Critical Signs Your Lower Back Pain Is a Medical Emergency
Lower back pain is extremely common, affecting nearly all of us at one point or another. Usually, that twinge or achiness in the lower back has a benign explanation; perhaps you pushed your body past its limits in yesterday’s workout or sat with poor posture throughout yesterday’s meeting. But that doesn’t mean lower back pain is never a cause for concern – certain symptoms warrant emergency medical care to prevent serious complications.
Here, we’ll break down critical signs your lower back pain is a medical emergency to ensure you receive the proper care for your needs.
Red Flag Symptoms of Lower Back Pain
Red flag symptoms of lower back pain include loss of bladder or bowel control, severe neurological symptoms, sudden numbness or weakness, and sharp or unusual pain patterns.
Loss of Bladder or Bowel Control
Lower back pain with a loss of bladder or bowel control is often associated with cauda equina syndrome, a severe complication that requires emergency medical care. The cauda equina is a collection of nerve roots at the base of the spine, and it’s essential to bladder and bowel control. When it’s compressed, immediate medical care is vital to preventing permanent nerve damage and possible paralysis.
Severe Neurological Symptoms
Neurological symptoms like tingling, radiating pain, weakness, and numbness can occur with various spinal conditions, including herniated disc, spinal stenosis, and spondylolisthesis. If a spinal nerve becomes compressed, it sends irregular signals to the area of the body it supplies, causing these symptoms. If these symptoms become severe, debilitating, or worrying, seek immediate medical care to address the nerve irritation and prevent lasting nerve damage.
Sudden Numbness or Weakness
Numbness or weakness that occurs suddenly or progresses rapidly is a major red flag, as it can point to a severely compressed nerve or cauda equina syndrome. These symptoms may require emergency medical care to rule out these serious complications and stop further nerve damage.
Sharp, Unusual Pain Patterns
If your lower back pain becomes exceptionally sharp or follows an abnormal pain pattern, it’s time to pay closer attention. A pain pattern is how your pain shifts with activities, as well as its location, intensity, and sensation. Common examples include:
- Sudden vs. gradual pain
- Constant vs. intermittent pain
- Sharp vs. dull pain
- Localized vs. radiating pain
- Severe vs. moderate vs. mild pain
Lower back pain that’s sudden, constant, sharp, or severe justifies a medical evaluation, especially if it occurs with other red flag symptoms.
Emergency Back Pain Conditions
Emergency back pain conditions like cauda equina syndrome, spinal fractures, abdominal aortic aneurysm, and severe herniated discs require immediate medical care to prevent severe complications. Understanding the warning signs of these conditions can help you get the care you need if an emergency strikes.
Cauda Equina Syndrome
As discussed above, cauda equina syndrome is a serious neurological condition that can lead to permanent nerve damage and even paralysis if left untreated. Although it’s relatively rare, if you experience any of the following symptoms of cauda equina syndrome, seek emergency medical care:
- Bladder and/or bowel dysfunction
- Severe or worsening numbness, tingling, or burning in these regions of the lower extremities:
- The saddle region, including the perineum, buttocks, and inner thighs (the parts of the body that would touch a saddle)
- The backs of the legs
- The feet or heels
Spinal Fractures
A spinal fracture (also known as a vertebral fracture) is a crack or break in a vertebra, one of the bones that make up the spinal column. Spinal fractures pose the risk of nerve damage – including damage to the spinal cord – and are often treated as a medical emergency. Traumatic spinal fractures (following a major fall or auto accident, for example) and unstable fractures pose the highest risk of serious complications.
Compression fractures from osteoporosis are a common type of vertebral fracture. Osteoporosis weakens the bone tissue, making it more prone to fractures.
Abdominal Aortic Aneurysm
Abdominal aortic aneurysm, or AAA, occurs when the portion of the aorta (the body’s largest artery) that travels through the abdomen swells or bulges. In most cases, it’s asymptomatic, meaning it causes no symptoms. But it can trigger deep lower back pain with a throbbing or pulsing sensation, like a heartbeat, in the abdomen.
