Back injuries are not always straightforward, and they don't always present the same symptoms. For some people, a sharp pain at the moment of their injury acts as a clear indication, while for others, recurring chronic pains could arise later that signify that an injury has occurred. In fact, there are a number of symptoms that people may not expect when they first injure their spine, but which can indicate an injury you were unaware of, or complicate your recovery.

Among these, bowel dysfunction can be among the most uncomfortable. Bladder and bowel problems may only be temporary in the aftermath of an injury, especially if the nerves are compressed or inflamed due to an accident. However, if the nerves are severed, or if compression or inflammation leads to nerve damage, bowel management issues may become permanent, especially if they result from a spinal cord injury. In these cases, the symptom is often referred to as 'neurogenic' bowel dysfunction.

This is a common symptom experienced by people with cauda equina syndrome (CES). CES is a rare but serious neurological condition where the bundle of nerves at the lower end of the spinal cord - known as the cauda equina - becomes compressed. If this is not dealt with urgently by doctors when it is detected, it can lead to permanent bladder and bowel symptoms. Other types of back injury can also affect bowel movements and demand treatments ranging from surgery to medication.

Thankfully, there are often treatment options available. Further, if you suffered a back or spinal cord injury because doctors did not react quickly enough to your symptoms, or failed to diagnose a back injury that later got worse, you may be entitled to compensation. This can cover any costs associated with prescription medication, private treatment, or corrective surgical interventions that you need.

Here, the experienced clinical negligence solicitors at JMW explain how bowel issues can arise from a back injury, other lesser-known symptoms to look out for, and when you might be able to make a medical negligence claim for problems with bowel health.

How Does a Back Injury Affect Bowel Movements?

Any damage to the spinal cord or the nerves branching out from it, especially in the lower back, can affect the body’s ability to control bowel movements. The nerves in the lower spine, particularly those in the lumbar and sacral regions, play a direct role in managing bowel and bladder function. With that said, any spinal injury (whether a complete or incomplete injury) that interferes with these nerves, even further up the spine, can lead to neurogenic bladder or bowel management problems.

If these nerves are compressed, inflamed or severed due to trauma, a person may experience a range of bowel or bladder control issues. Symptoms that can arise under these conditions include:

• Constipation
• Incontinence (loss of bowel control)
• Incomplete emptying
• Changes in bowel habits that do not improve with dietary or lifestyle changes

These problems may be temporary if the nerves are bruised or irritated, or long-term if the damage is more severe. In the most serious cases, they may be permanent, although certain medications and bowel management techniques may be used to minimise the impact on your quality of life.

In some cases, the loss of bowel function following a back injury is a sign of cauda equina syndrome. Any symptoms of cauda equina syndrome should be considered a medical emergency, and doctors must immediately refer patients for tests. After you begin experiencing problems with your bowels, surgery may be necessary to reduce compression of the cauda equina nerves before the symptoms become permanent. If doctors fail to identify or act on the signs quickly, this may be grounds for a medical negligence claim.

What Other Symptoms Can Indicate Cauda Equina Syndrome?

Beyond affecting bowel function, there are several other symptoms that cauda equina syndrome or other undiagnosed spinal cord injuries could cause. In some cases, acting urgently on these symptoms could prevent complications or long-term problems while, in others, they may indicate that the time for action has already been missed.

Symptoms that people may also experience include:

• Severe lower back pain, which could be a sharp pain or an ache, that gets worse over time and does not respond to over-the-counter pain medication.
• Saddle anaesthesia, which refers to a loss of sensation, numbness or tingling (pins and needles) in the inner thighs, buttocks, perineum and genitals. This is considered a hallmark symptom.
• Weakness in the legs or feet, particularly when walking or climbing stairs.
• Bladder dysfunction, which may include:
• Urinary retention, where it is difficult to start urinating or completely empty the bladder.
• Overflow incontinence, the medical name for leakage of urine due to a full bladder.
• Loss of sensation during urination.
• Sexual dysfunction or loss of sexual response, including reduced genital sensation and erectile dysfunction in men.
• Lower limb weakness or numbness in one or both legs, which varies from mild weakness to near paralysis, and often affects walking or rising from a seated position.
• Diminished or absent tendon reflexes in the lower limbs, especially the ankle and knee-jerk reflexes.
• Chronic fatigue, due to the strain of ongoing pain or nerve damage.
• Mood changes, such as anxiety or low mood linked to the physical and social effects of the injury.
• Poor circulation, which may lead to cold feet or swelling in the lower limbs.

