Cauda Equina Syndrome (abbreviated as CES) is a confusing medical term most commonly used for when disc hernias of the lower spine are large enough to damage the nerve roots responsible for bladder, bowel and sexual function. It can however refer to damage of these nerves from any cause such as fractures of the pelvis or tumors compressing these nerves.
The Latin term Cauda Equina refers to the nerve fibers along the lower part of the spine looking like a horses tail with the many fibers spreading out like hair. The fibers are much thicker than hair though – approximately the size of a ballpoint tip. These fibers emerge from the spine to supply the legs, bladder bowel and sexual function. These fibers are very sensitive to injury. That said they are well protected within the spinal canal but a fracture of the pelvis, a cancerous growth or most commonly a large disc hernia (occurs in approximately one of 100.000 persons per year), can exert pressure on these sensitive fibers and damage them.
The symptoms of CES may be misleading as the onset can be gradual or very rapid. Disc hernias usually cause pain in the lower back and often down one or both legs (toothache like pain) but occasionally if only the nerves supplying bladder bowel and genitalia are affected, pain may be moderate only. Concerning symptoms are numbness of genitalia, the inability to void urine (a weak stream that was previously fine) or incomplete voiding and dribbling. In more severe loss of function the anal area becomes numb and it is no longer possible to squeeze (anyone can check this by just squeezing their anal muscle) – if the squeeze is weak or if the sensation around the anus and genitals is numb or pins and needles there is a concern.
Because these nerves are so sensitive an urgent evaluation is warranted when this occurs – it is not something that a “wait and see” approach is good for. Please contact your GP or local A&E department for assessment.
Assessment will include a physical examination, sometimes placement of a urinary catheter and often an MRI scan if the findings are concerning. The MRI scan is painless and is necessary to see if and how the nerve fibers are being squeezed. If the finding is severe then surgery to remove the pressure may be recommended. This needs to be done urgently in order for the best chance of recovery. Once treatment is delayed beyond 48 hours the chances of recovery drop rapidly. The sooner the assessment can be done the better so that there is enough time to prepare and conduct surgery in a timely fashion if it is necessary. Health care professionals are very much aware of the urgency of this condition and will assist in any way to help. It is entirely acceptable to go to your GP or A&E urgently if you suspect a CES condition!
If surgery is required and this can be performed within a reasonably short time after the symptoms start then chances of recovery are good. Immediately after surgery there may still be some symptoms and these may persist for some time. Improvement can take several months and sometimes improvement is incomplete.
What is very important after the diagnosis of CE and surgery for this, is for sexual partners to understand what has happened and speak about their concerns and learn about how to help work though this together. Often consulting a clinical sexologist is a very good first step and is entirely expected. This is what these dedicated professionals are for. They are able to discuss these very private matters in a friendly open manner and provide extremely useful information and practical techniques to help recover and work through the condition.
A few very important points for you and your partner to know if you have been diagnosed with CES:
- It is totally acceptable to touch each other. No harm comes from stimulating but it may take time for normal sensation to return. It is better to continue stimulation than not as this keeps the tissues active and aids recovery.
- With the guidance of a sexologist vibrators can be a very useful medical tool to aid recovery. Use water based lubricants.
- Explore other sensitive areas and erogenous zones – this can help the body regain sexual function overall. Take more time to set the scene and and consider learning massage techniques.
- Again, consulting a clinical sexologist can provide a wealth of information and techniques in adapting and improving intimacy.
- CES does not affect fertility.
- CES can cause bladder dysfunction and it may be necessary to use intermittent emptying of the bladder va a catheter (a small tube inserted into the bladder to help void). This can be managed discreetly and easily by most people and should not interfere with sexual function.
- Open discussions with your partner on what has happened and enlisting professional help early on is key in restoring sexual intimacy. This help is available – please use it.