[24F] With sharp lower back pain, nausea, and fatigue

Patient Description

A 24-year-old female presents with sharp lower back pain that started yesterday. The pain is intermittent, worsens with walking, and radiates down the legs without associated numbness or tingling. The patient also reports nausea, fatigue, decreased appetite, diarrhea, and sharp abdominal pain since yesterday. There is no history of recent injuries, accidents, unusual food intake, travel, or changes in sexual activity. The patient has an irregular menstrual cycle and a history of iron deficiency. No medications or known allergies. No recent exposure to sick individuals.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, here are some possible explanations:

Nausea and Abdominal Pain

  • Gastroenteritis: This is an inflammation of the stomach and intestines, often caused by a viral or bacterial infection. Symptoms can include nausea, diarrhea, and abdominal pain.
  • Food Poisoning: Consuming contaminated food can lead to sudden nausea, diarrhea, and abdominal pain.
  • Irritable Bowel Syndrome (IBS): This condition can cause abdominal pain, bloating, and changes in bowel habits, including diarrhea.

Lower Back Pain Radiating Down Legs

  • Sciatica: This condition occurs when the sciatic nerve is compressed, often due to a herniated disc or spinal stenosis. It can cause sharp pain in the lower back that radiates down the legs.
  • Lumbar Strain: Overuse or injury to the muscles and ligaments in the lower back can cause sharp pain that may radiate down the legs.

Fatigue and Loss of Appetite

  • Iron Deficiency Anemia: Given your history of low MCHC value, iron deficiency anemia could be contributing to your fatigue and loss of appetite.
  • Chronic Stress or Anxiety: These can lead to fatigue, loss of appetite, and gastrointestinal symptoms.

What you can do

Nausea and Abdominal Pain

  • Stay Hydrated: Drink plenty of fluids like water, clear broths, or oral rehydration solutions to prevent dehydration.
  • Eat Bland Foods: Stick to bland, easy-to-digest foods like bananas, rice, applesauce, and toast (the BRAT diet).
  • Avoid Irritants: Stay away from spicy, fatty, or fried foods, as well as caffeine and alcohol.
  • Over-the-Counter Medications: Consider taking anti-nausea medications like meclizine or antacids, but consult with a healthcare provider first.

Lower Back Pain Radiating Down Legs

  • Rest and Gentle Movement: Avoid activities that worsen the pain, but try to keep moving gently to prevent stiffness.
  • Apply Heat or Cold: Use a heating pad or ice pack on the affected area for 15-20 minutes at a time.
  • Over-the-Counter Pain Relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help reduce pain and inflammation.
  • Physical Therapy: Consult a healthcare provider for a referral to physical therapy for targeted exercises and treatments.

Fatigue and Loss of Appetite

  • Balanced Diet: Ensure you're eating a balanced diet rich in iron, vitamins, and minerals. Foods like lean meats, leafy greens, and fortified cereals can help.
  • Regular Sleep Schedule: Maintain a consistent sleep schedule to improve your energy levels.
  • Consult a Doctor: Given your history of iron deficiency, it may be beneficial to have your iron levels checked and discuss potential supplements with your healthcare provider.

What you should look out for

Given the severity of your symptoms, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

  • Severe or Worsening Pain: If your back pain or abdominal pain becomes severe or unmanageable.
  • Persistent Vomiting or Diarrhea: If you cannot keep fluids down or if diarrhea persists for more than a couple of days.
  • Signs of Dehydration: Such as dry mouth, dark urine, or dizziness.
  • Blood in Stool: This can be a sign of a more serious condition and should be evaluated by a healthcare provider.
  • Fainting or Severe Weakness: These could indicate a more serious underlying issue.

Remember, while I can provide guidance, it's important to consult with a healthcare professional for a formal diagnosis and treatment plan. You can use MDandMe to journal your symptoms, track your progress, get insights, and share your medical notes with your provider.

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4 mo ago


People Also Ask


What could be causing my sharp lower back pain that radiates down my legs?

Your sharp lower back pain that radiates down your legs could be due to sciatica, which occurs when the sciatic nerve is compressed, or a lumbar strain, which involves overuse or injury to the muscles and ligaments in the lower back.


Why am I experiencing nausea, fatigue, and a decreased appetite?

Nausea, fatigue, and decreased appetite could be related to iron deficiency anemia, given your history, or could be symptoms of a gastrointestinal issue like gastroenteritis or food poisoning.


How can I manage my symptoms of diarrhea and abdominal pain at home?

To manage diarrhea and abdominal pain at home, stay hydrated with fluids like water or oral rehydration solutions, eat bland foods such as bananas and rice, and avoid irritants like spicy or fatty foods. Over-the-counter medications may help, but consult a healthcare provider first.


When should I seek medical attention for my symptoms?

You should seek medical attention if you experience severe or worsening pain, persistent vomiting or diarrhea, signs of dehydration, blood in your stool, or fainting and severe weakness.


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