Cauda Equina Syndrome

Cauda equina syndrome (CES) is a time-critical compression of the lumbar and sacral nerve roots below the conus medullaris. It can be signalled by any one of the following: new bilateral saddle anesthesia, urinary retention or incontinence, fecal incontinence, or sexual dysfunction. These findings may appear in different combinations, and a patient does not need to display the complete syndrome before emergency assessment begins. The nurse's first clinical question is not simply whether the back pain is severe. It is whether sacral nerve function has changed. Ask specifically about altered sensation when wiping, difficulty starting the stream, loss of bladder sensation, leakage, bowel control, and new sexual dysfunction. A patient who says the pain is better but the perineum feels numb may be deteriorating rather than recovering. Suspected CES requires an emergent lumbar MRI without delay. A bladder scan can support the assessment, but it cannot be used to rule out CES when the history and neurological examination remain concerning. The treatment pathway changes again when imaging confirms compression: urgent neurosurgical or orthopaedic consultation and decompression as soon as possible.