Increasingly large abdomin low back pain

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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(Yes... the correct spelling is "abdomen" but people occasionally will misspell it during the course of an internet search.) This combination of symptoms, while uncommon, may be disturbing. Probably the most common combination here is obesity and a bad back.

Obesity is becoming increasingly common throughout the world. In the United States, this increase has been dramatic: Between 1980 and 1999, the percentage of overweight people increased from 47 to 61%, and the percentage of obese people increased from 15 to 26%. (Figures from the CDC, Atlanta)

Obesity is more common among women than among men. Obesity is equally common among black and white men and is slightly more common among Hispanic men. However, obesity is much more common among black and Hispanic women than among white women. About 67% of middle-aged black women are overweight or obese compared with 45% of middle-aged white women.

Severely obese people often walk abnormally as a result of the excess weight. The abnormal stress on joints leads to osteoarthritis in the hips, knees, and ankles. Low back pain may also result.

An obvious association of increasing abdominal girth and low back pain is pregnancy. It is not uncommon for low back pain to develop during the course of pregnancy.

Another common cause of an enlarging abdomen and low back pain is fibroids.

Fibroids are common, benign growths of uterine muscle. They range in size from small to enormous, capable of filling the whole abdomen! They are more common in obese women and those who have no children.

The most common complaints of women with fibroids are pressure symptoms and heavy periods. They can cause back ache, lower abdominal discomfort and pain on intercourse.

Other potentially serious problems may cause the combination of increasing abdominal size and low back pain.

For instance…

Inatraabdominal malignancies can present with enlarging abdominal girth. If there is spread to bone (metastases) low back pain can also occur.

Sometimes tumors or other inflammatory disorders inside the abdomen such as pancreatitits or hepatitis/cirrhosis will cause fluid accumulation. This is called ascites and may also be associated with low back pain.

Kidney disorders can also cause low back symptoms. If associated with bleeding into the space behind or within the abdomen, there may be abdominal distention as well.

Regardless of cause, it is important for a person who has persistent low back pain, particularly if there is a change in abdominal size, to see a physician immediately.

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