Question: Dear Doctor,

I would like to ask you for help with the diagnosis and treatment of my symptoms. I have been suffering from chronic back pain since about the age of 16, progressively worsening until now. The back pain occurs mainly when I'm sitting (in any kind of position, in an armchair, table chair, on a gym ball, in a car), when I'm standing, and when I'm walking slowly. When I'm doing some work that requires movement (such as cooking, tidying) or when walking fast, I do not experience this pain.

As for my personal history, I have rarely done any kind of regular exercise, except for running (for two years), and dancing (for another year). To make matters worse, I have always spent a lot of time sitting at school or at home in front of the computer since my childhood.

Last year the pain became so severe that I became incapacitated in the sense of not being to do any work that requires sitting, which in today's world means almost any work. I had to drop out of university and submit a notice in my job.

I began intensive physiotherapy in September 2014 (3 times a week), which lasted until December 2014. I was treated at two different clinics by 2 different physiotherapists using different methods. I conscientiously started doing 3 hours of exercise daily, including stretching and muscle building exercises. I do this until today.

The exercise that I do provides temporary relief, in the sense that I always feel better, less tight and less painful than before the exercise. However, it doesn't relieve the pain completely.

In fact, as soon as I sit down into any kind of position (and I've tried numerous computer chairs, armchairs, etc..), in the space of a few minutes I begin to feel unbearable pain again.

So the progress has been none in 4 months. Pills do not work with the pain. I can barely finish writing this message and I'll soon need to go take some rest in the sense of moving of walking.

If I sit for longer than 10 minutes, all my body starts contracting. Firstly, it's the muscles in the neck area and the lumbo-sacral area. Then, it's the muscles on the belly. It progresses until all my back and front muscles are extremely tight. In this stage, I can barely take a breath how tight I feel. Also, I start feeling pain and a burning sensation in my coccyx. Further, I feel a strange tingling sensation in my belly, back and in my hands.

At the same time, together as the pain and tightness increase, I start having problems with urinary dribbling. So whenever I sit, my underpants get wet.

I have been to several specialists who have not been able to provide an answer to my problems.

(the following is a translation from my mother tongue, so it may be incorrect)
I had an MRI done of the Lubosacral spine: flattened lumbar lordosis, slight S-shaped scoliosis, signs of Sheurmann. Slightly bulging disk L4/L5 with increased fluid in the facet joints bilaterally - bilateral borderline Intervertebral Foramina. Functional blockage of vertebrae

MRI of Cervical spine: slight S-shaped scoliosis with rotation of vertebrae, cervical lordosis flattened in C2-C4 - functional blockage. Starting uncovertebral arthritis. C4/C5, C5/C6 uncovertebral osteophytes on the left side cause a narrowing in lateral recessus and IV foramen.

On the urological examination (cystoscopy and cystometry) they found a hypersensitive, hyperactive detrusor, and a dyscoordinated sphincter.

In addition, I have had 2 MRIs of the brain, EEG, countless blood tests, immunology screen, endocrine screen, internal screen, neurological examination and many other diagnostic tests looking into things that could possibly be causing back pain and all came negative of any organic disease.

I am yet to undergo an MRI of thoracic spine.

What helps is when I use special heating pillows, I heat them as much as is bearable, then put them on all my back, lie still for 20 minutes, then do the exercises from the physiotherapy, where I literally feel how all my vertebrae crack back to their right position, and not only vertebrae but also joints like my shoulders and my hips, everything cracks into the position, then I stretch and then for a moment the pain is bearable.

However, as soon as I sit down, it's back on.

Would you please be so kind and provide some insight as to what I can do so I can study at university and have a job again, and live again? This situation is debilitating and unbearable. Perhaps the doctors missed something?

Thank you very much.

All the best,

XXXX

Thank you for your answer.

Could you please provide a description of both the dynamic X-rays and the MRI the way you would prescribe it? That will make it easier for me to convince my doctors to do these tests... or in case they refuse, I can order them myself.

I know that those MRI findings do not justify urinary dysfunction but since that occurs primarily when I'm sitting, I have a theory that as I sit and the belly muscles get tighter and tighter, they put additional pressure on the bladder and the sphincter which then under the pressure leak a little urine. Therefore, it's something like stress incontinence, where the bladder is naturally hypersensitive and when more pressure is added it leaks a little urine (such as when coughing etc..). Do you think this would be a reasonable explanation?

Thank you.

All the best,

XXXX

Thanks again for your answer.

I'm quite happy that you like my explanation... Otherwise it would remain a mystery - my doctors tell me that my problems are real but it's impossible to find the cause...

One last thing - I've had EMG and evoked potentials done, together with MRIs and they all came clean. There doesn't seem to be any central or peripheral nerve damage.

Therefore, if the MRI of thoracic spine also comes clean of any lesion, could we confidently rule out a neurologic urinary bladder?

I further had a filling cystometry/ cystoscopy. The doctor writes that everything is there as it should be but it doesn't work as it should. The conclusion is a non-neurogenic LUTS, hypersensitive and hyperactive detrusor with normal compliance and normal capacity; sphincter dyscoordination.

I think that the conclusion of the urologist is that it's neither urologic, nor neurologic bladder dysfunction (since he said that everything is there as it should be).

1) So with this amount of information, assuming that the thoracic MRI is OK, can we conclude that my theory with the stress incontinence is the most likely explanation? (where the stress incontinence is probably psycho-somatic in origin).

2) Maybe I should consult a urologist here as well?

Thanks again.

All the best,

XXXX