Introduction In primary care, cauda equina syndrome (CES) is rare but GPs are often the front line for the recognition of possible CES. Since 2020, national guidance for GPs has stated that symptoms of CES are sufficient to mandate emergency referral for imaging even in the absence of objective signs of CES (such as altered perianal sensation [PAS] or anal tone [AT]). Indeed, rectal (PR) examination to determine altered PAS and AT is not recommended in primary care.
