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Cauda equina syndrome (CES) is a condition that occurs when the bundle of nerves below the end of the spinal cord known as the cauda equina is damaged. [2] Signs and symptoms include low back pain, pain that radiates down the leg, numbness around the anus, and loss of bowel or bladder control. [1] Onset may be rapid or gradual. [1]
Common symptoms include lower back pain, headaches, weakness (myasthenia), numbness (hypoesthesia) above and below the involved limb, [2] leg pain, [3] and sometimes rectal and genital pain. [2] Bowel and bladder dysfunction , urinary retention or incontinence may occur. [ 4 ]
The nerves that compose the cauda equina innervate the pelvic organs and lower limbs to include motor innervation of the hips, knees, ankles, feet, internal anal sphincter and external anal sphincter. In addition, the cauda equina extends to sensory innervation of the perineum and, partially, parasympathetic innervation of the bladder. [1]
Bladder stone; Cancer of the bladder and prostate; Detrusor muscle weakness and/or instability; Diabetes; Use of ketamine [12] Neurological conditions; for example multiple sclerosis, spinal cord injury, cauda equina syndrome; Prostatitis, including IgG4-related prostatitis [13] [14] [15] Urethral stricture; Urinary tract infections (UTIs) [16]
Bladder involvement is more likely if the damage is in the area of the pons. Damage to the spinal cord can be caused by traumatic injury, demyelinating disease, meningitis-retention syndrome, vitamin B 12 deficiency, syringomyelia, cauda equina syndrome, or spina bifida.
This is most commonly in the lower back area in the region of the conus medullaris or cauda equina. Therefore, spina bifida affects the bowel similarly to a lower motor neuron spinal cord injury, resulting in a flaccid, unreactive rectal wall. The anal sphincter does not contract and close, leading to stool leakage. [12]
Such severe spinal stenosis symptoms are virtually absent in lumbar stenosis, however, as the spinal cord terminates at the top end of the adult lumbar spine, with only nerve roots (cauda equina) continuing further down. [15] Cervical spinal stenosis is a condition involving narrowing of the spinal canal at the level of the neck.
In acute cases of urinary retention where associated symptoms in the lumbar spine are present such as pain, numbness (saddle anesthesia), parasthesias, decreased anal sphincter tone, or altered deep tendon reflexes, an MRI of the lumbar spine should be considered to further assess cauda equina syndrome. [citation needed]