Why Might A Person With Cauda Equina Syndrome Become Incontinent
The cauda equina nerves supply muscle sensation to the bladder, bowel and legs. When these nerves become suppressed from Cauda Equina Syndrome then muscle sensation becomes lost which can result in loss of bladder and/ or bowel control.
Common incontinence conditions include
- Urinary retention
- Loss of bladder and bowel sensation
Most cases of Cauda Equina Syndrome require emergency surgery to decompress the nerves and prevent permanent damage and loss of sensation to the bladder and bowel.
If you are experiencing symptoms of Cauda Equina Syndrome it is important to seek help straight away in order to receive treatment as soon as possible. It has been proven that if surgery takes places within 48 hours of symptoms that for many sensation and bladder and bowel control can be restored.
Further information and downloads can be found in the help & information section. Living with a bladder or bowel condition or caring for someone with a bladder and bowel condition can affect you emotionally and socially sometimes it can help to speak to others who understand your situation.
There are many ways you can find help on this site, including our which is a moderated space for peer support and discussion.
How Do The Intestines Work
The intestines are part of the digestive system and run from the abdomen to the anus. Most nutrients are absorbed in the intestines. The intestines are a few metres long. On average, the small intestine is 6 metres and the large intestine one and a half metres. Via peristaltic movements the small intestines transport undigested food to the large intestines. In the large intestines, this food is processed and various rotting and fermentation processes take place. This is where bowel problems, such as flatulence or wind, often occur.
In most of the cases, the cause of bowel problems is an incorrect lifestyle, such as smoking and lack of exercise. Also, food with too much fat and too few fibres may cause diarrhoea or constipation. To prevent or reduce bowel problems, it is recommended to ensure you eat high-fibre foods .
Fibres are parts of vegetable foods that your small intestines cannot digest or absorb. They go to the large intestines undigested. Due to a lack of fibres in food, there will be fewer indigestible material in the intestines. In the absence of sufficient bulk and the stimulating action of the food fibres, the intestines are insufficiently stimulated. This is detrimental for proper digestion of food. Moreover, too little fluid is absorbed causing hard stools and making bowel movements difficult.
Where Does Urine Go After An Urostomy Surgery
Then the bladder stores that urine until its surrounding nerves signal to the brain that its time to urinate and empty the bladder. After urostomy surgery, the kidneys still filter blood to create urine. However, urine will instead pass from the ureters into a surgically-created tube called an ileal conduit.
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Lower Back Pain May Be Caused By Bowel Problems
Problems of the lower back may be related to bowel problems or painful and swollen bowels. Back pain and piercing or nagging pain in the abdomen may be attributable to swollen bowels and flatulence.
For all kinds of reasons, the stomach may feel uncomfortable and cause back problems at the same time. In turn, back problems may cause abdominal pain. The nerves of both regions run lumbar . So, they have considerable impact on each other.
What Causes Cauda Equina Syndrome
Cauda equina syndrome is caused by significant narrowing of the spinal canal that compresses the nerve roots below the level of the spinal cord. Numerous causes of cauda equina syndrome have been reported, including traumatic injury, disk herniation, spinal stenosis, spinal tumors , such as metastatic tumors, meningiomas, schwannomas, and ependymomas, inflammatory conditions, infectious conditions, and accidental causes by medical intervention .
Trauma
- Traumatic events leading to fracture or partial dislocation of the low back result in compression of the cauda equina.
- A collection of blood surrounding the nerves following trauma in the low back area can lead to compression of the cauda equina.
- Penetrating trauma can cause damage or compression of the cauda equina.
- A rare complication of spinal manipulation is partial dislocation of the low back that can cause cauda equina syndrome.
Herniated Disk
Spinal Stenosis
- Spinal stenosis is any narrowing of the normal front to back distance of the spinal canal.
- Narrowing of the spinal canal can be caused by a developmental abnormality or degenerative process.
- The abnormal forward slip of one vertebral body on another is called spondylolisthesis. Severe cases can cause a narrowing of the spinal canal and lead to cauda equina syndrome .
Tumors
Inflammatory Conditions
Infectious Conditions
Accidental Medical Causes
- Lower extremity muscle weakness and loss of sensations
- Reduced or absent lower extremity reflexes
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Medical History And Physical Examination
Your doctor will ask you about your overall health, when the symptoms of cauda equina syndrome began, and how they impact your activities.
He or she will then assesses stability, sensation, strength, reflexes, alignment and motion. You may be asked to stand, sit, walk on your heels and toes, bend forward, backward and to the sides, and lift your legs while lying down. Your doctor might check the tone and numbness of anal muscles with a rectal exam. You may need blood tests.
How Is A Pinched Nerve Diagnosed
Weakness, tingling and numbness, and pain are all warning signs that you may be suffering from a pinched nerve. Constant pain is very unpleasant and can stop you from going to work or engaging in your day-to-day activities.The symptoms tend to worsen without treatment, so make sure to contact the experts at NJSO to help you take charge of your health with a custom-tailored treatment plan.
