and supportive space for those living with CES to find the help they need.”