Overview
A caudal epidural is a targeted treatment used when inflammation in the epidural space contributes to pelvic pain, lower back pain, buttock pain, or nerve related leg symptoms. The epidural space surrounds the spinal nerves and can become inflamed because of disc problems, arthritis, nerve irritation, or post surgical scar tissue.
When this inflammation persists, pain may involve the lower spine, pelvis, buttocks, or legs. 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 allows medication to spread towards 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 herniation contributing to inflammation
- Limited improvement with physiotherapy or medication
A consultation is required to confirm suitability and determine whether a caudal epidural matches the likely source of symptoms.
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 usually contains:
- Local anaesthetic for temporary numbing
- Steroid medication to reduce inflammation
X ray guidance is commonly used to confirm accurate needle placement. In some cases a small amount of contrast is used to check spread within the epidural space and improve precision.
What to expect during the procedure
Your consultant will explain the treatment plan and answer any questions before the procedure begins.
- You lie comfortably, usually face down
- The skin is cleaned and numbed with local anaesthetic
- A fine needle is guided into the sacral hiatus using imaging guidance
- Medication is delivered into the epidural space
- You are monitored briefly before going home the same day
The procedure is usually performed as a day case and typically takes a short time to complete.
After the procedure
Mild soreness at the injection site is common after a caudal epidural. Temporary numbness or heaviness in the legs can occur and usually settles within hours.
Some people notice early relief from the local anaesthetic, while steroid benefit often develops more gradually over several days and may 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 nerve related leg pain
- Useful when multiple nerve levels may be involved
- Minimally invasive with a short recovery time
- Can support improved movement and daily function
- May reduce reliance on medication
- Can support rehabilitation by improving comfort
Possible risks and side effects
Caudal epidural treatment is generally safe when performed by experienced clinicians, but all procedures carry some risk.
- Temporary increase in pain
- Local bruising or soreness
- Temporary leg numbness or weakness
- Headache in some cases
- Infection, which is rare
- Bleeding
- Allergic reaction, uncommon
- Very rare nerve irritation
Your consultant will explain the possible risks, expected benefits, and any suitable alternatives during assessment.
When to consider other options
If symptoms do not improve or the pain pattern suggests another source, your consultant may discuss sacroiliac joints injection, pudendal nerve block, genito femoral nerve block, targeted nerve root treatment, or a broader multidisciplinary pelvic pain plan.
Safety note
Please inform your consultant about blood thinning medication, diabetes, pregnancy, allergies, or recent infection before treatment. If numbness or heaviness persists after the procedure, avoid driving until it has fully settled.
Arrange a consultation to discuss whether a caudal epidural may help your pelvic pain or nerve related symptoms.
You can also explore our pelvic pain treatments, view all pain treatments, or learn more about our pain management services.