Cauda Equina Syndrome: Symptoms and Recovery

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Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine 

Fortunately, back pain is generally mild, and the prognosis for recovery is favorable. But there are certain conditions where back pain can be extremely serious, and cause irreversible after-effects if it is not treated quickly.

Cauda equina syndrome, although rare, can cause symptoms as serious as lower limb paralysis and incontinence.

This article covers everything you need to know about cauda equina syndrome, from diagnosis to various ways to optimize recovery from this condition.

Cauda Equina Syndrome: Points to Remember

Understanding Cauda Equina Syndrome (Definition)

Let's start with a little anatomy lesson to better understand cauda equina syndrome.

What is ponytail? Also called “Cauda Equina”, it is a bundle of nerves in the shape of a ponytail, which extends down the spinal cord. This amalgam of nerve roots then descends to the level of the lower limbs.

The role of these nerves is to provide sensation and strength in the legs. Likewise, they control the function of the genitals.

In cauda equina syndrome, the cauda equina is damaged for one reason or another.

It affects approximately 1 in 100 people, and constitutes between 000-2% of disc surgeries.¹. It mainly affects people between 31 and 50 years old.

Its onset can be either acute (sometimes within a few hours!), or even gradual in people with chronic low back pain.

In acute onset, symptoms of cauda equina syndrome develop rapidly (within 24 hours). Often, there is severe lower back pain and changes in the genitals (such as rapid onset urinary incontinence).

There are also sensory and/or motor changes in the lower limbs (such as loss of sensation or paralysis).

In its progressive form, symptoms appear after several weeks or months. They can be latent and intermittent.

For example, low back pain associated with episodes of sciatica can be noted. Motor changes such as difficulty walking can be observed, as well as reduced sensation in the leg and more or less pronounced incontinence.

How to diagnose cauda equina syndrome?

Above all, let us remember that cauda equina syndrome constitutes a medical emergency, and that the time between the appearance of symptoms and the diagnostic assessment should ideally be within the same day.

On the one hand, the patient's medical history will provide valuable clues to the clinician. Then, a complete physical examination will direct towards a diagnosis of attack of the cauda equina. Among the clinical tests (including a neurological examination), there are sensitivity tests (dermatomas), myotomes, reflexes, etc.

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Then themedical imaging will confirm the presence of cauda equina syndrome. MRI (magnetic resonance imaging) is the examination of choice to issue this diagnosis, and thus plan the consequent surgical treatment. A contrast medium may be used if a tumor or infection is suspected.

Note: It is important to remember that the sooner the diagnosis is made, the more favorable the recovery will be.

Finally, to quantify the bladder dysfunction associated with cauda equina syndrome, we could use an ultrasound or a urinary catheter.

What is the link between herniated disc and cauda equina syndrome?

La herniated disc lumbar spine is the most common cause of cauda equina syndrome.

For information, a herniated disc refers to refers to a displacement of the gelatinous nucleus inside a disc which pushes and pierces the periphery of the intervertebral disc.

Typically, a herniated disc does not affect the cauda equina. Indeed, there must be a relatively massive disc herniation (and posterior) to observe compression of the ponytail. This is not the case for the majority of herniated discs.

Access our full article for more information on herniated discs.

What causes cauda equina syndrome?

Although disc herniation is the main cause of cauda equina syndrome, this condition can appear for various reasons.

Here are other causes that can also cause compression in the ponytail area: 

How does cauda equina syndrome manifest? (Symptoms not to be missed)

The symptoms of cauda equina syndrome will vary depending on the affected individuals. They depend on the nerves affected, as well as the degree of nerve irritation or compression.

Generally speaking, they appear bilaterally, that is, they affect both lower limbs.

Cauda equina syndrome symptoms include:

  • Severe lower back pain that sometimes radiates to the feet (of the sciatica or burn)
  • Loss of sensation in the lower extremities
  • Loss of sensation in the area of ​​the genitals (glutes, adductors, upper thighs, perineum, anus)
  • Numbness and/or tingling in the legs
  • Loss of strength in one or both legs
  • Loss of balance and difficulty walking
  • Vesico-sphycteric disorders, like the urinary and/or fecal disorders (incontinence, loss of sensation when urinating, urinary retention, constipation, difficulty holding a stool, etc.)
  • Sexual dysfunctions and erectile disorders

The treatment of choice for cauda equina syndrome: Surgery

Once cauda equina syndrome has been diagnosed, the surgery emergency is most often the treatment of choice. Corticosteroids are sometimes prescribed to reduce the swelling that would help compress the nerve roots.

The most commonly used surgical option following cauda equina syndrome is decompression surgery. A lumbar microdiscectomy can be considered, or a laminectomies.

Either way, the goal will be to take pressure off the nerves causing the patient's symptoms.

Other operations may be indicated depending on the patient's specific condition following a cauda equina syndrome, and the surgeon's preference.

The possible options are: 

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Regardless of the surgical technique, the main objective following a cauda equina syndrome will correct neurological disorders. To do this, we suggest operating within 24-48 hours of symptoms appearing to optimize the prognosis.

