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I have back pain, why are you asking about my bladder control?

Posted 6/14/2018

Have you ever gone to physiotherapy for back pain? Do you remember them asking you about if you had any problems with your bowels or bladder? Did you think it was strange? So why do we ask you this? We ask because of your cauda equina. Okay.....wait......WHAT????

What is the Cauda Equina?

The term relates to the lower end of the spinal cord, where the nerves fan out into a bundle of fibres that looks like a horse’s tail (‘cauda equina’ is Latin for ‘horse tail’). These nerve fibres leave the spinal canal through holes between each vertebra (the bones in your back). Some of the nerves join to form the sciatic nerve or nerves controlling the legs. Some also provide the sensation and control for the bladder, anal and genital regions.

The cauda equina lies behind the lumbar discs, in the spinal canal. These discs sit between the vertebrae (bones of the back) but can sometimes rupture (known as a large disc prolapse or ‘slipped disc’). This can happen quite suddenly, usually in younger people. When this happens, the nerves of the cauda equina can become trapped and squashed. In older people, it may happen gradually and be combined with other arthritic changes within the spine. The effects may be noticed more slowly, and even regarded as simply ‘part of getting old’. Any squashing of the nerves can cause pain, numbness and/or weakness of the legs, particularly the foot and ankle. It could also cause difficulty with bladder and bowel control, numbness between the legs or over the buttocks and difficulty with sexual function.

Some injuries to the back can cause Cauda Equina Syndrome. Pressure from structures in the back (such as a disc herniation) press on the nerves and limit their ability to work properly. This limited function can affect the structures that they control such as your bowel, bladder and genitals.

Our job is to help identify the cause of your concerns and direct you to the right place. So for that reason, we sometime ask questions that might seem intrusive and personal; so that we can rule out anything more serious. Now, we don;t want to scare you. Please be assured that cauda equina syndrome is RARE- I have seen one confirmed case and one case that I suspected but did not receive an update on in 24 years of practice. 


So, if it is rare, why do you worry about it?

Although rare, it can be serious and lead to permanent damage. It is usually requires immediate surgery and therefore, we want to get you to the appropriate health professional right away. Here is a great informatic of some of the possible symptoms of cauda equina syndrome. If you experience nay of these symptoms please speak to your health care provider. Many of these can be early signs, but if you experience loss of bowel or bladder control or if you have numbness in the perineum, please go to the closest emergency department. (That said.....keep in mind many of the symptoms below can be caused by author causes including medications so please don't panic.)