AAA is an uncommon, but possible, cause of back pain. Around 1% to 2% of lower back pain cases result from non-mechanical spine or visceral conditions, like AAA. It’s a medical emergency that can be life-threatening, making immediate care absolutely essential.
Warning signs of AAA include:
- Pulsing or throbbing sensation near the navel
- Constant pain in the abdomen
- Deep lower back pain
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Severe Herniated Discs
Herniated discs are common, impacting around five to 20 out of every 1,000 adults each year. They occur when a tear develops in a spinal disc’s interior, causing the soft disc interior to protrude outward. If a herniated disc is severe, the damaged disc material can press on nearby nerves and even the spinal cord, posing the risk of serious nerve damage.
Warning signs of a severely herniated disc include:
- Severe pain that radiates from the back to the extremities
- Muscle weakness
- Severe numbness or tingling in the back or extremities
- Balance problems or difficulty moving
- Changes in bowel or bladder function
When to Go to the Emergency Room vs. See Your Doctor
Lower back pain doesn’t usually require a visit to the emergency room; in most cases, a regular doctor’s appointment will suffice. But how can you tell when to go to the emergency room and when to see your doctor for back pain?
Signs that you’re dealing with a true emergency that requires an ER visit include:
- Loss of bowel or bladder control
- Sudden, severe, intense back pain
- Fever or chills
- Nausea or vomiting
- Abdominal pain
- Confusion, dizziness, or unconsciousness
- Sudden weakness in the extremities
- Difficulty walking or standing
- Back pain following an accident, fall, or other trauma
- Unexplained weight loss
Signs that you need prompt care, but it’s not an emergency, include:
- Pain radiating from the back to the extremities
- Pain that worsens with movement
- Pain that worsens at night
Signs that your condition can be addressed with a regular doctor’s visit include:
- Mild to moderate pain
- Pain that clearly occurs with certain movements, like twisting or lifting objects
Steps to Take During a Back Pain Emergency
During a back pain emergency, following certain steps as you go to the hospital can help facilitate care and healing.
What to Tell Emergency Responders
During a back pain emergency, if you’re able, tell the emergency responders:
- The location of your pain
- Pain characteristics (sharp, dull, radiating, etc.)
- Pain severity
- Other symptoms you’re experiencing (fever, muscle weakness, etc.)
- Recent injuries, surgeries, or traumas (if applicable)
- Positions that worsen your pain
Additionally, if you have a medical alert device, inform the responders of it.
Important Medical Information to Bring
If you’re able to gather this information before going to the ER, it can help your providers better understand your needs:
- A list of the medications you’re currently taking
- Any allergies
- Any recent injuries or traumatic events, like a car accident
- Past diagnoses, treatments, and surgeries
- Any relevant legal documentation you have, like an advanced directive, living will, or Do Not Resuscitate (DNR) order
What to Expect at the ER
Upon arriving at the ER, you’ll move through an examination and treatment process that may take several hours, depending on how busy the hospital is and the urgency of your symptoms.
- If you arrive in an ambulance, you’ll go straight to the ED for treatment.
- If you arrive on your own, you’ll go into the waiting room and get checked in by a hospital staff member, who will gather your information.
- In a process known as “triage”, a nurse may conduct a basic exam to record your vital signs and evaluate how urgent your condition is.
- After any applicable waiting period, you’ll move to the exam area to be checked by a physician, who may order additional tests (like an EKG, imaging, or blood testing).
- Based on this evaluation, your physician will determine the next steps for treatment and/or discharge. For non-severe cases, you may be given medications and/or IV fluids, and your physician will outline the next steps before you’re discharged. In severe cases, you may be admitted to the hospital for further treatment or surgery, if applicable.
Follow-Up Care Requirements
Your physician at the hospital will outline any follow-up care requirements, which may involve taking certain medications, visiting a specialist during their normal clinic hours, or preparing for surgery. Make sure to follow your physician’s instructions to a T to prevent worsening symptoms and promote healing.