Possible sequelae

Surgery, although indicated for most cases of cauda equina syndrome, unfortunately does not guarantee complete recovery. Indeed, if surgery is delayed too long, irreversible damage could be observed.

For example, after-effects such as:

  • Residual and persistent pain
  • Residual weakness and paralysis of the lower limbs (paraplegia)
  • Urinary and fecal incontinence
  • etc.

The severity of the after-effects following a cauda equina syndrome will depend on pre-operative symptoms, as well as the time elapsed between the appearance of symptoms and medical treatment.

In some rare cases, symptoms may worsen after failed spinal surgery.

Rehabilitation after operation

In general, rehabilitation after cauda equina syndrome is aimed at preserving function and maximizing healing potential.

After an operation, the surgeon will prescribe medications to control pain. Of the catheters will also be used to control symptoms of incontinence.

In physiotherapy (physiotherapy), strengthening and balance exercises will increase the strength of the lower limbs, thereby reducing the risk of falls.

Analgesic modalities will also allow pain to be controlled naturally.

Massages and gentle mobilizations carried out by a physiotherapist or osteopath will also relax tense muscles, increase mobility and improve function.

Note that neurological and reproductive system damage can continue to improve over the years, even after surgery.

If the cause of cauda equina syndrome is a tumor, chemotherapy or radiation treatments should be considered to treat the source of the problem.

Living with cauda equina syndrome

In addition to the physical symptoms, the psychological and social consequences of cauda equina syndrome should not be underestimated (especially when the symptoms are chronic, or if the surgery has left sequelae).

Certainly, significant pain can prevent the affected person from exercising their profession. But urinary incontinence problems sometimes limit outings and other social activities, in addition to causing repeated urinary infections.

Cauda equina syndrome and sex life, we talk about it

The sexual repercussions of cauda equina syndrome are often relegated to the background, probably because of their taboo nature.

The consequences of this syndrome on sexuality affect both men and women.

Sensory disorders, in particular, can be a major source of dissatisfaction in the sexual sphere, and this is more pronounced in women.

In men, the most common sexual complaints include decreased orgasmic intensity and problems with erectile dysfunction. Ejaculation disorders, although rarer, are also present.

On the female side, common complaints include a decrease or even loss of lubrication, a significant drop in libido, as well as a reduction in orgasmic sensation. Local discomfort or pain is also often reported. Sexual disorders are generally permanent and, in most cases, permanent.

It is imperative to adopt a global approach to aspire to regain a fulfilling sex life following a cauda equina syndrome.

This care should not only address the physical symptoms but also offer psychological and emotional support to those affected, helping them navigate through the challenges posed by sexual disorders linked to the syndrome.

Conservative strategies for urinary problems

Urinary problems related to cauda equina syndrome are very debilitating.

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To remedy the situation, the treatment team offers solutions such as:

 1- Pelvic floor exercises

Pelvic floor exercises or Kegel are forms of perineal rehabilitation that can correct, or at least improve, urinary disorders and problems related to the pelvic floor.

They can be done alone or guided by a physiotherapist (physiotherapist). But according to statistics, perineal rehabilitations that have been assisted are more effective.

Here are some examples of exercises prescribed by health professionals:

Exercises 1: slow contraction

  • Lying down and knees bent, contract the pelvic muscle for 5 seconds then rest for 10 seconds.
  • Repeat this ten times
  • Pause for 60 seconds, then do two more sets of 10 contractions each.

Exercise 2: rapid contraction

  • Same procedure as the first exercise, but this time contract the pelvic muscle quickly on the exhale.
  • Release quickly and inhale.

Exercise 3: Perineal lock

This last exercise is done daily, before any effort that may cause urinary leakage (cough, sneeze): tighten the pelvic muscles before coughing or sneezing.

2- Kinesitherapy (Physiotherapy)

Urinary disorders can also be controlled with physical therapy (Physiotherapy).

Several techniques can be used by the physiotherapist (Physiotherapist) specialized in perineal rehabilitation:

  • Manual method: consisting in evaluating the contractions of the perineum.
  • Toning the muscles: thanks to electrostimulation of the muscles via two electrodes. The patient must at the same time perform contractions.
  • Biofeedback: Allows you to visualize the contractions of the perineal muscle on screen.
  • Behavioral management, which is rather a kind of educational session to guide the patient to better manage his urges to urinate.


Anticholinergic medications help reduce bladder sensitivity and overactivity associated with cauda equina syndrome. Combined with a therapy session, the results can only be beneficial.

4-Avoid bladder irritants

Minimize the intake of foods that irritate the bladder such as: coffee, tea, soft drinks, alcohol, chocolate, acid fruits and spices. You should also wear loose clothing!

Are you looking for solutions to relieve your pain?

Discover the opinion of our team of health professionals on various products available on the market (posture, sleep, physical pain), as well as our recommendations.


Testimonials from people living with cauda equina syndrome


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Each article is written by a qualified healthcare professional following strict editorial procedures (More information). This article is regularly revised in the light of the most recent scientific evidence.

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