Back Pain

Back Pain Warning Signs You Should Not Ignore

Most back pain improves on its own. However, some symptoms can be a sign of a more serious problem that needs urgent medical attention. This short explains some of the warning signs, often called 'red flags'.

Symptoms affecting your legs, bladder or bowel

These symptoms, sometimes called cauda equina syndrome, can suggest serious pressure on the nerves at the base of the spine and require urgent assessment.

• Saddle anaesthesia. This is numbness or a pins-and-needles feeling in the area that would touch a saddle, including your genitals, buttocks and inner thighs.
• Bladder or bowel changes. This includes new problems with starting or stopping urination, or a loss of control over your bladder or bowel function.
• Leg weakness. Progressive weakness, numbness, or loss of sensation in one or both of your legs can be a serious sign.

Other important warning signs

• After a major injury. If your back pain started after a significant trauma, such as a fall from a height or a road traffic accident, it should be checked.
• Worsening pain. Pain that is severe, constant, and gets progressively worse, particularly if it wakes you from sleep, needs investigation.
• Systemic symptoms. Back pain that occurs with unexplained weight loss or a fever can sometimes point to an underlying infection or tumour.
• In certain medical histories. If you have a known history of cancer, osteoporosis, or long-term steroid use, any new back pain should be assessed by a doctor.

What to do if you have these symptoms

• Seek urgent advice. If you experience any of these 'red flag' symptoms, you should seek a medical opinion without delay.
• See a specialist. Your doctor may refer you to a spine specialist for further assessment and to discuss your case.
• Expect diagnostic tests. An MRI scan is often required to examine the spinal cord and nerves in detail and help find the cause of the problem.

The suitability of any investigation or treatment depends on your individual circumstances. A final decision can only be made after a specialist has reviewed your medical reports and recent imaging.