Back pain

Back pain is a common symptom that affects 60–80% of people at some time in their lives.

The prognosis (outcome) is generally good. After 2 days, 30% are better and 90% have recovered by 6 weeks. Recurrences  of  pain  may  occur  and  about  10–15%  of patients  go  on  to  develop  chronic  back  pain  that  may  be difficult  to  treat.  Psychological  elements,  such  as  job  dissatisfaction,  depression  and  anxiety,  are  important  risk factor.

Causes of Back pain

  • Mechanical back pain
  • Prolapsed intervertebral  disc
  • Osteoarthritis
  • Vertebral fracture
  • Spinal stenosis
  • Paget’s disease
  • Spondylolysis
  • Bone metastases etc.

Others causes

Renal colic, Pyelonephritis

Pelvic inflammatory disease

Pancreatitis

Peptic ulcer disease

 

What causes back pain in children?

These injuries are usually caused by activity and overuse. Scheuermann’s disease causes pain that is not severe enough to limit activity. It is the second most common cause of back pain in children and young adults. Your child may have a rounded spine.

Can Stomach pain be caused by back pain?

A back injury or injury to the spine can cause pain to radiate in the abdomen. Also, a pinched nerve can not only cause pain to the entire area served by that nerve, but it can also cause various stomach functioning problems as well. Inflammation of the colon, or colitis, is very often associated with lower back pain.

Why do girls have back pain?

Lower back pain during your period, or primary dysmenorrhea, is caused by contractions in the uterus.

What causes muscle spasms in the lower back?        

Back spasms can be the result of injuries to the muscles, tendons, and ligaments in the back or it can be related to more serious medical conditions. Heavy lifting is a common cause of back spasms. Any activity that puts excessive strain on the muscles and ligaments in the lower back can cause an injury.

 

Symptoms of mechanical low back pain

  • Pain  varies  with  physical  activity  (improved  with  rest)
  • Sudden  onset,  precipitated  by  lifting  or  bending
  • Recurrent  episodes
  • Pain  limited  to  back  or  upper  leg
  • No  clear-cut  nerve  root  distribution
  • No  systemic  features
  • Prognosis  good  (90%  recovery  at  6  wks)

 

Red flags for possible spinal pathology (Danger features)

  • Age:  presentation  <  20  yrs  or  >  55  yrs
  • Character:  constant,  progressive  pain  unrelieved  by rest
  • Location:  thoracic  pain
  • Past  medical  history:  carcinoma,  tuberculosis,  HIV,  systemic corticosteroid  use,  osteoporosis
  • Constitutional:  systemic  upset,  sweats,  weight  loss
  • Major  trauma

Investigations

Investigations are not required in patients with acute mechanical back pain.  Those  with  persistent  pain  (> 6  weeks)  or  red  flags  should  undergo further  investigations such as MRI, X-Ray, Bone scan and some blood tests.

What are the treatment of LBP?

General

  • Self-limiting nature of the condition.
  • Stay active, exercise is helpful rather than damaging
  • Medication if necessary (preferably at fixed time intervals).
    • Paracetamol
    • NSAID like ibuprofen, indomethacin, naproxen.

Regular use, improved mobility, and facilitate exercise

  • Doctor may consider opioids, muscle relaxant medicine
  • Bed rest is not helpful it increase the risk of chronic disability
  • For pain relief doctor may consider spinal manipulation
  • Lumbar supports, back-specific exercises, traction, acupuncture, epidural or facet injections not helpful for mechanical back pain
  • Physiotherapy may be required if not improved within 6 weeks
  • Low dose Tricyclic anti-depressant drugs will help pain, sleep and mood

Specific

Treatment of other causes should be done accordingly with involving other special departments as per doctor advice.

What should we do for back spasms?

Warm water compression helps to promote healing by drawing healthy blood cells to the area of the back spasm. Heat also relaxes the nerves and muscle fibers. Try an ice & heat alternate cycle after the first 72 hours. Some physical therapists suggest using heat applications before stretching and ice after stretching.

What is the cause of muscle spasms?

Spasms may affect many different types of muscles in the body, leading to many different symptoms. Spasms of skeletal muscles are most common and are often due to overuse, dehydration, and electrolyte abnormalities. The spasm occurs abruptly, is painful, and is usually short-lived.

How do you get rid of a muscle spasm?

Natural Treatments for Muscle Spasms.

