Cauda Equina Syndrome – What You Need to Know About Recent Changes in Care

Cauda Equina Syndrome is a serious medical condition that many people haven’t heard of – until they or someone they know experiences it. It’s a medical emergency that requires immediate attention, and recent changes to how it’s diagnosed and treated in the UK could mean faster care and better outcomes for patients.

What is Cauda Equina Syndrome?

Cauda Equina Syndrome – often shortened to CES – happens when the bundle of nerves at the base of your spine becomes compressed. These nerves are called the cauda equina, which literally means “horse’s tail” in Latin.

This cluster of nerves controls sensation and movement in your legs, as well as bladder and bowel function. When these nerves become squeezed or compressed – usually by a herniated disc, tumour, infection, or spinal injury – they can’t work properly.

What are the warning signs?

The symptoms of CES can develop suddenly or gradually, but they’re distinctive and shouldn’t be ignored:

CES is a medical emergency. Without prompt treatment, it can lead to permanent paralysis, loss of bladder and bowel function, and severe long-term disability. The key is recognising the symptoms early and getting immediate medical attention.

What’s changed in how CES is diagnosed and treated?

There have been significant improvements in how the NHS identifies and treats CES. These changes are based on new research and clinical guidelines designed to speed up diagnosis and improve outcomes.

Faster diagnosis and scanning

Hospitals across the UK now follow a national clinical pathway for suspected CES. The most important change is the timing of MRI scans. If doctors suspect you have CES, you should now receive an MRI scan within four hours.

Doctors now act on symptoms alone. If you present with red flag symptoms of CES, you’ll be referred for urgent imaging straight away. You don’t need every test ticked off before you’re taken seriously.

What GPs now do differently

If you go to your GP with symptoms that could indicate CES, they’re now instructed to refer you immediately for urgent imaging if you have red flag symptoms like saddle numbness, bladder changes, or severe leg weakness.

GPs no longer perform rectal examinations to check for CES. Research showed this wasn’t reliable and could delay the crucial MRI scan. Now, GPs refer straight to A&E for emergency imaging and specialist care.

Surgery timing and what to expect

Surgery to decompress the affected nerves is still the primary treatment for CES, and it’s still considered urgent. However, new research shows that even if surgery can’t happen within the first few hours, many patients still see significant improvement. This doesn’t mean delays are acceptable, but there’s still hope for recovery even if circumstances mean surgery is delayed.

It’s important to understand that surgery isn’t an instant fix. Recovery takes time, and some symptoms may persist even after successful surgery. This is particularly true for bladder and bowel function, which can take months to improve.

What happens after surgery?

Most patients do see improvement, particularly with bladder control. Many people regain the ability to sense when their bladder is full and can urinate normally again, though this can take weeks or months.

Physiotherapy is almost always part of recovery. You may need help rebuilding strength in your legs, improving your balance, and learning to manage any ongoing pain or numbness.

Ongoing care and support are common – research shows that around two-thirds of patients need additional support after their initial treatment. This might include continence care, pain management, physiotherapy, or psychological support.

The importance of early action

If you notice sudden changes in bladder or bowel function, or you develop numbness around your bottom or genitals, don’t wait to see if it gets better. Go to A&E immediately.

Early diagnosis and treatment give you the best possible chance of recovery. Every hour counts when it comes to preventing permanent nerve damage.

When to seek legal advice

If you or a loved one has experienced CES and you believe there were delays in diagnosis or treatment, it’s worth speaking to a medical negligence solicitor. Delays in recognising symptoms, ordering scans, or performing surgery can have life-changing consequences.

We understand how difficult life can be after CES, and we’re here to help if things haven’t gone as they should have. Our medical negligence team has experience with CES cases and can advise you on whether you may have grounds for a claim.

If you’d like to discuss your situation in confidence, get in touch with our team. We’re here to listen and to help you understand your options.