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Managing Bladder And Bowel Incontinence
Some common treatments are:
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Changes in food or drink. Increasing your fiber intake can help manage diarrhea and constipation. Drinking plenty of fluids can also ease constipation. Not drinking fluids at certain times can help manage overactive bladder and urinary incontinence.
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Exercises. Kegel exercises can strengthen the sphincter muscles and pelvic floor. This can help you have better control.
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Medicines. Some medicines can help control bowel incontinence. Antidiarrheal medicines can help manage diarrhea. And medicine can help bladder muscles relax to give you better control.
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Keeping a bathroom schedule. Setting a regular schedule for using the toilet can give you better control. This includes attempting to urinate or move your bowels at the same time each day.
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Electrical stimulation. This therapy can stimulate damaged nerves. This may give you better muscle control in your bladder or bowel.
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Surgery. In rare cases, you may need surgery to repair damage to muscles or nerves.
Your healthcare provider will work with you to create a treatment plan.
What Can I Expect If I Have Spinal Stenosis
First, spinal stenosis develops slowly over time, so you may not have symptoms even though changes are occurring in your spine. Your first noticeable symptoms may be pain, numbness, tingling or weakness in your back or neck or arms and legs depending on the location of the stenosis. Conservative treatments such as pain-relieving and anti-inflammatory medicines, ice or heat, and physical therapy may be enough to relieve pain for a period of time. As stenosis worsens and your quality of life is no longer acceptable to you, talk with your healthcare provider. Most people who undergo spinal stenosis surgery achieve good to excellent results with pain relief. Surgery results depend on your general health and presence of other medical conditions, severity and location of your spinal stenosis, experience and skills of your surgeon and your commitment to your recovery plan.
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How Are Bladder And Bowel Issues Evaluated
Evaluating bladder and bowel problems, especially if their underlying source is endometriosis, may be particularly challenging since many similarly presenting conditions have the ability to cause these issues. As an example of this potential difficulty, an individual may go to their general practitioner with a complaint of pain while urinating or defecating. Their primary care doctor may then send them to a gastroenterologist to determine what could be impacting their bowel function, as well as to a urologist to look at their bladder. These specialists may speculate a bowel or bladder-only related condition, and not consider endometriosis. It may take a long time for other non-endometriosis causes to be ruled out, which may not even occur until the individual starts experiencing other symptoms that might bring them to their OB-GYN, who then might suspect endometriosis.4
Conversely, if an individual is having pelvic pain and difficulty while defecating, they may be sent directly to an OB-GYN, but have a gastrointestinal-related condition rather than endometriosis. Since all of these conditions are very similar and are sometimes treated or investigated in different ways, it may take some time for all of the pieces to come together.
What Tests Diagnose Cauda Equina Syndrome
The initial diagnosis of cauda equina syndrome is made based on findings from the individual’s history, symptoms, and physical exam. The physical exam includes testing muscle strength of the lower extremities, evaluating sensation to touch and pain, especially around the groin , checking the lower extremity reflexes, and evaluating rectal tone, sensation, and reflex.
Imaging studies helpful in the diagnosis include plain x-ray films of the lower back to assess for evidence of trauma or severe arthritis . MRI with and without contrast provides a detailed look at tumors, infection, intervertebral disks, and nerve roots. This study allows the doctor to determine if the nerves are being compressed, to what degree, and by what structures. Findings from these studies help the surgeon plan the appropriate treatment.
Not all people with back pain and/or leg pain and changes in bowel or bladder function have cauda equina syndrome. More common causes of bladder changes are urinary tract infections, which can be identified by a simple urine test, and diabetes, which can be identified with blood tests.
People with symptoms suggesting a possible infection or tumor should be further evaluated with blood and other tests to identify any abnormalities.
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What Are The Causes
A large ruptured disc can cause cauda equina syndrome. During a herniation, the gel-like center of a spinal disc can bulge or rupture through a weak area in the disc wall and compress the nerves. In the majority of cases, the disc herniation occurs at the L4-5 or L5-S1 discs in the lumbar spine. A sports injury, fall, or car accident can fracture the spine or tear a muscle and damage nerves. Other causes include a narrowing of the spinal canal , a tumor, an infection, or a hemorrhage.
What Happens After Spinal Surgery
If youve had a laminectomy, you may be in the hospital for a day or two. If youve had spinal fusion, you may have a three- to five-day hospital stay. If youre older, you may be transferred to a rehabilitation facility to receive additional care before going home.
You will be given pain medications and/or NSAIDs to reduce pain and swelling. You may be given a brace or corset to wear for comfort. You will likely be encouraged to get up and walk as soon as possible. Your healthcare provider or physical therapist will recommend a light form of exercise right after spinal surgery to insure that your back does not stiffen and to reduce swelling. Your physical therapist will develop an individualized exercise plan to stretch and strengthen muscles to support your back and stabilize your spine.
Taking hot showers and using hot compresses may help alleviate pain. Additionally, using an ice pack may ease pain before and after exercise.
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What Are The Risks Of A Laminectomy
As with any surgical procedure, complications can occur. Some possible complications may include:
- Bleeding
- Blood clots in the legs or lungs
- Spinal cord or nerve root injury
- Risks linked to the use of general anesthesia
Nerve or blood vessels in the area of surgery may be injured. This can cause weakness or numbness. The pain may not be eased by the surgery or may become worse, although this is rare.
