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Caudal Epidural

Date issued: August 2023

Review date: August 2025

Ref: B-176/Pain Management/Caudal Epidural v5

PDF:  Caudal Epidural final August 2023 v5.pdf [pdf] 163KB

Why has an epidural been suggested as a way of helping with my pain?

  • Epidurals can be useful in helping you to start to move more freely and engage in physiotherapy and positive lifestyle changes if you have certain types of leg and back pain. 

What is an epidural injection?

  • Caudal epidural injections are done at the bottom of your tailbone (sacrum).

  • It involves injecting a mixture of local anaesthetic and a long acting steroid into the space around your spinal cord and nerves (the epidural space).

  • We perform these in sterile conditions and under x-ray guidance in University Hospitals Plymouth. 

How do epidural injections work?

  • Epidurals provide some pain relief and possible reduction in inflammation for the nerves that go down your legs and around your lower back.

  • Steroids are not licensed for use, into the epidural space. However medical evidence suggests that the treatment can be beneficial for people with leg pain, and although there is some risk, individual injections are considered acceptable. 

How long will the pain relief last?

  • There is potential for this injection to provide prolonged pain relief and we hope that it would allow you to do more gentle activity, physiotherapy and positive lifestyle changes that will also help.                                                           

 You must fast unless otherwise advised.

You must inform the Pain team if:

  • You have had any form of infection during the 14 days before your procedure OR

  • You are on drugs that thin the blood or suffer with a problem that means your blood doesn’t clot normally 

What are the side effects of the treatment?

  • It is possible to worsen your symptoms with these injections.

  • Very occasionally temporary numbness in the legs and buttocks which will wear off.

  • The numbness may affect your bladder; you may find it difficult to pass urine for a short period of time, after your epidural.

  • Repeated injections with steroids potentially increase the risk of spinal fractures. They may also suppress your ability to fight infections, and increase the risk of stomach irritation and bleeding.

  • Spinal infections or bleeding can occur in rare circumstances; these are potentially very serious. 

What happens immediately after the injection?

  • You will be asked to lie on your back, or affected side, for up to 45 minutes.

  • Your blood pressure and pulse will be measured, as you may feel faint, normally due to anxiety. 

Before you are discharged

  • You will be helped to your feet, to check your walking ability. Occasionally the injection can make your legs feel numb but the strength in your legs should not be affected.

  • You will be asked to pass water before being allowed home. 

Post procedure advice

  • You must not drive yourself home and you should have someone with you at home for 24 hours

  • It is not abnormal to have a flare of pain in the days following the injection but this should be resolving within a week to 10 days.

  • If you are diabetic check your blood sugars regularly for a couple of days as the steroid can affect them.

  • Take it easy for the first 24-48hrs.

  • Slowly start to increase your movement in the weeks following the injection. Why not start by trying some gentle Tai Chi.

  • Consider trying mindfulness relaxation techniques.

  • Your pain consultant may have referred you for physiotherapy, if not you can self-refer for advice about improving your activity and endurance.


  • If you have new leg weakness, or new problems with bowel or bladder control, with new back pain or fever in the weeks following your injection please seek urgent medical advice.

  • You should either ring:   

    • Your GP.

    • NHS 111.

    • Pain Clinic (in office hours) 01752 437706.

    • Or attend Derriford Emergency Department.

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