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A 57 year old lady having going to bathroom several times, and have pain in abdomen and also radiates to back

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I now have sufficient clinical information to provide a thorough differential diagnosis and management approach. Let me compose a comprehensive answer.

Clinical Assessment: 57-Year-Old Female with Frequent Urination + Abdominal Pain Radiating to the Back

This presentation has several important diagnostic possibilities that need to be considered systematically.

Top Differential Diagnoses

1. Acute Pyelonephritis (Upper UTI) - Most Likely

A 57-year-old woman with frequency, abdominal/flank pain fits pyelonephritis very well.
Classic features:
  • Urinary frequency, urgency, and dysuria (lower tract symptoms)
  • Flank/CVA (costovertebral angle) tenderness - the back radiation
  • Fever, chills, nausea, malaise (systemic features)
  • Occasionally, lower abdominal pain that lateralizes
"Pyelonephritis is associated with flank and CVA pain, although lateralizing lower abdominal pain occasionally is present." - Berek & Novak's Gynecology
Key distinguishing feature: New-onset frequency, dysuria, and urgency without vaginal discharge have a 90% positive predictive value for acute cystitis; if fever and flank pain are also present, pyelonephritis is favored.

2. Urolithiasis (Kidney/Ureteric Stone)

A classic mimic with similar features:
  • Severe colicky pain starting in the flank, radiating to the groin/lower abdomen
  • Associated urinary frequency, urgency, and hematuria
  • Pain is typically sudden onset, "waves" of severity
"Flank pain radiating toward the groin... usually associated with hematuria, urinary frequency, urgency, and dysuria and is relieved immediately after passage of the stone." - Swanson's Family Medicine Review
Postmenopausal women are at increased risk due to reduced estrogen (loss of urinary pH buffering).

3. Acute Pancreatitis

Should be on the differential given the abdominal pain radiating to the back, especially if the pain is epigastric.
Classic features:
  • Epigastric pain radiating straight to the back - hallmark symptom
  • Nausea, vomiting, diarrhea
  • Pain constant and worsening (unlike colicky stone pain)
  • No urinary symptoms primarily (but can have irritative symptoms from retroperitoneal inflammation)
"The cardinal symptom of AP is epigastric or periumbilical pain that radiates to the back." - Sabiston Textbook of Surgery
Note: At age 57, gallstones (the #1 cause of pancreatitis) are common in women. Also consider pancreatic neoplasm - especially since she is over 40 years old.

4. Acute Cystitis (Lower UTI)

If the pain is more suprapubic (not back-radiating) and there are no systemic features:
  • Dull suprapubic pain, frequency, urgency, dysuria, occasional hematuria
  • No fever or flank tenderness
  • Common in postmenopausal women (loss of estrogen causes vaginal/urethral atrophy)

5. Other Causes to Consider

ConditionDistinguishing Features
Ovarian/adnexal pathologyLateral lower abdominal pain, may radiate; check pelvic exam
Aortic aneurysmSevere back pain, pulsatile abdominal mass, older patient - rule out urgently
CholecystitisRight upper quadrant pain, Murphy's sign, fatty food intolerance
Interstitial cystitisChronic frequency/urgency/pain without infection
Colorectal pathologyEspecially in a 57-year-old; colon cancer, diverticulitis

Recommended Workup

Immediate / Bedside

  • Urine dipstick - leukocyte esterase, nitrites, blood, protein
  • Urine microscopy - WBCs (pyuria), RBCs, bacteria, casts
  • Urine culture (before starting antibiotics)

Blood Tests

  • FBC - WBC count and differential (infection vs. other)
  • CMP/renal function - creatinine, electrolytes
  • Serum amylase and lipase (3x upper limit of normal = pancreatitis if raised)
  • LFTs - bilirubin, ALP (biliary obstruction/gallstones)
  • Blood cultures if febrile (rule out urosepsis)
  • Serum CRP/procalcitonin

Imaging

  • Renal/Abdominal Ultrasound - first-line for kidney stones, hydronephrosis, gallstones, pancreas
  • CT Abdomen/Pelvis (non-contrast) - best for urolithiasis
  • CT Abdomen with contrast - if pancreatitis/abdominal pathology suspected

Initial Management (Pending Diagnosis)

If pyelonephritis suspected:
  • Oral fluoroquinolone (ciprofloxacin) or trimethoprim-sulfamethoxazole x 10-14 days (outpatient if mild)
  • IV antibiotics + admission if systemic features (fever, vomiting, sepsis signs)
  • Adequate IV hydration
If acute pancreatitis confirmed:
  • NPO status, aggressive IV fluid resuscitation (lactated Ringer's preferred)
  • IV analgesia + antiemetics
  • Monitor for complications (organ failure, necrosis)
  • Hospitalization required
If kidney stone:
  • IV analgesia (NSAIDs/opioids)
  • Hydration
  • Alpha-blockers (tamsulosin) to facilitate stone passage
  • Urology referral if stone >10mm or obstructed

Red Flags Requiring Urgent Attention

  • High fever + rigors + hypotension - urosepsis, needs IV antibiotics immediately
  • Sudden, tearing back pain - consider aortic aneurysm
  • Severe unrelenting epigastric pain + elevated lipase - acute pancreatitis, needs admission
  • Urinary retention + neurological symptoms - spinal pathology
Sources: Goldman-Cecil Medicine (26th ed.), Berek & Novak's Gynecology, Sabiston Textbook of Surgery, Campbell-Walsh-Wein Urology, ROSEN's Emergency Medicine, Textbook of Family Medicine (9e)
Clinical Note: This information is for educational purposes. A full history (onset, character, severity, associated symptoms, medications, past medical history, menopausal status, bowel habits) and physical examination are essential before any diagnosis or treatment is made.
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