Red Flags- Indicators of More Serious Back Problems

Serious back problems are fortunately very rare. Nonetheless, health professionals always check for particular symptoms to help make the decision whether someone may have more serious back problems. These signs are known as Red Flags. If you have any of the red flag symptoms listed below you should seek medical advice as they require further investigation.

• Changes in bladder and bowel control
  
  This usually means loss of control of your bladder or bowel or an inability to pass water. Many people with lower back pain have constipation, this may be due to using pain killers, reduced activity levels or pain, don't confuse this with these other more serious symptoms.

• Loss of control of your legs

Or your legs don't feel like they belong to you. Don't confuse this with difficulty walking because you are in pain, this is more about feeling a sense of weakness or tripping because you don't have good control over your legs. Watch out for symptoms of dropped foot too.

• Pins and needles or numbness around the saddle (genital or anal) area
  
  
• Pins and needles or numbness of both legs or feet.
  
  
• Recent, unexplained weight loss

The key word here is unexplained, if you have lost weight because of diet or exercise or because pain and worry has been reducing your appetite that is not such a concern. If you have lost weight and you have no idea why this may be a sign of more serious back problems.

• Severe pain that only comes on at night.
  
  This is a bit trickier because although people with serious back problems do get night pain, lots of people with nothing seriously the matter get it too. A study in the UK examined 213 patients who had night pain, with 90 having pain every night. No serious problem was identified with any of them (see reference 1 below). However, If you have this symptom it is important that you discuss it with your doctor.
  
  
• Night sweats
  
  
• Major trauma such as vehicle accident or fall from a height
  
  
• Minor trauma, or even just strenuous lifting, in people with osteoporosis
  
  
• History of cancer
  
  
• Constitutional symptoms, e.g. fever, chills, unexplained weight loss
  
  
• Recent infection (e.g. bladder infection)
  
  
• Intravenous drug abuse
  
  
• Immune suppression

If you have any of these symptoms you MUST go and see a qualified medical practitioner immediately.

The first three symptoms can indicate cauda equina compression, which is a serious type of spinal cord compression. If you have these symptoms you need to seek emergency treatment, don't hang about, get this checked out straight away.

If you are unsure if you have any of these symptoms discuss it with your doctor.

References

(1) Harding I, Davies E, Buchanan E, Fairbank J. The symptom of night pain in a back pain triage clinic. Spine 2005; 30 (17):1985-1988.

(2) Prodigy Guidance on lower back pain

More information on the causes of lower back pain

02-Nov-2009