The cauda equina is a bundle of nerve roots communicating with your brain. If it becomes squeezed, you can develop cauda equina syndrome (CES). You may need surgery, physical therapy, or medications.

The cauda equina, Latin for “horse’s tail,” sits at the lower end of your spine. It sends nerve signals back and forth regarding the sensory and motor functions of your lower limbs and the organs in your pelvic region.

CES is a rare condition, estimated to affect 1 in 33,000 to 100,000 people. CES influences your control over your bladder, legs, and other body parts. If left untreated, it can lead to serious long-term complications.

Keep reading to learn what symptoms the condition causes, how it’s managed, and more.

CES symptoms can take a long time to develop and may vary in severity. This can make diagnosis difficult.

In most cases, the bladder and the legs are the first areas to be affected by CES.

For example, you may have difficulty holding or releasing urine (incontinence).

CES can cause pain or a loss of feeling in the upper parts of your legs, as well as your buttocks, feet, and heels. The changes are most obvious in the “saddle area,” or the parts of your legs and buttocks that would touch a saddle if you were riding a horse. These symptoms can be severe and, if left untreated, worsen over time.

Other symptoms that may signal CES include:

  • intense lower back pain
  • weakness, pain, or a loss of sensation in one or both legs
  • bowel incontinence
  • loss of reflexes in your lower limbs
  • sexual dysfunction

If you experience any of these symptoms, you should see a doctor.

A herniated disk is one of the most common causes of CES. A disk is a cushion between the bones in your vertebrae. It’s made up of a jelly-like interior and a tough exterior.

A herniated disk occurs when the soft interior pushes out through the hard exterior of the disk. As you get older, disk material weakens. If the wear and tear is severe enough, straining to lift something heavy or even just twisting the wrong way can cause a disk to rupture.

When this happens, nerves near the disk can become irritated. If the disk rupture in your lower lumbar is large enough, it may push against the cauda equina.

Other possible causes of CES include:

  • lesions or tumors on your lower spine
  • spinal infection
  • inflammation of your lower spine
  • spinal stenosis, a narrowing of the canal that houses your spinal cord
  • birth defects
  • complications after spinal surgery

People most likely to develop CES include those who have a herniated disk, such as older adults or athletes in high-impact sports.

Other risk factors for a herniated disk include:

  • being overweight or obese
  • having a job that requires a lot of heavy lifting, twisting, pushing, and bending sideways
  • having a genetic predisposition for a herniated disk

If you have had a severe back injury, such as one caused by a car accident or a fall, you’re also at higher risk for CES.

When you see your doctor, you’ll need to provide your personal medical history. If your parents or other close relatives have had back problems, share that information, too. Your doctor will also want a detailed list of all your symptoms, including when they started and their severity.

During your appointment, your doctor will do a physical examination. They’ll test the stability, strength, alignment, and reflexes of your legs and feet.

You will probably be asked to:

  • sit
  • stand
  • walk on your heels and toes
  • lift your legs while lying down
  • bend forward, backward, and to the side

Depending on your symptoms, your doctor may also check your anal muscles for tone and numbness.

You may be advised to have an MRI scan of your lower back. An MRI uses magnetic fields to help produce images of your spinal cord nerve roots and tissue surrounding your spine.

Your doctor might also recommend a myelogram imaging test. For this test, a special dye is injected into the tissue surrounding your spine. A special X-ray is taken to show any issues with your spinal cord or nerves caused by a herniated disk, tumor, or other issues.

A CES diagnosis is usually followed by surgery to relieve pressure on the nerves. If the cause is a herniated disk, an operation can be done on the disk to remove any material pressing on the cauda equina.

The surgery should be done within 24 or 48 hours of the onset of serious symptoms, such as:

  • serious lower back pain
  • sudden loss of feeling, weakness, or pain in one or both legs
  • recent onset of rectal or urinary incontinence
  • loss of reflexes in your lower extremities

This can help prevent irreversible nerve damage and disability. If the condition is left untreated, you could become paralyzed and develop permanent incontinence.

After surgery, your doctor will see you periodically to check on your recovery.

Full recovery from any CES complications is possible, although certain people do have some lingering symptoms. If you continue to have symptoms, be sure to tell your doctor.

If CES impacted your ability to walk, your treatment plan will include physical therapy. A physical therapist can help you regain your strength and give you exercises to help improve your stride. An occupational therapist may also be helpful if everyday activities, such as getting dressed, are affected by CES.

Specialists to help with incontinence and sexual dysfunction may also be part of your recovery team.

For long-term treatment, your doctor might recommend certain drugs to help with pain management:

  • Prescription pain relievers, such as oxycodone (OxyContin), may be helpful immediately after surgery.
  • Over-the-counter pain relievers, such as ibuprofen (Advil) or acetaminophen (Tylenol), can be used for daily pain relief.
  • Corticosteroids may be prescribed to help reduce inflammation and swelling around the spine.

Your doctor may also prescribe medication for better bladder or bowel control. Common options include:

  • oxybutynin (Ditropan)
  • tolterodine (Detrol)
  • hyoscyamine (Levsin)

You might benefit from bladder training. Your doctor can recommend strategies to help you empty your bladder on purpose and lower your risk for incontinence. Glycerin suppositories may help you empty your bowels when you want too.

Learn more: Adult incontinence »

After surgery, your senses and motor control may be slow in returning. Bladder function in particular may be the last to fully recover. You may need a catheter until you regain full control over your bladder. Some people, however, need many months or even a couple of years to recover. Your doctor is your best resource for information about your individual outlook.

If bowel and bladder function don’t fully recover, you may need to use a catheter a few times a day to make sure you void your bladder completely. You’ll also need to drink a lot of fluids to help prevent a urinary tract infection. Protective pads or adult diapers may be helpful in dealing with bladder or bowel incontinence.

It will be important to accept what you can’t change. But you should be proactive about symptoms or complications that may be treatable after your surgery. Be sure to discuss your options with your doctor in the years ahead.

Emotional or psychological counseling may help you adjust, so talk to your doctor about the options available to you. The support of your family and friends is also very important. Including them in your recovery may help them understand what you’re dealing with every day and enable them to better help you through your recovery.