[36F] With lower back pain and urinary symptoms

Patient Description

A 36-year-old female presents with lower back pain, pain throughout the right side and lower abdomen, and a foul odor when urinating. The patient reports that these symptoms have been present for months but have worsened over the past 3 days. The back pain is described as consistent with pressure, particularly in the lower back above the tailbone and the right side, extending under the rib. The pain is exacerbated by bending over and is not relieved by rest or heating pads. The patient also experiences very painful menstrual cramps with a heavy flow lasting 4-6 days, and constipation is a common issue. Nausea is also reported, but there is no fever, chills, or blood in the urine. Previous tests for UTI, kidney infections, bacterial vaginosis, trichomoniasis, and STDs were negative. The patient has a history of cryotherapy for pre-cancerous cells at age 21 and reports the use of methamphetamine. No known drug allergies. Current medications include Seroquel, Paxil, Hydroxyzine, and Prazosin.

Arora's Assessment

What might be happening

Based on the symptoms you've described, there are a few potential explanations for your condition:

Kidney Stones or Kidney Issues: The pain in your lower back and right side, along with the foul odor when urinating, could suggest a kidney-related issue. Kidney stones or an infection might not always show up in standard tests, so further evaluation may be needed.
Endometriosis or Ovarian Cyst: Given your history of painful periods and the pressure in your right side, endometriosis or an ovarian cyst could be contributing to your symptoms. These conditions can cause pelvic pain, pressure, and heavy menstrual bleeding.
Fibromyalgia: Your existing diagnosis of fibromyalgia could also be contributing to your widespread pain and discomfort, as it often causes chronic pain and fatigue.
Substance Use Impact: Methamphetamine use can exacerbate pain and other symptoms, potentially affecting your overall health and well-being.

What you can do

Lower Back and Right Side Pain:

Seek Medical Attention: It's important to consult with a healthcare professional to investigate the cause of your pain, especially since it has worsened recently. They may recommend imaging tests or other evaluations.
Pain Management: Over-the-counter pain relievers like ibuprofen or acetaminophen may help alleviate some discomfort. However, consult your doctor before taking any new medications.

Foul Odor When Urinating:

Hydration: Drink plenty of water to help flush out your urinary system and reduce odor.
Medical Evaluation: Since previous tests were negative, further evaluation by a healthcare professional is recommended to rule out any underlying issues.

Painful Menstrual Cramps:

Heat Therapy: Applying a heating pad to your lower abdomen may help relieve menstrual cramps.
Consult a Gynecologist: Discuss your symptoms with a gynecologist to explore potential treatments for painful periods, such as hormonal therapy or other interventions.

General Health:

Substance Use: Consider seeking support for substance use, as it can impact your overall health and exacerbate symptoms.
Symptom Tracking: Use MDandMe to journal your symptoms, track progress, and share insights with your healthcare provider.

What you should look out for

Given the complexity of your symptoms, it's important to monitor for any changes or worsening of your condition. Seek medical care if you experience:

Severe or sudden pain
Blood in your urine
Fever or chills
Difficulty urinating
Any new or concerning symptoms

Remember, while I can provide guidance, it's essential to consult with a healthcare professional for a formal diagnosis and appropriate treatment. If you have any more questions or need further assistance, feel free to reach out.

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2 d ago

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[36F] With lower back pain and urinary symptoms

What might be happening

What you can do

What you should look out for

Experiencing symptoms?