Urology Awareness Month: the dangers of delayed diagnosis and treatment of Cauda Equina Syndrome

Posted: 22/09/2016

In Urology Awareness month, the clinical negligence team at Penningtons Manches takes a look at a condition called Cauda Equina Syndrome. This is relatively rare and little known by the general population but it can affect bladder function if it is not diagnosed and treated appropriately.

Cauda Equina Syndrome is a serious condition that causes extreme pressure and swelling of the nerves at the end of the spinal cord (the lower back). This is a serious medical emergency that requires urgent investigation, typically by way of an MRI scan, and urgent surgical intervention to relieve the pressure on the nerves in the majority of cases. If patients with Cauda Equina Syndrome do not receive treatment quickly, the adverse results can include permanent paralysis, impaired bladder and / or bowel control, difficulty walking, and / or other neurological and physical problems.

The symptoms of Cauda Equina Syndrome can vary in terms of severity and progression from one patient to another but the symptoms are typically regarded to be severe lower back pain together with one or more of the following symptoms:

• Pain, numbness, altered sensation and / or weakness in the lower limbs – ie in one or both legs / feet
• Loss of or altered sensations in the “saddle area” - ie in the buttocks and genital area - which can get progressively worse (called saddle anesthesia)
• Recent problems with bladder or bowel function, such as trouble passing urine or waste (retention) or trouble holding it in (incontinence)
• Sexual dysfunction that has come on suddenly.

Medical practitioners typically label the above symptoms as “red flag symptoms”. If you develop any one or more of these problems, then it is very important to seek urgent medical advice from your GP or the A&E department at your local hospital.

A number of investigations are needed to formally diagnose Cauda Equina Syndrome, which typically involves the following:

• A medical history, in which you answer questions about your health, symptoms, and any problems that affect your physical activity. It is very important that the doctor is fully informed about the onset of any of the above symptoms, including when these problems developed and whether you have noticed any deterioration
• A physical examination to assess strength, reflexes, sensation, stability, alignment, and motion
• An MRI scan is likely to be performed, which produces three-dimensional images of your spine
• A myelogram - an X-ray of the spinal canal after injection of contrast material - which can pinpoint pressure on the spinal cord or nerves
• A computed tomography (CT) scan. 

If a diagnosis of Cauda Equina Syndrome is reached following these investigations, then urgent surgery is needed to relieve the pressure on nerves to prevent permanent damage such as paralysis of the legs, loss of bladder and bowel control, sexual function, or other problems. Unfortunately, in some cases, even with treatment, a return to full function may not be possible, as it depends on how much damage has occurred.

Naomi Holland, a lawyer in the Penningtons Manches clinical negligence team, comments: “Sadly, we see a lot of cases where, despite clearly presenting with “red flag symptoms”, patients are often wrongly diagnosed as suffering with back pain or “sciatica” by medical practitioners and this can lead to devastating consequences. Unfortunately, back pain is very common – the statistics show that an estimated 10 million Britons suffer with back pain on a daily basis causing restrictions on day to day activities which makes a diagnosis difficult.

“However, if any patients develop problem symptoms in either or both legs, any disturbance in bladder or bowel function and / or altered sensation in the saddle area in addition to back pain, doctors should appreciate that this is not normal for “typical” back pain and these symptoms should be investigated urgently. We have many clients who have experienced significant delays in investigation and surgery which have resulted in permanent problems. These include severe dysfunction of the bladder - incontinence, retention and urgency - which is sometimes managed by self-catheterisation and / or the use of urinary incontinence pads.

“We hope that by raising these issues through awareness campaigns such as Urology Awareness Month, patients will be better informed about the signs and symptoms to look for." 

For more information on Cauda Equina Syndrome and / or pursuing a legal claim for the management of Cauda Equina Syndrome, click here.

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