Cauda Equina Syndrome: Symptoms and Treatment

By Dr Ken Nakamura+

Cauda Equina Syndrome CES | Dr Ken Nakamura Downtown Toronto Chiropractor

Cauda Equina Syndrome (CES) is fairly rare occurring at 0.002% in one report. Compared to another health facility in the United Kingdom has a 3.5% rate of occurrence.

What is Cauda Equina Syndrome (CES)?

Vertebra & Spinal cord | Dr Ken Nakamura
Vertebra & Spinal cord

Cauda Equina Syndrome is a rare problem that occurs when nerves found below your spinal cord get compressed. Your spinal cord starts just below your brain and is protected by vertebrae. Most people’s spinal cords end at L1 or L2 of your lower back but your spine extends much further to L5. Often a disc herniation pushes on the nerves around the L4 and L5 vertebrae or the L5 and S1 vertebrae. The pressure from your disc pushes on the nerves that control your bowel, bladder, sexual function, muscles, and pain. The pressure can be so great that the nerves can be damaged sometimes permanently.

Causes of CES

The most common cause of cauda equina syndrome is a disc herniation. Other causes such as tumour, infection or osteoarthritis, along with spinal stenosis and fracture can cause be the cause of CES.


Cauda Equina Syndrome symptoms include:

  • Bowel incontinence: You cannot control your bowel so you need a diaper to control your bowel movements. If your nerves are permanently damaged you need surgery to get a colostomy bag.
  • Urinary retention: This means you cannot urinate or pee even when you try.
  • Numbness, tingling, pins & needles or altered sensation around the buttock and the inside of your thighs and groin.
  • Severe lower back pain. Although you may have no lower back pain.
  • Constant severe thigh or leg pain usually going down to the foot or toes often on both sides.

Most people I have examined have symptoms that are not quite CES. They have severe lower back and leg pain with trouble urinating but can still urinate and no bowel incontinence or a little bit of incontinence. They can have pins and needles or numbness around their buttock and inner thighs.

This is a tricky situation and if in doubt go to the hospital especially if symptoms are deteriorating. Experience in following up with these type of patients has shown me that most of these patients don’t eventually get surgery.

Severe lower back pain, with sciatica alone, is a relatively common symptom and is not CES or an emergency situation. However, when these symptoms along with weakness in the leg that is progressively worse then you may need surgery to release the nerve.

Sciatica with progressively worsening leg weakness like drop foot are not Cauda Equina Symptoms but should be looked at urgently meaning you need to get to a doctor shortly, whereas Cauda Equina Symptoms can be an emergency. This means you should get to your Emergency Department of your nearest hospital immediately.

If your symptoms are very slowly getting worse it’s time to see a professional such a chiropractor or physiotherapist who will help diagnose your problem.


It’s best to go to a chiropractor, physiotherapist or medical doctor if you have just some of the symptoms of CES. Your doctor will do a history, examination and possibly some imaging.

During the history your chiropractor will ask you about where the pain is and how far down the leg or foot the symptoms go. They will ask about leg weakness and bowel incontinence, urinary retention and possibly sexual dysfunction. Also if you have numbness/pins & needles around the buttock and the inner thigh.

Your chiropractor or medical doctor may send you for imaging or send you immediately to the hospital if Cauda Equina Syndrome is suspected.

As there can be permanent damage to the nerve it is prudent to be safe and send you to the emergency department if there any doubts.

Treatment for CES

If you are diagnosed with Cauda Equina Syndrome you really have no choice but to get surgery. There is no conservative therapy once it is diagnosed as Cauda Equina Syndrome.

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Dr Ken Nakamura

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