[29F] With swollen feet, back pain, and urinary changes

Patient Description

A 29-year-old female presents with sudden onset of firm swelling in the feet for about a week. She also reports middle back pain by the ribs, worsening with standing or bending over, and alleviated by lying down. Additional symptoms include nausea, severe fatigue, loss of appetite, and burning sensation during urination, with increased frequency and change in urine odor. The patient has a history of epilepsy and a p10 genetic mutation, diagnosed at age 13, and is currently on Lamictal 200mg once daily, Effexor 150mg once daily, and Oxybutynin 10mg once daily. There are no recent changes in medications, diet, or activity level, and no recent injuries or travel. The patient denies fever, chills, or family history of kidney disease. Menstrual periods are absent.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, there are a few potential explanations for what you might be experiencing:

  1. Urinary Tract Infection (UTI): The burning sensation when urinating, increased frequency, and change in urine odor suggest a possible UTI. UTIs are common and can cause discomfort and fatigue. They are typically treated with antibiotics.

  2. Edema: The sudden swelling in your feet could be due to fluid retention, known as edema. This can be caused by various factors, including medication side effects, heart, liver, or kidney issues. Given your medication and health history, it's important to have this evaluated by a healthcare provider.

  3. Fatigue and Nausea: These symptoms can be related to several conditions, including infections, medication side effects, or other underlying health issues. Your fatigue could also be exacerbated by your epilepsy or the medications you are taking.

  4. Back Pain: This could be musculoskeletal in nature, possibly related to posture or strain. However, given the location and your other symptoms, it could also be related to kidney issues, especially if associated with a UTI.

What you can do

Swollen Feet (Edema):

  • Elevate your feet when sitting or lying down to help reduce swelling.
  • Avoid standing for long periods.
  • Wear comfortable shoes and consider compression stockings if recommended by a healthcare provider.

Urinary Symptoms:

  • Drink plenty of water to help flush out your urinary system.
  • Avoid irritants like caffeine and alcohol, which can worsen symptoms.
  • Seek medical attention for a possible UTI, as antibiotics may be needed.

Fatigue and Nausea:

  • Ensure you are getting adequate rest and try to maintain a regular sleep schedule.
  • Eat small, frequent meals to help manage nausea and maintain energy levels.
  • Monitor your symptoms and discuss them with your healthcare provider, especially if they persist or worsen.

Back Pain:

  • Apply heat or cold packs to the affected area to alleviate pain.
  • Practice gentle stretching exercises to improve flexibility and reduce tension.
  • Consider over-the-counter pain relief, such as ibuprofen, if appropriate and not contraindicated by your current medications.

Remember, you can use MDandMe to journal your symptoms, track progress, and share insights with your healthcare provider.

What you should look out for

It's important to seek medical attention if you experience any of the following:

  • Persistent or worsening swelling in your feet or other parts of your body.
  • Severe or increasing pain in your back or abdomen.
  • High fever, chills, or other signs of infection.
  • Changes in your urine, such as blood or a significant change in color.
  • Any new or worsening symptoms related to your epilepsy.

Please consult with a healthcare professional for a formal diagnosis and appropriate treatment. Your symptoms may require further evaluation to determine the underlying cause and ensure you receive the best care.

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People Also Ask


What are the common symptoms of a urinary tract infection (UTI)?

Common symptoms of a UTI include a burning sensation during urination, increased frequency of urination, cloudy or strong-smelling urine, pelvic pain, and sometimes fever or chills. It's important to seek medical attention for proper diagnosis and treatment.


What could cause sudden swelling in the feet?

Sudden swelling in the feet, known as edema, can be caused by fluid retention due to various factors such as medication side effects, heart, liver, or kidney issues, or prolonged standing. It's important to have this evaluated by a healthcare provider.


How can fatigue and nausea be managed when related to medication side effects?

To manage fatigue and nausea related to medication side effects, ensure adequate rest, maintain a regular sleep schedule, and eat small, frequent meals. It's also important to discuss these symptoms with a healthcare provider to determine if medication adjustments are needed.


What are some potential causes of middle back pain by the ribs?

Middle back pain by the ribs can be caused by musculoskeletal issues such as posture or strain, or it could be related to kidney problems, especially if associated with a UTI. It's important to monitor the pain and consult a healthcare provider for a proper evaluation.


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