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Although it is rare, cauda equina syndrome (CES) can arise during pregnancy. In this article we explore CES during pregnancy in more detail, explaining why it might happen and what treatment should be provided.
Cauda equina syndrome is a neurological condition that happens when a bundle of nerves ā called the cauda equina nerves ā are compressed and injured. This limits the functional ability of the nerves, leading to a collection of symptoms which together indicate the presence of cauda equina syndrome. These symptoms will get progressively worse the longer compression continues, as the injury to the nerves will become increasingly severe.
The symptoms associated with cauda equina syndrome are: lower back pain, numbness in the saddle area (perineum, buttocks and genitals), leg weakness and bladder dysfunction.
For cauda equina syndrome to happen, something must compress and damage the nerves. Ordinarily this will be something such as a slipped or sequestered disc, a spinal tumour, and conditions such as spinal stenosis.
In some very rare cases, this compression can occur as a result of pregnancy. Medical experts estimate that this happens in around one in 10,000 cases. It arises because pregnancy is associated with mechanical and positional stresses on the lower back. This frequently leads to lower back pain in women. For some, however, the strain will be so severe that it actually causes a disc to herniate.
Cauda equina syndrome is a medical emergency and should be treated immediately, even if the patient is pregnant. The only way to effectively treat cauda equina syndrome is with surgical decompression of the cauda equina nerves.
Evidently undergoing surgery while pregnant requires particular care. Therefore a patient should be urgently assessed by an obstetrician and anaesthetist. If it is deemed safe after this assessment, a patient should undergo emergency surgery.
Lower back pain is very common is pregnant women. The presence of lower back pain in a pregnant woman may therefore be overlooked and a diagnosis of cauda equina syndrome missed.
However, cauda equina syndrome is associated with other symptoms such as urinary disturbance and numbness. These symptoms should be considered alongside the back pain and further investigations performed without delay. Indeed, clinicians should be aware of cauda equina syndrome and the need for emergency treatment. A failure to recognise the condition will amount to medical negligence.
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