While back injuries can also be associated with pain, stiffness and mobility issues, the symptoms above - although they may not be related to cauda equina syndrome - often point to nerve problems, spinal cord compression, or disrupted signals between the brain and body.

Cauda equina syndrome can also have an impact on the patient's mental health, particularly as symptoms may affect their comfort, self-esteem and quality of life. If the condition is left untreated when symptoms arise, or treatment is not administered urgently enough, this can have lifelong effects on the patient's physical health and mental wellbeing.

Can You Get Compensation for Bowel Problems that Result from a Back Injury?

If you suffered neurogenic bowel dysfunction due to cauda equina syndrome, a spinal cord injury or a related health condition that was not diagnosed properly and got worse as a result, you may be entitled to claim compensation. This can be an important aspect of your recovery, as compensation can cover the costs of bowel care treatment, corrective surgery, time taken off work due to your health issues, and other things that can make the aftermath of an injury more comfortable for you.

When cauda equina syndrome or a related condition leads to bowel or bladder management problems, claims often arise due to the failures of doctors or healthcare professionals to identify and treat red-flag symptoms. In these cases, cauda equina syndrome can often be prevented - but if it was not addressed as a result of medical mistakes, you may be owed compensation. Examples of medical negligence that may entitle you to claim compensation include:

• Failure to identify red-flag symptoms: saddle numbness, urinary retention or bilateral sciatica should spur doctors to refer you for further investigation and treatment immediately. If doctors fail to identify the possibility of cauda equina syndrome, you may be owed compensation.
• Delayed diagnosis: When general practitioners, emergency departments, or physiotherapists did not escalate your case appropriately and this led to a delay in diagnosing cauda equina symptoms, you may be entitled to make a claim.
• Failure to refer: If doctors failed to arrange an urgent MRI scan or neurological examination after you presented with symptoms indicating a possible CES diagnosis, this could enable you to claim.
• Delays in surgery: Any delay in carrying out surgery to decompress the affected nerves. If this was not carried out within an appropriate timeframe - ideally within 24-48 hours of red-flag symptoms developing - you may be able to claim compensation.
• Surgical errors: If you must undergo surgery, any mistakes made by your surgeon could make your condition worse, or compound the issues you have been facing with your bowel function. Mistakes during back surgery can lead to compensation.
• Inadequate aftercare: If doctors failed to provide suitable aftercare following surgery to address a spinal cord injury or cauda equina syndrome, and your condition got worse, this may enable you to pursue medical negligence compensation.

A spinal injury is extremely serious, especially when nerves may be affected, and doctors must act quickly. If you have been let down and suffered bowel problems as a result of medical errors, speak to the team at JMW for advice on whether or not you are entitled to claim compensation.

Is There Treatment for Neurogenic Bowel Problems?

If you experience losing control of your bowels, severe constipation or any other of the symptoms listed above, it is vital to speak to a doctor. They can advise you on treatment for the bowel problem itself, and potentially diagnose any underlying spinal cord injury that may be causing your issues.

Bowel problems caused by cauda equina syndrome or other neurological injuries can often be managed using a range of treatments and techniques. While there is no complete cure for the underlying nerve damage, various strategies can help to improve continence and reduce discomfort.

Strategies can include:

• Dietary management with a fibre-controlled diet
• Medication
• Enemas, suppositories and other treatments
• Transanal irrigation, whether the bowel is flushed with water
• A scheduled bowel management routine
• Botulinum toxin (Botox) injections to relax muscles
• Surgery

At JMW, our team has a wealth of expertise in helping those who have experienced life-changing bowel and bladder problems due to misdiagnosed cauda equina syndrome or poor care after a back injury. We understand how distressing and isolating these complications can be, and we can help you work through the legal process if something has gone wrong with your care, to make sure you get the compensation you deserve.