Cauda equine syndrome causes and treatment for the same

The bundle of nerves found at the bottom of your spinal cord is called as Cauda equine. It contains the nerve roots from the sacral and lumbral spine and joins the sacral plexus. The sacral plexus involves nerves in the genital and anal regions.

Syndrome of CE:

The symptoms caused by nerve damage to it are:

• Severe pain in buttocks, back, genitals, legs and saddle area between the legs.

• Numbness in the saddle area.

• Weakness in legs.

• Bowl, bladder and sexual dysfunction.

• Loss of ankle and knee reflexes.

This combination of symptoms arising suddenly requires immediate medical attention to avoid permanent nerve damage and is considered as a medical emergency.

Causes of CES:

• Compression of the nerve, for example from a spinal fracture or prolapsed disc.

• Stretching of the nerve, when one of the vertebras slips on another.

• Arachnoiditis

• In conditions like Multiple Sclerosis, losing the myelin sheath around nerves.

• Damage of toxic from spinal anaesthetics.

Whilst CES can arise gradually from chronic illnesses such as Multiple Sclerosis, if it is often caused by compression of the nerve in which case it may respond well to prompt surgical removal of the cause. The duration of the injury and the amount of damage suffered are the factors to be considered for recovery.

Effects of CES:

CES is a devastating condition. Often the sufferer is unable to work because of continence problems, severe pain, muscle weakness, or a combination of these problems.

• There is a negative impact on the loss of bladder and bowel control, social life, and relationships.

• Sexual functioning loss is also devastating for the sufferer and may cause relationship difficulties.

• Severe nerve pain is difficult to treat and strong painkillers have side-effects. At night nerve pain tends to be worse and poor sleep worsens general well-being.

• Sensory loss can range from pins and needles to complete numbness. It may affect the bladder, genitals and bowel.

• Walking becomes difficult because of weakness in the legs.

Treatment:

To decompress the nerve injury Acute CES requires urgent surgery and there also may be some residual problems that take some months to resolve. Sometime bladder re-training and extensive physiotherapy may be required.

Long term CES is much harder to treat.

• Pain: usually requires low dose antidepressants or strong painkillers.

• Bladder Control: may be treated with intermittent self-catheterisation or drugs and in some cases regular kidney checks may be necessary. To protect against urine leakage often pads have to be worn in the underwear.

• Bowel Control: It is difficult to empty the bowel most commonly, so eating a high fibre diet, keeping a good fluid intake and using laxatives can help.

• Weakness: As long as there is no inflammation, physiotherapy can help.

• Sexual dysfunction: specialists can help to improve functioning and also counselling for the sufferer and their partner.

• Sensory loss: conventional treatment is unfortunately less.

• Sore feet: loss of foot control may cause pain. To maintain range of movement exercises may help however a brace may help if a foot drop is significant.

• Poor circulation: feet may get cold and turn white with Raynaud's syndrome. For example with thick socks it is best to avoid cold feet.

• Depression: For severe depression antidepressants are used, but preferred management is counselling.