Development of Cauda Equina Syndrome Symptoms

What symptoms should a GP test for and a patient look out for if they may be developing cauda equina syndrome?

Lower back symptoms

Cauda equina syndrome usually starts with pain in the lower back. This may develop gradually over time or occur suddenly due to a specific trauma or action by the patient.

The symptoms of this unpleasant condition stem from problems in the lumbar region of the back when a problem in the spinal area, such as a tumour or herniated disc, causes the cauda equina nerves to become compressed or squashed. As the compression increases, the patient will start to notice a variety of other, neurological symptoms.

A neurological symptom is an effect on the functioning of the body caused by the inability of the nerves to function properly such as messages of sensation not being passed to the brain. With cauda equina syndrome, the patient will probably experience the following:

Leg symptoms

In the early stages, the patient will probably start to experience pain and tingling in one leg. This may be accompanied by weakness in that leg and possibly a loss of ankle reflex.

At this stage, the patient may be given a diagnosis of sciatica. However, it is important that a patient visiting their GP with these symptoms is tested for and advised of the red flag symptoms of cauda equina syndrome and the need to attend A&E as a matter of emergency should they start to develop.

It is of particular concern if the patient starts to experience these symptoms in both legs as this may suggest that they are suffering a problem with the cauda equina nerves.

Perineal symptoms

The patient may start to lose sensation in the ‘saddle’ region between the legs and around the anus and perineum. This may present as a tingling sensation or numbness.

The patient may also start to lose sexual sensation and control.

Both these symptoms should alert medical practitioners to the possibility of the patient having cauda equina syndrome and should merit urgent investigation as to the underlying cause.

Bladder symptoms

The symptoms relating to the bladder are of considerable importance in both diagnosing and treating cauda equina syndrome.

The patient may initially find that their bladder habits are changing. They may have difficulty in fully emptying the bladder, finding that they have to strain or that the flow seems poor or altered.

A patient presenting these symptoms requires an emergency MRI scan to confirm the cause of their symptoms. If a diagnosis of cauda equina syndrome is confirmed, they are likely to require immediate surgery.

The patient may, however, deteriorate to complete loss of bladder sensation and incontinence. Surgery is still necessary at this point but may be less successful.

Bowel symptoms

In some cases, loss of sensation and neurological control can result in bowel problems such as urgency and incontinence.

Medical negligence

When a patient attends their GP with lower back and leg symptoms, a failure to test them for additional signs of cauda equina syndrome or to refer them for further investigation may be considered to have been negligent.

Where red flag symptoms of this shocking condition are ignored, impacting on the patient’s long-term outcome, it may be appropriate to make a claim for compensation.

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