  • Prevent Electrolyte Imbalances. A potassium and/or magnesium deficiency can contribute to muscle spasms.
  • Stretch and Massage Your Muscles.
  • Stay Hydrated.
  • Use Ice or Heat Packs on Sensitive Muscles
  • Fix Your Posture.
  • Take a Bath with Epsom Salt.

How long does it take to heal from a back spasm?

After the first three days, you can start using heat to loosen muscle tightness and increase blood flow. Waiting at least 72 hours after your spasms start allows the initial swelling and inflammation to go down, and moist heat is generally preferred to dry because it reduces the potential for dehydration.

Dr. Md Elias Bhuiyan

MBBS, FCPS (Medicine)

Registrar

Bangladesh Medical College & Hospital, Dhaka.

Haemorrhoids (piles)

Haemorrhoids, also known as piles, are swellings containing enlarged blood vessels found inside or around the bottom (the rectum and anus).

When symptoms do occur, they may include:

  • bleeding after passing a stool – the blood is usually bright red
  • itchy bottom
  • a lump hanging down outside of the anus, which may need to be pushed back in after passing a stool
  • a mucus discharge after passing a stool
  • soreness, redness and swelling around your anus

Haemorrhoids aren’t usually painful, unless their blood supply slows down or is interrupted.

When to seek medical advice

See your GP if you have persistent or severe symptoms of haemorrhoids. You should always get any rectal bleeding checked so your doctor can rule out more potentially serious causes.

The symptoms of haemorrhoids often clear up on their own, or by using simple treatments that can be bought from a pharmacy without a prescription.

Speak to your GP if your symptoms don’t get better or you experience pain or bleeding.

Your GP can often diagnose haemorrhoids using a simple internal examination of your back passage, although they may need to refer you to a colorectal specialist for diagnosis and treatment.

Some people with haemorrhoids are reluctant to see their GP. But there’s no need to be embarrassed – GPs are very used to diagnosing and treating haemorrhoids.

What causes haemorrhoids?

The exact cause of haemorrhoids is unclear, but they’re associated with increased pressure in the blood vessels in and around your anus. This pressure can cause theblood vessels in your back passage to become swollen and inflamed.

Many cases are thought to be caused by too much straining on the toilet as a result of prolonged constipation. This is often caused by a lack of fibre in a person’s diet.

Chronic (long-term) diarrhoea can also make you more vulnerable to getting haemorrhoids.

Other factors that might increase your risk of developing haemorrhoids include:

  • being overweight or obese
  • age – as you get older, your body’s supporting tissues get weaker, increasing your risk of haemorrhoids
  • being pregnant – this can place increased pressure on your pelvic blood vessels, causing them to enlarge; read more about piles in pregnancy
  • having a family history of haemorrhoids
  • regularly lifting heavy objects
  • a persistent cough or repeated vomiting
  • sitting down for long periods of time

Preventing and treating haemorrhoids

Haemorrhoid symptoms often settle down after a few days without needing treatment. Haemorrhoids that occur during pregnancy often get better after giving birth.

Making lifestyle changes to reduce the strain on the blood vessels in and around your anus is often recommended.

These can include:

  • gradually increasing the amount of fibre in your diet – good sources of fibre include fruit, vegetables, wholegrain rice, wholewheat pasta and bread, pulses and beans, seeds, nuts and oats
  • drinking plenty of fluid – particularly water, but avoiding or cutting down on caffeine and alcohol
  • not delaying going to the toilet – ignoring the urge to empty your bowels can make your stools harder and drier, which can lead to straining when you do go to the toilet
  • avoiding medication that causes constipation – such as painkillers that contain codeine
  • losing weight if you’re overweight
  • exercising regularly – this can help prevent constipation, reduce your blood pressure, and help you lose weight

 

These measures can also reduce the risk of haemorrhoids returning or even developing in the first place.

Treatment

Medication that you apply directly to your back passage (topical treatments) or tablets bought from a pharmacy or prescribed by your GP may ease your symptoms and make it easier for you to pass stools.

More severe cases need to be treated by a specialist.

One possible treatment is rubber band ligation. Rubber band ligation can be performed in the doctor’s surgery or outpatient clinic and does not require hospital admission.

The procedure involves placing a small rubber band at the base of the haemorrhoid with a special applicator. The rubber band cuts off the blood supply to the haemorrhoid, which eventually falls off after a few days.

Injection of a substance that makes the blood in the haemorrhoid clot is another option (sclerotherapy).