There may be other risks depending on your specific health condition. Be sure to discuss any concerns with your healthcare provider before the surgery.
Bowel Injury During Hysterectomy
Injury to the small bowel or colon can happen during a hysterectomy. This can become a serious complication if it is not quickly recognized as bowel contents spill in the womans pelvis.
A womans chance of bowel injury is about o.4%. This is most common during a laparoscopically-assisted abdominal hysterectomy.
When bowel injuries are not noticed and repaired during surgery, women will soon complain about fever and painful, tense, and swollen abdomen. Untreated bowel injuries may lead to a life-threatening condition called peritonitis.
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Bladder Management After Spinal Cord Injury
Proper management of neurogenic bladder dysfunction is essential for optimizing quality of life after spinal cord injury.
Management interventions primarily focus on emptying the bladder before it gets too full, however the specifics of a bladder intervention program will depend on the location of the injury.
Catheterization is the most common form of bladder management after SCI. It involves inserting a narrow tube into the body to drain urine from the bladder.
There are two main types of catheterization:
Intermittent catheterization requires using a catheter every 4-6 hours to empty the bladder. If you prefer not to be connected to a catheter all the time, this method is ideal.
Indwelling catheterization involves being connected to a catheter at all times. This method brings higher risk of a UTI, and is typically only used if there is a specific reason the individual cannot perform intermittent catheterization.
Alternative bladder management interventions include:
Depending on your lifestyle and the severity of symptoms, some management interventions will be more ideal than others. Talk to your doctor to see which treatments will be best for you.
How Do I Prepare For Spinal Stenosis Surgery
To prepare for spine surgery, quit smoking if you smoke and exercise on a regular basis to speed your recovery time. Ask your provider if you need to stop taking any non-essential medications, supplements or herbal remedies that you may be taking that could react with anesthesia. Also, never hesitate to ask your healthcare team any questions you may have or discuss any concerns.
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What Causes Spinal Stenosis
Spinal stenosis has many causes. What they share in common is that they change the structure of the spine, causing a narrowing of the space around your spinal cord and nerves roots that exit through the spine. The spinal cord and/or nerve roots become compressed or pinched, which causes symptoms, such as low back pain and sciatica.
The causes of spinal stenosis include:
- Bone overgrowth/arthritic spurs:Osteoarthritis is the wear and tear condition that breaks down cartilage in your joints, including your spine. Cartilage is the protective covering of joints. As cartilage wears away, the bones begin to rub against each other. Your body responds by growing new bone. Bone spurs, or an overgrowth of bone, commonly occurs. Bone spurs on the vertebrae extend into the spinal canal, narrowing the space and pinching nerves in the spine. Pagets disease of the bone also can also cause on overgrowth of bone in the spine, compressing the nerves.
- Bulging disks/herniated disk: Between each vertebrae is a flat, round cushioning pad that acts as shock absorbers along the spine. Age-related drying out and flattening of vertebral disks and cracking in the outer edge of the disks cause the gel-like center of these disks to break through a weak or torn outer layer. The bulging disk then press on the nerves near the disk.
Herniated disks and bone spurs are two common causes of spinal stenosis.
Life After Bowel Surgery
Having sex
You will need time to get over surgery before having sex again. Give yourself at least six weeks after major surgery.
The effects mentioned below don’t affect everyone who has bowel cancer treatment. Some of the problems may get better over time. But some changes can be permanent. You may feel very embarrassed to talk to doctors or nurses about sexual problems. But if you tell them about any problems you have, they can find ways of helping you to deal with them.
An operation involving the rectum can affect the nerves to the sex organs. A man may not be able to get, or keep, an erection, or might have problems with orgasm and ejaculation. Women might also notice changes.
You may have surgery for cancer in your lower rectum, to remove your anus and rectum. If you’re used to having anal sex, you will no longer be able to. Your surgeon and specialist nurse will talk to you about this before and after your surgery. Sharing your thoughts and feelings with your partner can help with this.
After surgery you might notice changes to your bowels including:
- pooing more often
- having little or no warning that you need to poo or pass wind
- changes to your poo such as loose runny poo or hard, difficult to pass poo
- feeling bloated and passing wind
- difficulty emptying your bowel completely when you poo
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Can Alternative Treatments Such As Acupuncture Or Chiropractics Help Relieve Pain From Spinal Stenosis
Acupuncture and chiropractic manipulation may help relieve mild pain in some people with spinal stenosis. Its important to keep in mind that similar to other nonsurgical treatments, these alternative therapies dont improve the narrowing of the spinal canal. Also, chiropractic manipulation must be used in the proper person. For instance, manipulation may worsen symptoms or cause other injuries if a herniated disk is the cause of your spinal stenosis. That being said, alternative therapies are increasingly popular and are used to treat and manage all kinds of pain. Be sure to ask your healthcare provider if these alternative treatments as well as others, like yoga, massage or biofeedback, may be safe and appropriate to manage the cause of your spinal pain.