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Cauda equina syndrome

cauda equina uk logo as part of the spinal injuries association

Cauda equina syndrome (CES) is the signs and symptoms when the nerves of the cauda equina are compressed.

Within your spine, the spinal cord extends from the brain down through a canal inside the vertebral column.

At each level of the spine, there are nerves branching off from your spinal cord. These are called nerve roots. They are responsible for sending signals to and from the muscles and other structures throughout the body.

The area which we need to concentrate on is the area of the spine which is approximately just above the waist. This area of the spine is where the spinal cord finishes. Below this is the group of nerves which are called the cauda equina.

The nerves of the cauda equina are responsible for the supply of nerves to the bladder, bowels, lower limbs and also supply sensation to the skin around the bottom and back passage.

Cauda equina syndrome (CES) is the signs and symptoms when the nerves of the cauda equina are compressed.

This syndrome has a complex spectrum of signs and symptoms. If your doctor has suspicions of CES, then in some causes it can be confirmed with a MRI scan.

What are the causes of CES?

Whilst the cauda equina are protected by the vertebrae (the bones that make up the spine). It is still vulnerable to damage.  These are the main causes:

  • Intra-vertebral disc herniated (slipped or prolapsed disc)
  • Tumours of the cauda equina
  • Spinal injury fracture/trauma
  • Secondary to medical procedure
  • Vascular problems of cauda equina
  • Infections of the cauda equina

Red Flag Signs & Symptoms

Patients should be aware of the following “red flag” symptoms that may indicate CES:

Saddle Anaesthesia

  • Loss of feeling between the legs
  • Numbness in or around the back passage and / or genitals
  • Inability to feel the toilet paper when wiping

Bladder Disturbance

  • Inability to urinate
  • Difficulty initiating urination
  • Loss of sensation when you pass urine
  • Inability to stop or control urination
  • Loss of the full bladder sensation

Bowel Disturbance

  • Inability to stop a bowel movement
  • Constipation
  • Loss of sensation when passing a bowel motion

Sexual Problems

  • Inability to achieve an erection or ejaculate
  • Loss of sensation during intercourse

Nerve Root Pain

It is quite common to have a combination of back pain, leg pain, leg numbness or weakness. These symptoms however are also common in people who have a history of back problems but do not have cauda equina syndrome.


Poster: © Ruth Eaves, Medical Artists, Bolton NHS Foundation Trust 2023.

Cauda equina syndrome is a medical emergency!

If you are visiting this page and have any of the red flags listed above, this should be treated as a medical emergency. Urgent treatment leads to better outcomes. This would mean being assessed at your local Accident and Emergency Department.

There is a recognised Suspected cauda equina syndrome pathway for healthcare professionals to follow, to ensure you get the right treatment at the right time.


Wheelchair provision

Cauda Equina Syndrome is a condition where many are still able to walk, either independently, or with the use of walking aids. Walking any distance may be limited and could cause significant fatigue, pain and limit independence. A wheelchair may help in many ways, but it is vital that the wheelchair fits the needs of the individual.

SIA , CESCI and The Wheelchair Alliance, have produced a template letter which can be downloaded and given to the GP to support them to outline the more specific information that can help to make the referral to the wheelchair services more effective. This should ensure that the most appropriate equipment is provided.

download template letter


More information

Download our leaflet about CES

For further information, you can contact our support line on 0800 980 0501 or contact our specialist clinicians.

Our knowledge hub will also equip you with information on everything from bowel and bladder management and skin care to mental health and your right to accessibility. Find out more .  We also have information about CES aimed specifically at healthcare professionals.

information for healthcare professionals

We have a range of services providing support and advice to help you live a fulfilled live.

The UK charity Cauda Equina Syndrome UK (CES UK) joined with SIA in December 2020 to help people living with CES in the UK to better access the wider-ranging services and support that we can provide.