Differential Diagnosis for Lower Back Pain, Abdominal Pain, and Constipation in a 53-Year-Old Female with Obesity
Single Most Likely Diagnosis
- Diverticulitis: This condition is common in adults, especially those over 40, and can cause lower back pain, abdominal pain (usually on the left side), and changes in bowel habits such as constipation. Obesity may increase the risk of developing diverticulitis due to increased intra-abdominal pressure.
Other Likely Diagnoses
- Irritable Bowel Syndrome (IBS): Although IBS can present with a variety of symptoms including abdominal pain and changes in bowel habits, the presence of lower back pain is less typical but can occur. Obesity might exacerbate symptoms.
- Degenerative Disc Disease: Lower back pain is a hallmark of this condition, and while it might not directly cause abdominal pain or constipation, the discomfort and reduced mobility could indirectly contribute to these symptoms.
- Herniated Disc: Similar to degenerative disc disease, a herniated disc could cause lower back pain and, if the herniation affects nearby nerves, could potentially lead to referred pain or discomfort in the abdominal area.
Do Not Miss Diagnoses
- Ovarian Torsion: Although less common, ovarian torsion is a medical emergency that can cause severe lower abdominal pain and sometimes lower back pain. Constipation might not be a direct symptom, but nausea and vomiting could lead to decreased bowel movements.
- Appendicitis: Typically presents with abdominal pain, but atypical presentations can occur, especially in older adults or those with obesity, where the appendix is located higher in the abdomen, potentially causing lower back pain.
- Kidney Stones: Can cause severe lower back pain (flank pain) and abdominal pain, and while not directly causing constipation, the pain and associated nausea could lead to decreased oral intake and subsequently constipation.
Rare Diagnoses
- Colorectal Cancer: While more common in older adults, colorectal cancer can present with abdominal pain, changes in bowel habits (including constipation), and potentially lower back pain if the cancer has spread. Obesity is a risk factor for colorectal cancer.
- Spinal Infection (e.g., Discitis or Osteomyelitis): Infections of the spine can cause lower back pain and, if the infection spreads or affects nearby structures, could potentially cause abdominal pain and constipation due to decreased mobility and discomfort.
- Endometriosis: Although more commonly associated with pelvic pain and menstrual irregularities, endometriosis can cause chronic lower abdominal and back pain, and constipation if endometrial implants involve the bowel.