Differential Diagnosis for 54-year-old Female with Back Pain and Bed Wetting
Single Most Likely Diagnosis
- Degenerative Disc Disease or Lumbar Spondylosis: This condition is common in older adults and can cause back pain. The bed wetting (nocturnal enuresis) could be related to the back pain causing discomfort or pressure on the bladder, or it could be a sign of a neurological component such as cauda equina syndrome, although this would be less common.
Other Likely Diagnoses
- Urinary Tract Infection (UTI): A UTI could cause both back pain (if the infection involves the kidneys) and urinary incontinence or bed wetting.
- Overactive Bladder: This condition can cause a sudden, intense urge to urinate, leading to bed wetting, and back pain could be a separate, unrelated issue.
- Menopause-related Symptoms: Hormonal changes during menopause can lead to urinary incontinence and back pain due to osteoporosis or other menopause-related conditions.
Do Not Miss Diagnoses
- Cauda Equina Syndrome: A serious condition where the nerves in the spinal canal are compressed, leading to severe back pain, urinary retention or incontinence, and potentially permanent nerve damage if not promptly treated.
- Spinal Cord Compression or Tumor: Compression or a tumor on the spinal cord can cause back pain, bladder dysfunction (including incontinence), and other neurological symptoms.
- Kidney Stones: While not directly causing bed wetting, severe back pain from kidney stones could lead to discomfort that worsens at night, and if the stone is causing an obstruction, it could lead to urinary retention or incontinence.
Rare Diagnoses
- Multiple Sclerosis: An autoimmune disease that affects the brain and spinal cord, potentially causing a wide range of symptoms including back pain, bladder dysfunction, and neurological deficits.
- Tabes Dorsalis: A late manifestation of syphilis that affects the spinal cord, leading to back pain, bladder dysfunction, and other neurological symptoms.
- Sacroiliitis: Inflammation of the sacroiliac joints, which can cause back pain and, in rare cases, urinary symptoms if the inflammation affects nearby nerves or structures.