The most serious cases are third-degree haemorrhoids. These protrude through the back passage and can require surgical removal or ‘haemorrhoidectomy’. Such operations are successful in 90 per cent of cases. However, many third-degree haemorrhoids shrink and become symptom-free without surgical treatment.

Prenatal Care

Prenatal care helps decrease risks during pregnancy and increase the chance of a safe and healthy delivery for the mother and child. Regular prenatal visits can help your doctor monitor your pregnancy and identify any problems or complications before they become serious.

Prenatal care ideally starts at least three months before you begin trying to conceive. Some healthy habits to follow during this period include:

  • quitting smoking and drinking alcohol
  • taking folic acid supplements (400 to 800 micrograms)
  • talking to you doctor about your medical conditions and any dietary supplements and over-the-counter or prescription drugs that you take
  • avoiding all contact with toxic substances and chemicals at home or work that could be harmful

During Pregnancy

Once you become pregnant, your physician, or midwife will schedule regular appointments throughout each stage of your pregnancy.

A schedule of visits may involve seeing your doctor:

  • every month in the first six months you are pregnant
  • every two weeks in the seventh and eighth months you are pregnant
  • every week during your ninth month of pregnancy

During these visits, your doctor will check your health and the health of your baby.

Visits may include:

  • taking routine tests and screenings, such as a blood test to check for anemia, HIV, and your blood type
  • monitoring your blood pressure
  • measuring your weight gain
  • monitoring the baby’s growth and heart rate
  • talking about special diet and exercise

Later visits may also include checking the baby’s position and noting changes in your body as you prepare for birth.

Your doctor may also offer special classes at different stages of your pregnancy.

These classes will:

  • discuss what to expect when you are pregnant
  • prepare you for the birth
  • teach you basic skills for caring for your baby

If your pregnancy is considered high-risk because of your age or health conditions, you may require more frequent visits and special care. You may also need to see a doctor who works with high-risk pregnancies.

 

Pre Conceptional Care

What is preconceptional care and why is it important?

Having a healthy pregnancy is one of the best ways to promote a healthy birth. Getting early and regular preconceptional care improves the chances of a healthy pregnancy. This care can begin even before pregnancy with a preconception care visit to a health care provider.

Preconception Care

A preconception care visit can help women take steps for a safe and healthy pregnancy before they get pregnant.

Women can help to promote a healthy pregnancy and birth of a healthy infant by taking the following steps before they become pregnant

    • Develop a plan for their reproductive life.
    • Increase their daily intake of folic acid (one of the B vitamins) to at least 400 micrograms.
    • Make sure their immunizations are up to date.
    • Control diabetes and other medical conditions.
    • Avoid smoking, drinking alcohol, and using drugs.
    • Attain a healthy weight.
    • Learn about their family health history and that of their partner.
    • Seek help for depression or anxiety.

 

Postnatal Care

The postnatal period lasts six to eight weeks, beginning right after the baby is born.

During this period, the mother goes through many physical and emotional changes while learning to care for her newborn. Postnatal care involves getting proper rest, nutrition, and vaginal care.

Getting Enough Rest

Rest is crucial to new mothers who need to rebuild their strength. To avoid getting too tired as a new mother, you may need to:

  • sleep when your baby sleeps
  • keep your bed near your baby’s crib to make night feedings easier
  • allow someone else to feed the baby with a bottle while you sleep

Eating Right Nutrition

Because of the changes your body goes through during pregnancy and labor, getting proper nutrition in the postnatal period is crucial. The weight that you gained during pregnancy helps make sure you have enough nutrition for breastfeeding. However, you need to continue to eat a healthy diet after delivery.

Experts recommend that breastfeeding mothers eat when they feel hungry. Make a special effort to focus on eating when you are actually hungry—not just busy or tired.

Try to:

  • avoid high-fat snacks
  • focus on eating low-fat foods that balance protein, carbohydrates, and fruits and vegetables
  • drink plenty of fluids

Vaginal Care

New mothers should make vaginal care an essential part of their postnatal care. You may experience:

  • vaginal soreness if you had a tear during delivery
  • urination problems, such as pain or a frequent urge to urinate
  • discharge, including small blood clots
  • contractions during the first few days after delivery

Schedule a checkup with your doctor about six weeks after delivery to discuss symptoms and receive proper treatment. You abstain from sexual intercourse for four to six weeks after delivery so that your vagina has proper time to heal.