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Symptoms of Incomplete and Complete Cauda Equina Syndrome

The symptoms of incomplete cauda equina syndrome and complete cauda equina syndrome are slightly different. The main difference is the level of bladder dysfunction.

Cauda equina syndrome and bladder dysfunction

Patients with cauda equina syndrome will lose sensation and function in their bladder. This is due to the nerves which serve the bladder being damaged by compression. Compression can be caused by various factors, including a slipped disc or a spinal abscess.

The more the nerves are damaged, the worse the bladder dysfunction will be. Therefore a patient’s symptoms will become increasingly severe the longer the cauda equina syndrome continues.

Symptoms of incomplete cauda equina syndrome

At first the patient’s condition will be incomplete. An incomplete cauda equina syndrome presents with symptoms of impaired bladder function, including frequency, painful urinary retention and urge incontinence. There may also be a need to raise intra-abdominal pressure by either standing in the case of the female and/or pressing on the anterior abdominal wall using the hands in the case of the female/male.

Symptoms of complete cauda equina syndrome

If the clinical situation is allowed to progress, a patient will go from having incomplete cauda equina syndrome to complete cauda equina syndrome. Complete cauda equina syndrome is typically characterised by painless urinary retention with overflow incontinence.

With complete cauda equina syndrome there will be an enlarged bladder which can be detected on an ultrasound scan. The placement of a catheter may also reveal retained volumes of urine which exceed 700mls, which is abnormal. In addition an ultrasound scan post-voiding will reveal a high residual volume post-voiding, but the large bladder volumes will often not distress the patient because sensation has been lost.

Preventing complete cauda equina syndrome

Emergency surgery to decompress the nerve roots is required to prevent further deterioration in neurological function, and to try to prevent the neurological effects becoming permanent.

There is uncertainty amongst medical experts regarding surgical outcomes in relations to the timing of decompression surgery. However, it is reasonable to state that surgery is best performed when the neurological deficit is least – meaning while the condition is still incomplete.

Once the patient develops complete cauda equina syndrome, the nerves will be extensively harmed and surgery will produce little improvement in symptoms. Medical practitioners must therefore prevent complete cauda equina syndrome by treating the condition in the early stages.

Failure to treat

If medical practitioners fail to treat cauda equina syndrome before it progresses to the complete stage, there may be grounds for a compensation claim. Contact us for more information.

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