We are gynos, and we do pelvic exams, and in fact we find out that as often as not, the real back story to back pain is a treatable pelvic condition. If you are going to massages, PT therapy, or using ice or heat to your lower back on a regular basis, you may have forgotten one important step: checking back in with your gyno as well! Uterine fibroids, ovarian cysts, adenomyosis, endometriosis, pelvic infections, STDs, and pelvic floor problems like prolapse are just some of the common causes of lower back pain that have nothing specifically to do with the back.
Back pain is categorized as either acute: under a month, or chronic: over 3 months. There are some conditions called subacute that are in that 2 month range, but most causes are acute or chronic! Something new: just hang in for 4 weeks, it might just resolve, as long as there is nothing lie fever or something that you suspect is clearly a red flag alert to speak to a provider about.
Go over these facts with your gyno:
- Rate your pain
- Does it interfere with life enjoyment
- Does this pain interfere with activity
- How long has it been going on
- What can you do to make it better
- Have you had a recent injury or taken up new sports
- Are there associated bowel or bladder symptoms
- Does it hurt worse when you have sex?
If you aren’t diagnosed with a treatable medical condition yet, here’s some simple things that may help relieve the pain:
- STAY ACTIVE!
- Read about the Back pain initiative from the ABIM; http://www.choosingwisely.org/patient-resources/imaging-tests-for-back-pain/
- Get a pelvic exam: prolaspse can only be diagnosed on exam! And non-hormonal solutions can be discussed.
- Try some active self-therapy: this would include massage, roller foam, heat, ice, stretching, yoga
- Acupuncture or other alternative therapy can be very successful
- If you can safely use try an NSAID
- Try topical medications, may want to do this with your PCP primary care provider’s advice
- For more advanced medication, get a consultation
Back pain can be a big topic to discuss, but here are a few other hints:
Other considerations for women who commonly have back pain, note it is often more pronounced in pregnancy, during stress, and during illnesses, even Covid 19. Hot showers, and heating pads, maternity girdles, ice packs, and rest, have been the main options for most women and all are safe if you are pregnant. When that fails prescription pain medications have been used, but only some are safe in pregnancy
It is possible for some pelvic pain to be caused by back pain. Walking in the tall pointy high heels will exaggerate your lower back curvature forward causing strains that can lead to lower back pain and pelvic pain. It is not always possible to pinpoint the cause of some of these nagging back or pelvic pains, because some physical signs are subtle. That vague pain that hurts a bunch more if you start to do sit-ups or the elliptical, this might be a sign of something else. If you have a history of crooked spine (scoliosis) or back or muscle problems you are more likely to be suffering from muscular derived pain than inner abdominal or pelvic organ problems, but the pelvic exam should help you figure that out.
If your stretching and exercising hurts a bunch more than ever before, then you are more likely to have a muscle or fascia problems. If you contract your abdominal wall and you feel a bit better, again, it might be myofascial pain. Radiating pain from back to groin or thigh is more likely muscular. Remember it could be both muscular and organ in nature. You will need a pelvic exam to determine if you in fact have uterine fibroids or a treatable cause of the pain. And your gyno can sort, so don’t go it alone is your pain is persistent!
