Cauda equina syndrome is a rare but serious condition in which the bundle of nerves at the bottom of the spine is squeezed, most often by a large slipped disc. These nerves control the bladder, bowel, sexual function and sensation around the saddle area. It is a medical emergency: if you have back pain or sciatica and notice any of the warning signs below, go to A&E straight away, because early surgery gives the best chance of recovery.
Also known as CES, cauda equina compression
Anatomy: where the problem is
Side view of the lower back. Highlighted in the diagram: spinal canal and nerves.
Symptoms
- Numbness, tingling or altered feeling around the genitals, back passage, buttocks or inner thighs (the saddle area)
- Difficulty starting to pass urine, a weak stream, or not feeling when the bladder is full
- Leaking urine, or loss of the feeling of passing urine
- Loss of bowel control, or not feeling a bowel movement
- Loss of sensation in the genitals during sex, or new difficulty getting an erection
- Sciatica, numbness or weakness in both legs
- Altered feeling when wiping with toilet paper
Causes and risk factors
- A large slipped disc in the lower back, which is the most common cause
- Narrowing of the spinal canal (spinal stenosis)
- A spinal injury or fracture
- A tumour, infection or bleed in the spine
- Complications after spinal surgery, which are rare
What the evidence says helps
- Recognising the warning signs early is the most important step. A UK-developed warning card lists the symptoms so that people with back pain know what to act on.2
- Suspected cauda equina syndrome needs an emergency MRI scan, which is the only way to confirm or rule out the diagnosis.1
- Treatment is urgent surgery to take the pressure off the nerves. An analysis of surgical results found that people operated on within 48 hours of symptoms starting recovered bladder, bowel, sensation and strength better than those operated on later.3
- Most people who attend with possible warning signs turn out not to have the condition, but the only safe approach is to be checked.1
Things you can try at home
- Do not wait to see if it settles: go to A&E if you notice any warning sign
- Do not book a routine GP, physiotherapy or osteopathy appointment for these symptoms
- Tell staff clearly that you are worried about cauda equina syndrome
- If you have back pain or sciatica, learn the warning signs so you can act quickly if they appear
- After treatment, ask about bladder, bowel and sexual function support, which is available
When to get urgent help
Contact your GP urgently, call NHS 111, or call 999 in an emergency if you have:
- Numbness or altered feeling around the genitals, back passage or inner thighs: go to A&E now
- New difficulty passing urine, a poor stream, or leaking urine: go to A&E now
- Loss of bowel control or not feeling a bowel movement: go to A&E now
- Sciatica, numbness or weakness in both legs, or leg weakness that is getting worse: go to A&E now
- Loss of sensation during sex or new erection problems together with back pain or sciatica: go to A&E now
How Apollo can help
We ask every person with low back pain or sciatica about these warning signs, at the first appointment and whenever symptoms change, and we give written safety advice. If your symptoms suggest cauda equina syndrome, we do not treat you: we send you to A&E immediately with a letter explaining our findings. After surgery, and once your surgical team is happy, we can help you rebuild strength, walking and confidence through our surgical rehabilitation and clinical exercise services.
No GP referral needed. Clinics in Sheringham, Coltishall and Norwich.
Related reading
Frequently asked questions
What are the first signs of cauda equina syndrome?
The key signs are numbness or tingling around the genitals, back passage or inner thighs, changes in passing urine such as difficulty starting or not feeling the need to go, loss of bowel control, and sciatica or weakness in both legs. Any of these with back pain needs emergency assessment.
How quickly does cauda equina syndrome need treating?
It is an emergency. Evidence shows that people who have surgery within 48 hours of symptoms starting recover better than those treated later, so go to A&E as soon as you notice a warning sign.
Can an osteopath or physiotherapist treat cauda equina syndrome?
No. It needs emergency hospital assessment and usually surgery. The role of an osteopath or physiotherapist is to recognise the warning signs and send you to A&E without delay, and later to help with rehabilitation.
References
- Hoeritzauer I, Wood M, Copley PC, Demetriades AK, Woodfield J (2020). What is the incidence of cauda equina syndrome? A systematic review. Journal of Neurosurgery: Spine 32:832-841. View source
- Greenhalgh S, Truman C, Webster V, Selfe J (2016). Development of a toolkit for early identification of cauda equina syndrome. Primary Health Care Research & Development 17:559-567. View source
- Ahn UM, Ahn NU, Buchowski JM, Garrett ES, Sieber AN, Kostuik JP (2000). Cauda Equina Syndrome Secondary to Lumbar Disc Herniation. Spine 25:1515-1522. View source
This page is general information, not a diagnosis or a substitute for medical advice. If you are worried about your symptoms, speak to your GP or a registered healthcare professional. Content prepared from the sources above, November 2026.
