Back pain is common. We’ve posted many blogs on our site about lower back pain and the different diagnoses associated with it. Perhaps we tend to focus on the more common types of back pain that are present in our Burlington clinic, however, cauda equina syndrome is a very serious condition that should not be overlooked.
It is very common at our clinic to have patients present with lower back pain and associated “sciatic” or leg pain from a pinched or irritated nerve. The symptoms can vary, but they usually include numbness, pain, tingling, pins and needles, weakness or dull pain in one leg. Perhaps this is the most important point in this discussion; the nerve symptoms are on one side only. Symptoms of nerve irritation in both legs at the same time can be concerning and a sign of cauda equine syndrome.
Cauda equine syndrome is relatively rare. Our clinic has rarely encountered this condition and we see many patients with lower back pain on a daily basis. Perhaps because we don’t encounter it very often (if at all) it’s easy to become complacent and not give it the attention it deserves on our blog. Cauda equine syndrome is very serious. The implications of the condition are quite significant; it’s important that patients with significant injury to their lower backs understand the “red flags” associated with this condition.
Numbness in the saddle area – This is a hallmark sign of cauda equine syndrome. Referred to as saddle anesthesia, it refers to a lack of sensation in the saddle area. It may also be related to a lack of sensation in the genitalia and difficulty with sexual function.
Sciatica in both legs – If you have sciatica in both legs (numbness, tingling, pain, pins and needles, etc.) then this may be a sign that the spinal cord is compromised and not just the nerve.
Bilateral weakness – This goes hand in hand with the sciatica. For many, the nerve irritation affects the nerves responsible for telling our muscles to activate. If you have weakness in both feet or legs, this may be a sign of spinal cord impingement.
Bowel/Bladder dysfunction – This is perhaps the most known symptom related to cauda equine syndrome. This can include urine or fecal retention as well as incontinence. In a nutshell, with this symptom we’re not as concerned about diarrhea or constipation. What is more of the question is whether you have adequate control of the muscles related to bowel movements and urination. Are you having “accidents”? Are you able to stop or start urination “mid-stream”?
Again, as mentioned above, cauda equine syndrome is very rare. At the same time, it is probably among the most serious conditions associated with lower back pain, so it is not something to take too lightly. If someone is suspected of having cauda equine syndrome, treatment at a clinic like ours (chiropractic, massage, physiotherapy) is not appropriate in the short term. The priority is getting accurately diagnosed so that the integrity of the structures involved are not compromised. Cauda equine is an emergency situation and those who believe cauda equine syndrome is suspected should go straight to their local hospital to be properly examined.
If you think you may have Cauda equine syndrome, although it’s unlikely, it’s still possible. You can stop by our office in Burlington on Harvester Road or Contact Us if your back pain worsens. We serve Burlington, Oakville, Milton, Hamilton and the surrounding areas.
Bednar DA. Five things to know about cauda equine syndrome from lumbar disc herniation. CMAJ 2016; 188(4): 284.