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What Effect Does CES Have On The Bladder?

Cauda equina syndrome (CES) is a neurological condition that can lead to permanent side-effects, including bladder dysfunction.

Cauda equina syndrome and the bladder

Cauda equina syndrome is when the nerves at the bottom of the spinal cord (called the cauda equina) are compressed and injured. Amongst other things, the cauda equina enable function and sensation in the bladder. Therefore when the nerves are compressed and injured, the nerve supply to the bladder will be inhibited, resulting in problems.

Patients who have cauda equina compression generally lose their sensation from the bladder, and lose motor innervation to the bladder. Consequently patients are unable to sense the increasing volume of the bladder as it expands, and are unable to contract/relax the muscles voluntarily to allow the emptying of the bladder.

Stages of bladder dysfunction

When a patient first develops cauda equina syndrome, the condition will be incomplete because there will still be a degree of bladder control. At this stage, there will be urinary difficulties due to inefficient bladder emptying and poor contraction of the muscles.

If the clinical situation is allowed to progress, a patient will develop complete cauda equina syndrome, where there is no bladder control. At this stage, there will be urinary retention with an enlarged bladder which can be detected on an ultrasound scan or placement of a catheter.

In complete CES, the volume of the bladder will often exceed 700mls, which is abnormal. In addition, an ultrasound scan post-voiding will reveal a high residual volume post-voiding. Nevertheless, a patient will not be distressed by the large bladder volumes because he/she will not have any sensation in the bladder. This is called painless urinary retention.

Urinary dysfunction after CES

Cauda equina syndrome can result in permanent bladder dysfunction if the condition is not treated quickly enough.

It is generally accepted by medical professionals that the outcome will be greatly improved if surgical decompression is performed while the condition is still incomplete.

Incomplete cauda equina syndrome presents with symptoms of impaired bladder function, including frequency, painful urinary retention, urge incontinence and the need to strain to urinate. This might involve the need to raise intra-abdominal pressure by standing (for females) and/or pressing on the abdominal wall with the hands.

If a patient presents with these symptoms, medical practitioners must realise that the condition is still incomplete and treat the condition as a medical emergency. This means proceeding directly to surgical decompression.

If there is a delay in treating a patient with incomplete cauda equina syndrome, and he/she progresses to complete cauda equina syndrome with permanent bladder dysfunction, there may be a case of medical negligence. Contact us today to find out more.

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