Lower back pain is a common symptom affecting millions of people every day. While it can cause discomfort, most people can still work and have a good quality of life despite it. They take efforts to control pain and prevent the problem from getting worse. Though there are many causes of back pain, and some of them have to do with trauma or underlying health conditions. If you are experiencing back pain a more uncommon cause might be cauda equina syndrome.
WHAT IS CAUDA EQUINA SYNDROME?
To explain cauda quina syndrome we first have to know what the cauda equina is, which is the collection of nerves at the end of the spinal cord. The reason it’s called cauda equina is because it resembles a horse’s tail. This portion of the spinal cord ends at the lower back and individual nerve roots at the end of the cord continue along the spinal canal and provide motor and sensory functions in the legs and bladder. The cauda equina nerve roots send signals from the lower limbs and pelvic organs to the brain.
Lower back pain due to Cauda Equina Syndrome develops when multiple nerve roots of the cauda equina are compressed. This pressure on them interrupts the normal motor skills and sensory signals, which makes it more difficult to control movement in the legs due to loss of balance and loss of coordination.
Cauda Equina Syndrome is also referred to as CES. It is one of the leading causes of the loss of bladder control. Patients with CES experience urinary retention, where the bladder is full but the patient cannot sense the urge to urinate, which can result in the incontinence of urine. In addition to incontinence, the problem can continue to worsen. Without proper treatment and recovery, a person with progressing symptoms may become permanently paralyzed from the waist down.
The progression of CES depends on the patient and the underlying reason for the compression on the back. It may be due to genetics, getting older, a work injury, or some type of trauma such as a car accident. For some patients, the problem doesn’t progress so the focus is on controlling pain and healing the underlying cause. For others, they continue to experience additional health issues so a detailed and thorough treatment plan is necessary to help them.
LUMBAR BACK PAIN
Cauda Equina Syndrome can be tied to lumbar back pain. This is because the nerves of the Cauda Equina end where the lumbar back begins. The nerve endings continue along this part of the back and through the spinal canal. They run all through the lumbar region of the spine. It is here messages are sent back and forth between the pelvic area and legs to the brain. This is why such nerve problems can prevent a person from controlling their bladder or balance and coordination.
When the nerves are compressed or pinched in a given area along the lumbar area, or at the Cauda Equina, the pain can be severe. It isn’t uncommon for patients to go to the emergency room to seek care for such pain. They are unable to find any comfort until they receive appropriate diagnosis and treatment or until the pinched area of those nerves is no longer compressed.
INCONTINENCE
Ongoing CES can cause incontinence in adults. If the problem is treated early on, they can quickly regain control over their bladder. Older individuals with these health concerns have the highest risk of incontinence. Patients who have gone through surgery for a lumbar herniated disc are also at a higher risk.
Unfortunately, many patients are distressed to tell anyone when they struggle with incontinence. They don’t share the details with friends or family members. They often don’t tell their doctor until the issue has gotten out of control. If you have any back pain along with incontinence it is likely connected and your doctor needs to know so they can assess the situation, and treat it as early as possible.
CAUSES OF CES
The most common reason CES occurs is due to a herniated disc in the lumbar area. The disc may have signs of degeneration due to age, genetics, or an injury. The ligaments around it get weaker and there is less cushion to support it over time. It begins to compress the disc below it, which in turn may cause the inner nucleus to bulge and pressure nerves. Something as simple as twisting or bending can cause a great deal of pain.
Other causes of CES include:
- Genetic deformity
- Lesions or tumors on the spine
- Hemorrhage in the spine
- Infection or inflammation in the spine
- Spinal Stenosis in the lumbar region
- Traumatic accidents including falls and car wrecks
SYMPTOMS OF CAUDA EQUINA SYNDROME
The symptoms a person with Cauda Equina Syndrome experience will vary. It depends on where the compression is located, the underlying cause, and how severe the problem has become. Let your doctor know if you experience any of the following:
- Back pain
- Changes in motor skills
- Loss of balance or coordination
- Loss of reflexes
- Incontinence of the bladder or bowels
- Numbness around the buttocks
- Weakness in the lower extremities
- Pain in the bladder or rectum
- Sexual dysfunction
Your doctor may order imaging tests to find out if CES is the underlying cause of the symptoms. An MRI is often completed to take 3-D images of the spinal cord, the root areas for the nerves, and to look for inflammation or compression in the spine. A type of x-ray known as a Myelogram may be done also to check the spine for any issues. A dye is injected to help more easily identify any bone spurs, herniated discs, or tumors.
CAUDA EQUINA SYNDROME TREATMENT
This type of health issue requires surgery or it will get worse. Without it, the incontinence will continue to the bowels if it hasn’t already. The risk of falls or other injuries increases due to the loss of balance and coordination. The pain can be very hard to handle, making it tough to sleep or take on daily tasks.
Without surgery, those with CES may end up paralyzed from the waist down. Many patients seen in the ER for it are taken into surgery the same or following day. It depends on their overall health and the severity of the diagnosis. Most patients improve after the surgery and a follow up treatment plan. They regain motor skills and coordination through progressive exercises and physical therapy.