Back Pain Red Flags That Need Urgent Attention

Back pain is extremely common, and most of it settles with time, movement and simple treatment. Serious causes are rare. But they do happen, and some of them need treatment within hours, not weeks.

Here are the warning signs every family should know.

Go to a hospital emergency department today if you have:

• Numbness or tingling between the legs, around the genitals or the back passage (sometimes called saddle numbness)
• New difficulty passing urine, not feeling when your bladder is full, or leaking urine
• Loss of bowel control or not feeling when you open your bowels
• Weakness in both legs, or legs giving way
• Sexual dysfunction that came on with the back pain

These can be signs of cauda equina syndrome, where the nerves at the bottom of the spinal canal are squeezed. It needs emergency surgery assessment. Delays can lead to permanent bladder, bowel and nerve problems.

See a doctor urgently (within a day or two) if you have:

• Back pain after a significant fall or accident, or a minor fall if you have osteoporosis
• Back pain with fever, chills or feeling generally unwell
• A history of cancer, with new back pain
• Unexplained weight loss
• Pain that is constant and severe at night, and doesn't ease with any position
• A foot or leg that is getting weaker day by day (for example, the foot slapping down when walking)
• Back pain in someone who injects drugs, has a weakened immune system or has been on long-term steroids
• Severe pain in the upper back or chest that spreads, especially with breathlessness, sweating or feeling faint (call emergency services; this could be a heart or major blood vessel problem)

What is reassuring

• Pain that came on after lifting, bending or an awkward movement
• Pain that changes with position and movement
• Pain that is easing over days to weeks
• Feeling otherwise well

Why physios ask strange questions

At your first appointment, a physiotherapist will ask about your bladder, bowels, weight, night pain and general health. It can feel unrelated to your back, but these questions screen for exactly these red flags. Answer honestly, even if it feels awkward.

If you have any of the emergency signs above, don't wait for a physiotherapy appointment. Go to hospital.