Diagnosing CES – Why Is A Rectal Examination Needed?

A digital rectal examination will be needed to assist the diagnosis of cauda equina syndrome.

What is cauda equina syndrome (CES)?

The cauda equina is formed by nerve roots below the level of the lower end of the spinal cord. Cauda equina syndrome can be defined as:

• Low back pain
• Unilateral or more usually bilateral sciatica (i.e. in both legs)
• Saddle sensory disturbance
• Bladder and bowel dysfunction
• Lower extremity motor and sensory loss

Cauda equina syndrome may result from any lesion that compresses the cauda equina nerve roots. They are particularly susceptible to injury. They tend to recover poorly from injury.

History of CES

A patient with CES will usually present with the following history:

• Low back pain
• Lower extremity motor and/or sensory abnormality
• Sciatica
• Bowel or bladder dysfunction
• Saddle anaesthesia

With regards to sensory loss, the toilet paper may feel different when wiping. This can be confirmed on examination if saddle anaesthesia is suspected. Bladder dysfunction may present as incontinence but often presents earlier as difficulty starting or stopping a stream of urine.

Changes around the anus

As well as the physical signs associated with sciatica, the most important physical signs are loss of sensation/altered sensation, around the anus and changes in anal tone. That is why a digital rectal examination is needed, as it is the best way to establish whether these clinical symptoms are present.

A digital rectal examination involves a medical practitioner inserting a finger into the patient’s anus. The patient may be asked to squeeze so that the clinician can test the level of anal tone. The patient may also be asked to say whether there is normal sensation and what can be felt.

Failure to perform rectal examination

When a patient presents with the symptoms associated with cauda equina syndrome, a neurological examination must follow. This should involve testing the sensation around the saddle area, mobility and sensation in the legs, and a digital rectal examination.

Without a digital rectal examination, the clinician may not appreciate the patient’s symptoms in their entirely, causing a diagnosis to be missed. If such medical errors do happen and a patient’s treatment is delayed as a result, there may be grounds for a compdensation claim.

Cauda equina solicitors

To talk to a solicitor about making a medical compensation claim for cauda equina syndrome, please contact us today for more information.

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