Dear Doctor,

I am 26 years old and for as long as I can remember, I have suffered with random backaches. Sometimes, I do not get one in like two months, but then it comes back. I visited a doctor but he only prescribed pain killers. When I get my period, it gets worse. I feel like someone is stabbing me with a knife. What is the reason behind this? It normally lasts a few minutes, maybe 20 at the most, but I’ve failed to follow how often. It feels like all the time. Do I need a scan? Is there a deeper problem?

Helena

Dear Helena,

Backache at such a young age can be due to multiple reasons. The most common cause is a bad posture while working. Bending from the back for doing multiple chores, lifting heavy weights, cause strain to the back muscles and its supporting structures, like ligaments and joints.  Using a very thick mattress for sleeping, slumping in cushioned chairs and sofas is also not good for the back.  Sometimes the muscle fibres can rupture, causing severe backache. The disc present in between two vertebrae, can herniate in the space below, causing severe backache and abnormal sensations in the legs if the nerves are compressed by the herniated disc. Strain and trauma to the back as in child birth, spinal injections taken for numbing the spine as during C-section or any other surgery, are yet other causes of backache. Backache due to any one of these musculoskeletal causes is compounded by softening of the bones due to calcium deficiency. During puberty, pregnancy or breast feeding, the demand for calcium is increased in the body. This, if not fulfilled, leads to joints pain, including backache.

A young woman can have backache due to pelvic and or urinary tract infections. In such a case, pain is localised over the lower back. It is associated with pain over the lower part of the abdomen as well.  One or more, other symptoms of infection will invariably occur, like burning pain during urination, frequency of urination, painful coitus, vaginal itching and discharge. Some women suffer from backache during menses as part of dysmenorrhoea (painful periods). This is said to occur due to the influence of hormones and subsides once periods are over. Infections of the lining of uterus, endometriosis, benign uterine tumours, also cause backache. But these are associated with heavy or altered menstrual bleeding and abdominal pain.

It is advisable to keep the back straight as far as possible. Instead of bending, one can sit straight on their knees for something to be done. Avoid chairs and sofas, where the back slumps. Avoid thick mattress on the bed.  C.T. and MRI scans will help to diagnose muscle strain/rupture or herniated intervertebral disc. Treatment lies in pain killers, correct postures and surgical intervention if the problem is severe or persistent.

Urinary tract and pelvic infections can be easily diagnosed by typical clinical features and laboratory tests and are treatable. Physical examination along with a pelvic ultrasound helps in diagnosis of uterine infections or tumours. Any one of these present is also treatable.

Dr Rachna is a specialist in internal medicine  at Ruhengeri Hospital

rachna212002@yahoo.co.uk