Symptoms of Cauda Equina Syndrome

Typical Cauda Equina Syndrome symptoms include:

  • Sudden and severe back pain, which may extend to the legs and buttocks.
  • Numbness or tingling in the buttocks and perineal region (which usually develops quickly after the onset of back pain.)
  • Sudden bowel and bladder problems which may include urinary retention (ie. an inability to pass urine), increased urgency to urinate and increased frequency to urinate, incontinence and a loss of anal sensation (ie. an inability to contract the anus).


These are all “red flag” symptoms and if a patient describes any of these symptoms then this should act as a warning to the Doctor.

How is Cauda Equina Syndrome diagnosed?

When Cauda Equina Syndrome is suspected a Doctor should perform some simple tests ie. checking reflexes in the legs and feet, checking sensation to touch and pain in these areas and an internal rectal examination to test anal tone.

If the tests indicate a diagnosis of Cauda Equina Syndrome then the patient should be referred for a MRI scan to confirm the diagnosis.

When should surgery be performed?

Once the diagnosis is confirmed then surgery should be carried out as soon as possible.

A delay in surgery can lead to:

  • Permanent severe pain and discomfort.
  • Permanent mobility problems.
  • Permanent loss of sensation in the legs and feet.
  • Irreversible loss of bowel and/or bladder control.
  • Incontinence.
  • The need for permanent self catheterisation and/or use of enemas.
  • Sexual dysfunction


Different experts give different views about the timing of surgery and the effect on recovery. Some say that once urinary incontinence occurs then, even with surgery, the outcome is likely to be very poor. Others say that there is a window of opportunity of 24-48 hours for surgery. If surgery is carried out within this timescale then the outcome for the patient is likely to be much better. Ultimately, the longer the delay in surgery, the less likely it is that a full recovery will take place and the more likely that the patient will be left with serious long term problems.

Thompsons are currently running a number of cases concerning delays in the diagnosis of Cauda Equina Syndrome.

Case Example

Miss X, a 28 year old, developed sudden and severe low back pain. She consulted her GP on 3 separate occasions during a 3 week period. Sciatica was diagnosed and she was prescribed painkillers. She was told that she was to be referred for a MRI scan and she should await an appointment.

She returned home and the pain remained severe, even after taking painkillers.

She consulted her GP again a week or so later. She explained that since the previous day she had experienced problems passing urine. She had the feeling that she needed to pass urine but was unable to do so. Her GP advised that she should drink lots of water and take laxatives. She also told the Doctor that she was experiencing shooting pains in both legs and the pain was deteriorating. She described tingling in her right big toe.

She was prescribed stronger painkillers, sent home and again told to await the MRI scan.

3 days later she saw a locum GP. She described her symptoms again and was immediately referred to the Accident and Emergency Department at the local hospital. At the hospital she was seen by an Orthopaedic Doctor. He examined her legs for numbness, tested her reflexes and carried out an internal rectal examination. She was then advised that she was being admitted to the hospital and would need an emergency MRI scan.

Despite this, the scan was not carried out until the following day. The scan confirmed a diagnosis of Cauda Equina Syndrome and she underwent decompression surgery a day later.

Despite the surgery, the Claimant continues to have severe and constant back pain, radiating down both legs, severely impaired mobility, bowel and bladder problems and reduced vaginal sensation. She can only walk outside with crutches and has to use a wheelchair for any distance. She has to self-catheterise 2-3 times every day. She suffers from recurrent urinary tract infections. She has severe pain when opening her bowels and is often incontinent at night. Her prognosis is poor.

She is unlikely to ever return to any form of paid employment and will always require assistance in all activities of daily living.

Thompsons Solicitors were instructed to investigate a claim. Experts have provided independent opinions and Miss X alleges had her GP referred her to hospital for a MRI scan when she first attended complaining of urinary retention she would have had decompression surgery very shortly thereafter. She further alleges that, once referred, the MRI scan ought to have been carried out the same day with surgery taking place within 24 hours. Her case is that had she been diagnosed and treated earlier she would have avoided her long term bowel and bladder problems and her other complications.

The case is ongoing.

If you feel there has been a delay in diagnosing and treating your Cauda Equina Syndrome then please contact Thompsons Solicitors' Clinical Negligence Department. You can reach us on 08000 224 224 or by completing one of our online personal injury compensation claim forms.