Diagnosis & Types of Cauda Equina Syndrome

How is Cauda Equina Syndrome diagnosed?

A Cauda Equina Syndrome diagnosis is built from two things: what a doctor finds when they examine you and what an MRI scan shows. Claims connected to CES usually trace back to gaps in the first or delays reaching the second.

Examination

A doctor working through a possible CES diagnosis needs to ask about your bladder, your bowels, any numbness around your bottom, your genitals and any change to your sex life, not just about back pain. In practice, this is where a number of cases break down; pain and mobility are discussed but bladder and bowel changes don’t come up, a patient mentions numbness but it gets noted rather than checked, something has changed since the last visit but that change doesn’t trigger a second look. A physical check should always follow a conversation such as this.

MRI

An MRI on the lower spine shows whether there is pressure on the nerves, and where the warning signs described above are present, that scan should take place urgently. Hours can be lost at this stage; patients are told to return at another time, told to attend a different hospital or it could be that the scan itself happens quickly but the results sit unread for longer than they should. Getting a correct diagnosis late causes the same harm as never getting a diagnosis at all.

A claim over how your CES was diagnosed usually comes down to two questions. First, whether the doctor did what any competent doctor should have done with the information available to them at the time. Second, whether being diagnosed sooner would actually have changed how you are now, given how quickly CES can progress and how much a few hours can matter. Your medical records answer both questions; what you were asked, what was checked, what was written down and how much time passed between each appointment all set out a clear timeline that a claim can be built on.

The Different Types of CES

There is no single classification of CES that medical literature agrees on but the ones most widely used in UK clinical and legal settings place the presentations into four groups based on how far bladder and bowel function have already been affected by the time a patient is seen:

CESS – Cauda Equina Syndrome Suspected describes patients with the early warning signs, back and leg pain but no evidence yet of bladder or bowel involvement. Not everyone in this group goes on to develop CES but they must be told what to watch for and to seek help immediately should things change.

CESI – Cauda Equina Syndrome Incomplete describes patients with early bladder involvement, a reduced urge to urinate, a weaker stream or needing to strain to pass urine. Sensation around the saddle and anal area is only slightly affected at this stage. CESI can progress into CESR if not treated urgently.

CESR – Cauda Equina Syndrome Retention describes patients whose bladder has moved beyond their control; it fills without the sensation of needing to empty which in turn leads to incontinence. This is a surgical emergency.

CESC – Cauda Equina Syndrome Complete describes patients with complete loss of function, a bladder and a bowel that no longer respond to voluntary control.

If you or a loved one experienced a delay in the diagnosing of Cauda Equina Syndrome and have been left with lasting symptoms as a result, we may be able to help you claim compensation. Get in touch with our team today for a free, no obligation discussion about your case.