Most back pain settles, but a few symptoms need fast action. Here’s how to tell when to keep moving, call your GP or seek emergency help.
You bend to pick up a bag and your back objects as though you’ve asked it to move a piano. At 50, that is annoying rather than surprising. The difficult bit is knowing whether to give it time or get help.
Most back pain is not caused by anything dangerous. But the symptoms that come with it — particularly changes in bladder control, sensation or leg strength — can change what you need to do next.
Get emergency help if back pain comes with new difficulty passing urine, loss of bladder or bowel control, or loss of feeling around your genitals, bottom or inner thighs. The change may be subtle: you might not feel toilet paper when you wipe, or find you cannot tell when your bladder is full. Do not wait to see whether it clears up.
New pain, tingling, numbness or weakness in both legs is another reason to act immediately. So is a new change in genital sensation or sexual function alongside back pain. For a man in midlife, an erection problem might have several explanations; in this setting, a sudden change is not one to quietly file under ‘getting older’.
These symptoms can signal cauda equina syndrome, in which nerves at the bottom of the spine are compressed. It is rare, but delayed assessment can mean lasting problems with movement, bladder, bowel or sexual function. You cannot rule it out by deciding the pain feels like your usual sciatica.
Go to A&E immediately or call 999 if you cannot get there safely. Do not drive yourself. Back pain with chest pain, or pain that began after a serious accident, also needs emergency assessment.
One other emergency is easy to mistake for a back problem: sudden, severe pain in the back or tummy can be a sign of a problem with the aorta, the main artery carrying blood from the heart. Call 999. You do not need to work out the cause before asking for help.
Ask for an urgent GP appointment if your back pain starts suddenly and is severe, gets worse quickly, or comes with feeling feverish, shivery or generally unwell. A spinal infection is uncommon, but fever alongside worsening pain deserves attention rather than another hot-water bottle.
Pain lower down at the side of your back, particularly below the ribs, may not be coming from your spine at all. If it comes with fever, sickness, pain when you pee or blood in your urine, get urgent advice: a kidney infection is one possibility. Tell the clinician about the whole collection of symptoms, not just the ache.
In England, Scotland and Wales, you can phone 111 for urgent advice when you cannot reach a GP. In Northern Ireland, use your GP out-of-hours service when the surgery is closed; Phone First may also be available in your area for urgent care. These routes are for advice that cannot wait, not a detour when you have the emergency symptoms above.
How your back hurts matters. What else has changed matters more.
Book a GP appointment if the pain is not improving after a few weeks, is stopping you doing ordinary things, or is worrying you. Mention pain that stays much the same regardless of movement, is worse at night or does not ease with rest. Pain between the shoulder blades rather than in the lower back is also worth discussing.
Tell your GP if you have lost weight without trying, have a history of cancer, or develop a new back pain while being treated for cancer. None of these signs means you have cancer. They do mean your clinician needs the full picture. For men with prostate cancer, new back pain is particularly important to report to their cancer team; if it comes with the emergency nerve symptoms described above, seek emergency help instead.
Do not dismiss a new, sharp pain after a fall simply because you managed to get up afterwards. A spinal bone can fracture after a relatively minor injury if it has been weakened by osteoporosis. That is possible in men too, particularly if you have had a previous fragility fracture or take long-term steroid tablets. A serious accident belongs in A&E; after a lesser injury, contact your GP promptly for advice if the pain is new or severe.
These are clues for a clinical assessment, not a home diagnosis. A useful account for your GP includes when the pain began, where it is, whether it travels down a leg, what makes it better or worse, and any change in strength, sensation, weight or general health.
If it feels like an ordinary episode of lower-back pain and none of the warning signs applies, the useful first move is usually to keep moving. Gentle walking and normal activities, adjusted to what you can manage, generally beat staying in bed. You do not have to prove anything to your back by lifting the heaviest thing in the garage, either.
Heat may help stiffness or muscle spasm; try an ice pack wrapped in a towel if it feels better. Ask a pharmacist which pain relief is suitable for you, especially if you have other conditions or take medicines. Anti-inflammatory medicines such as ibuprofen are not suitable for everyone, and paracetamol on its own is not recommended for back pain.
A scan is not automatically the next step. NICE advises against routinely offering imaging for lower-back pain or sciatica in a non-specialist setting; a clinician should consider whether a scan would change your care. If pain persists, your GP may discuss physiotherapy or other support. In many areas, you can approach an NHS musculoskeletal service directly without a GP referral.
And keep checking in with yourself. A back that is slowly settling is different from one that develops a new symptom. If bladder, bowel, saddle-area or both-leg symptoms appear, the plan changes immediately, even if someone has already told you it is probably a strain.
Most back pain improves with time and gentle activity. Seek emergency help for new bladder or bowel changes, numbness around the genitals or bottom, symptoms in both legs, or sudden severe back or tummy pain. Get urgent advice for rapidly worsening pain or fever, and see your GP about pain that persists or comes with other concerning changes.
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