Overview
The epidural space surrounds spinal nerves and can become inflamed due to disc problems, arthritis, nerve irritation, or post surgical scar tissue. When this inflammation persists, symptoms may include pelvic pain, deep lower back pain, buttock pain, or nerve related leg symptoms.
A caudal epidural delivers local anaesthetic and steroid medication into the epidural space through an opening at the base of the spine called the sacral hiatus. This approach can allow medication to spread toward irritated nerve pathways and may be helpful when pain involves multiple levels or when anatomy or scar tissue makes other epidural approaches less suitable.
Who This Treatment Helps
A caudal epidural may be suitable for people with:
• Pelvic pain linked to sacral or lower lumbar nerve irritation
• Chronic lower back pain with nerve related features
• Sciatica or nerve related leg pain
• Pain following spinal surgery where scarring may be present
• Disc bulges or herniations contributing to inflammation
• Limited improvement from physiotherapy or medication
A consultation is needed to confirm suitability.
What Is a Caudal Epidural
A caudal epidural is an epidural injection performed through the sacral hiatus at the base of the spine. The injection typically contains:
• Local anaesthetic for temporary numbing
• Steroid medication to reduce inflammation
X ray guidance is commonly used to confirm accurate placement. In some cases, a small amount of contrast may be used to check spread within the epidural space.
What to Expect During the Procedure
You will lie comfortably, usually face down. The skin is cleaned and numbed, and a fine needle is guided into the sacral hiatus using imaging. Medication is delivered into the epidural space, then you are monitored before going home the same day.
After the Procedure
Mild soreness at the injection site is common. Temporary numbness or heaviness in the legs can occur and usually settles within hours. Some people feel early relief from the local anaesthetic, while steroid benefit often builds over several days and can take up to two weeks.
Your consultant may advise:
• Avoid strenuous activity for 24 to 48 hours
• Continue physiotherapy and rehabilitation as planned
• Return to normal activity as comfort allows
• Monitor symptoms and report any concerns
Benefits
• May reduce pelvic, lower back, and leg pain
• Useful when multiple nerve levels may be involved
• Minimally invasive with short recovery time
• Can support improved movement and function
• May reduce reliance on medication
• Can support rehabilitation by improving comfort
Possible Risks and Side Effects
Caudal epidurals are generally safe. Potential risks include:
• Temporary increase in pain
• Local bruising or soreness
• Temporary leg numbness or weakness
• Headache in some cases
• Infection rare
• Bleeding
• Allergic reaction uncommon
• Very rarely nerve irritation
When to Consider Other Options
If symptoms do not improve or the pain pattern suggests an alternative source, your consultant may discuss SI joint injections, pudendal or other pelvic nerve blocks, targeted nerve root injections, or a multidisciplinary pelvic pain programme.
Safety Note
Please inform your consultant about blood thinners, diabetes, pregnancy, allergies, and recent infections. Avoid driving if numbness or heaviness persists.
Arrange a consultation to discuss whether a caudal epidural may help your pelvic or nerve related pain.