Cauda Equina Syndrome — A Surgical Emergency
Cauda equina syndrome occurs when nerves at the base of the spinal cord are compressed (usually by a large disc prolapse), threatening permanent bladder, bowel, and leg function. It requires emergency MRI and surgery, usually within 24-48 hours.Cauda Equina Red Flags — Go to A&E
- New numbness around the genitals, inner thighs, or buttocks ('saddle anaesthesia')
- New difficulty starting to urinate, or reduced sensation when passing urine
- New bowel incontinence or loss of sensation when opening bowels
- Loss of sensation of a full bladder
- Bilateral leg weakness or pain
- Sexual dysfunction, new onset
Other Red Flags for Back Pain
| Sign | Concern |
|---|---|
| Age <20 or new onset >55 | Consider tumour, infection, fracture |
| Fever with back pain | Spinal infection (discitis, epidural abscess) |
| History of cancer | Possible spinal metastasis |
| Unexplained weight loss | Possible malignancy |
| Significant trauma | Possible fracture |
| Pain worse at night, unrelieved by rest | Possible serious underlying cause |
Cauda Equina — EmergencyAny combination of saddle numbness, new bladder/bowel dysfunction, and bilateral leg symptoms with back pain requires IMMEDIATE emergency department attendance — delay beyond 24-48 hours risks permanent nerve damage and incontinence.
Stay ActiveFor ordinary mechanical back pain (without red flags), current guidance strongly recommends staying as active as possible and avoiding prolonged bed rest, which can worsen recovery and increase disability.
Do I need an X-ray or MRI for back pain?
Not routinely — imaging is reserved for cases with red flag symptoms or pain not improving after 4-6 weeks of appropriate treatment, as imaging findings often don't correlate with symptoms and can lead to unnecessary anxiety or intervention.
How long should back pain take to improve?
Most acute back pain improves significantly within 2-6 weeks with simple measures (staying active, appropriate pain relief, gradual return to normal activities).
Is bed rest good for back pain?
No — current evidence shows prolonged bed rest worsens outcomes for most back pain. Staying as active as possible, within pain limits, leads to faster recovery.
Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.