Cauda equina, the bundle of nerves found at the bottom of your spinal cord, translates from the Latin for 'horse's tail' and is so-called because of how it looks. It contains the nerve roots from the lumbral and sacral spine and joins the sacral plexus, which involves nerves in the anal and genital regions.
WHAT IS CAUDA EQUINA SYNDROME or CES?
CES is a specific pattern of symptoms which are caused by nerve damage to the cauda equina. These include:
• Severe pain in back, buttocks, legs, genitals and saddle area between the legs.
• Tingling or numbness in the saddle area.
• Weakness in legs.
• Bladder, bowel and sexual dysfunction.
• Loss of knees and ankle reflexes.
This combination of symptoms arising suddenly is a medical emergency and requires immediate medical attention to avoid permanent nerve damage.
WHAT ARE THE CAUSES OF CES?
• Nerve Compression, for example from a prolapsed disc or spinal fracture.
• Nerve Stretching, such as when one vertebra slips on another.
• Inflammatory conditions like arachnoiditis.
• Losing the myelin sheath around nerves, in conditions like Multiple Sclerosis.
• Toxic damage from spinal anaesthetics.
Whilst CES can arise gradually from chronic illnesses such as Multiple Sclerosis, if it is often caused by a nerve compression in which case it may respond well to prompt surgical removal of the cause. Recovery however depends on the duration of the injury and the amount of damage suffered.
HOW DOES CES AFFECT YOU?
CES is a devastating condition. Often the sufferer is unable to work because of severe pain, muscle weakness, continence problems, or a combination of these problems.
• Loss of bladder and bowel control has a negative impact on social life, work and relationships. Loss of sexual function is also devastating for the sufferer and may cause relationship difficulties.
• Severe nerve pain is difficult to treat and strong painkillers have side-effects. Nerve pain tends to be worse at night and poor sleep worsens general well-being.
• Sensory loss can range from pins and needles to complete numbness. It may affect the bladder, bowel and genitals.
• Weakness, usually in the legs, making walking difficult. If there is "foot drop" where the foot drags, walking aids or a wheelchair may be needed.
HOW IS CES TREATED?
Acute CES requires urgent surgery to decompress the nerve injury and there may still be residual problems, which take some months to resolve. Sometime extensive physiotherapy and bladder re-training may be required.
Long term CES is much harder to treat.
• Pain: usually requires strong painkillers or low dose antidepressants.
• Bladder Control: may be treated with drugs or intermittent self-catheterisation and in some cases regular kidney checks may be necessary. Often pads have to be worn in the underwear to protect against urine leakage.
• Bowel Control: most commonly it is difficult to empty the bowel, so eating a high fibre diet, keeping a good fluid intake and using laxatives can help.
• Weakness: physiotherapy can help so long as there is no inflammation.
• Sexual dysfunction: specialists can help with treatment, if possible, to improve function and also counselling for the sufferer and their partner.
• Sensory loss: unfortunately there is little conventional treatment.
• Sore feet: loss of foot control may cause pain. Exercises may help to maintain range of movement however if foot drop is significant, a brace may help.
• Poor circulation: a common problem, feet may get cold and turn white with Raynaud's syndrome. It is best to avoid cold feet, for example with thick socks.
• Depression: Antidepressants are used for severe depression, but preferred management is counselling. Support groups such as the online Cauda Equina Syndrome Support Group can also be a big help.
The tragic fact about Cauda Equina Syndrome, is that a number of cases are avoidable every year, if only the patient had received prompt surgery. Whilst treatment is available for the various symptoms, it remains a life-changing condition. At http://MedicalInjuryUK.com our specialist Cauda Equina solicitors understand the condition and its impact, and are experienced to advise you on making a claim. Call 0800 073 8080 to speak with one of the team or email info@medicalinjuryuk.com to see how they can help you or a loved one.
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