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Cauda equina syndrome is an exceptionally rare, but potentially life changing condition. It will one of the first things that a healthcare professional screens you for if you have a new episode of low back pain. 

It refers to an area of nerve roots at the lower end of the spinal cord, that in rare instances, can become compressed. These nerves are responsible for your bladder and bowel function, your sexual function and the power and sensation in your legs. The longer these nerves are compressed for the higher the chance of having long term problems with all of the aforementioned faculties. 


Bladder Dysfunction

  • An acute increase in bladder frequency.


  • Bladder incontinence - lack of bladder control, inability to stop flow, lack of awareness that you are passing urine, lack of having the urge to pass urine.


  • Bladder retention - difficulty initiating flow, inability to initiate flow, decreased flow power, not feeling like you have fully emptied your bladder when you have been.

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Bowel Dysfunction

  • Lack of control, inability to delay a bowel movement.

  • Lack of awareness of when you have stopped.

  • Reduced/lack of sensation when passing a stool


  • Constipation is not a concern.

Saddle Anaesthesia

  • Numbness or decreased sensation around your genitals, anus or perineum. Any area of skin that would be in contact with the saddle on a bike.

  • More subtly we might ask questions like: do you have sensation when wiping yourself? If you were to sit on a bike can you feel the area of skin that is contact with the saddle?

Cycling Up the Hill
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Sexual Dysfunction

  • Males - any difficulties achieving or maintaining an erection or any difficulties ejaculating

  • Females - applies to lack of sensation during intercourse.

Bilateral Sciatica

  • This normally presents as neuropathic/nerve pain and/or parasthesia (pins and needles or numbness) travelling down both legs.

  • Normally describe sharp, shooting, electric, lancinating type pain. 

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  • Numbness or decreased sensation around your genitals, anus or perineum. Any area of skin that would be in contact with the saddle on a bike.

  • More subtly we might ask question like: can you feel when you’re going to the toilet and wiping yourself? If you were to sit on a bike would you have sensation in that area?

Bare Feet
Bare Feet

Gait Disturbances

  • Sudden loss of power or control of your legs

  • Foot drop (inability to flex foot upwards)    

Some of these symptoms, particularly bladder and bowel dysfunction are associated with a number of other underlying health conditions. As a result they would not be of concern in relation to cauda equina syndrome if you already have a diagnosis for your symptoms. 

The main concern would be with any new, unexplained, worsening symptoms. 



If cauda equina syndrome is present there is only a small window, 24-48 hours, to ensure a positive outcome. The longer the spinal cord is compressed the more likely it is that you could have long term impairments with the aforementioned symptoms.

Don't wait to see your doctor, GP or other health care professional, take your self to the nearest accident and emergency department and let them know your symptoms. You will be taken seriously and a thorough assessment is likely to be completed to determine whether further investigation is necessary. 

If cauda equina is present then spinal decompression surgery may need to be completed to relieve the pressure on the spinal cord. 

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The exact incidence of CES is unknown but it is exceptionally rare. We think it is somewhere between 1 in 33,000 and 100,000. So even if we take a reserved approach there is a 0.0033% chance of developing this syndrome.

Of the individuals that we see who have cauda equina symptoms only between
16 - 19% of those actually have spinal cord compression. More research is currently being carried out in order to try and capture the incidences of CES more accurately.

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