[27F] With worsening lower back pain and associated symptoms

Patient Description

A 27-year-old female reports long-standing lower back pain that has worsened over the last couple of months. The pain is sharp when lying down and dull at other times, occasionally becoming shooting and sharp. It is exacerbated by long hours at work and somewhat relieved by stretching. The patient experiences a constant dull ache, with no relief for two weeks, sometimes preventing sleep. Additionally, there is lateral knee pain on the outside of the knee, which worsens with severe back pain, described as dull with a severity of 7 out of 10. No recent knee injuries reported. The patient also experiences urinary retention, feeling the need to urinate again after finishing, occurring at least once daily and becoming more noticeable recently. There is difficulty achieving orgasm for the last couple of months, potentially related to Lexapro use. Numbness or tingling is present in the legs, including the inner thighs or groin area. The patient has no known pre-existing conditions or allergies and is currently taking Lexapro (10 mg daily) and has a Kyleena IUD. A daily multivitamin is also taken.

Arora's Assessment

What might be happening

Based on your symptoms, there are a few possibilities to consider:

Cauda Equina Syndrome: This is a serious condition where the bundle of nerves at the end of the spinal cord is compressed. Symptoms can include severe lower back pain, numbness or tingling in the legs, urinary retention, and difficulty with sexual function. This requires immediate medical attention to prevent permanent damage.
Herniated Disc: A disc in your spine may be pressing on nerves, causing pain that radiates down your legs and affects your knee. This can also lead to numbness and tingling.
Sciatica: This occurs when the sciatic nerve is irritated, often due to a herniated disc or spinal stenosis, leading to pain that radiates from the lower back down the legs.
Medication Side Effects: Lexapro can sometimes affect sexual function, which might explain the difficulty in reaching orgasm.

What you can do

Seek Immediate Medical Attention: Given the possibility of cauda equina syndrome, it's crucial to see a healthcare provider or visit an emergency room as soon as possible. This condition can lead to permanent nerve damage if not treated promptly.
Avoid Strain: Try to avoid activities that worsen your pain, and consider taking breaks during long work hours to stretch and move around.
Document Symptoms: Keep a record of your symptoms, including when they occur and their severity, to help healthcare providers with diagnosis and treatment.
Discuss Medications: Talk to your doctor about the side effects of Lexapro, especially if it's affecting your quality of life.

Please remember, this information is not a substitute for professional medical advice. It's important to consult with a healthcare provider for a proper diagnosis and treatment plan. If your symptoms worsen or you experience new symptoms, seek medical help immediately.

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6 mo ago

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