An enlarged spleen, also known as splenomegaly, refers to an increase in the size of the spleen beyond its normal dimensions. The spleen is an organ located in the upper left part of the abdomen, under the diaphragm and behind the stomach. An enlarged spleen can occur for many reasons, ranging from infections to liver disease to cancer. But can splenomegaly also lead to back pain? Here is a closer look at the relationship between an enlarged spleen and back pain.
What is the spleen and what causes it to enlarge?
The spleen is an important organ for immune function and blood filtration. It is about the size of a fist in healthy adults. The spleen contains white blood cells that help fight infection, filter out old red blood cells, and store platelets and blood. When the spleen grows larger than normal, this is called splenomegaly. Some common causes of an enlarged spleen include:
- Infections: Viral infections like mononucleosis, bacterial infections like endocarditis, and parasitic infections like malaria can all inflame and enlarge the spleen as it works hard to fight infection.
- Cirrhosis and liver disease: Cirrhosis causes blood circulation through the liver to become backed up, leading to congestion in the spleen.
- Cancers of the lymph system or blood: Lymphomas and leukemias cause abnormal cell growth that enlarges the spleen as it tries to filter out these abnormal cells.
- Anemia and blood cell disorders: The spleen grows larger when it must work harder to filter out abnormal blood cells in diseases like sickle cell anemia.
- Congestion in the spleen: Blood clots, portal hypertension, and Gaucher disease can cause blood and cell buildup in the spleen.
In some cases, the cause of splenomegaly is unknown (idiopathic). Doctors usually identify an enlarged spleen through a physical exam, blood tests, and imaging tests like ultrasound or CT scan of the abdomen. Determining the underlying reason for splenomegaly is important for getting the right treatment.
Can an enlarged spleen cause back pain?
In some cases, an enlarged spleen can cause pain in the upper left area of the back, under the ribs. There are a few reasons why splenomegaly might lead to back pain:
- Enlarged spleen pushes on other organs: As the spleen swells in size, it can press up against other organs like the stomach, pancreas, and left kidney. This extra pressure in the upper left quadrant of the abdomen can sometimes refer pain to the left back area.
- Stretching of the spleen capsule: The spleen is surrounded by a membrane called the splenic capsule. As the spleen enlarges, it can stretch this capsule, which is rich with nerves and blood vessels. This stretching can irritation and pain signals that are felt in the back.
- Low platelet counts: One role of the spleen is storing platelets, which help blood clot. An enlarged spleen often leads to lower platelet counts, which causes easy bruising and bleeding. Bleeding into the spleen capsule can cause sudden, acute pain in the back.
However, most people with mild to moderate splenomegaly do not experience significant back pain. More commonly, an enlarged spleen causes abdominal discomfort, fullness, and pain in the upper left quadrant where the spleen is located.
When to see a doctor
See your doctor promptly if you develop any of the following warning signs related to an enlarged spleen:
- Sudden, severe pain in your upper left abdomen or back
- Feeling full after eating only a small amount of food
- Fever higher than 101°F (38.3°C)
- Night sweats
- Unexplained weight loss
- Easy bleeding or bruising
These types of symptoms could signal a problem like spleen rupture, which requires emergency medical care. Seek immediate medical attention if you experience dizziness, rapid heart rate, weakness, or fainting along with upper left back or abdominal pain, as these may be signs of dangerous internal bleeding.
When back pain may indicate an enlarged spleen
While most back pain results from muscle strain or spine issues like disc herniation, back pain in the upper left side under the ribs could potentially indicate splenomegaly. See your doctor for evaluation if you have back pain in this area along with:
- Abdominal swelling or fullness
- Feeling full after small meals
- Fever or night sweats
- Unexplained weight changes
- Fatigue
- Easy bruising or bleeding
Splenomegaly would be an uncommon cause for most back pain. But it is a possibility doctors may investigate if back pain is specifically located on the left side under the rib cage, associated with other typical enlarged spleen symptoms, and has no apparent explanations like injury or strain.
How is back pain from an enlarged spleen diagnosed?
To determine if upper left back pain may be linked to an enlarged spleen, doctors will typically:
- Take a full medical history looking for risk factors like recent infections or blood disorders.
- Ask about any abdominal symptoms or bruising/bleeding issues.
- Examine the abdomen for splenic enlargement or tenderness.
- Check blood cell counts for abnormalities.
- Order imaging tests like an abdominal ultrasound, CT, or MRI to visualize the size and shape of the spleen.
- Consider scans like CT or bone scan to rule out other potential causes of back pain like spinal issues or kidney problems.
If testing confirms that you have splenomegaly that could be causing back pain, further evaluation would be done to determine the reason for spleen enlargement, such as blood tests for infectious or hematologic causes. Ongoing monitoring of your spleen size and symptoms may be required as well.
Treatments for back pain caused by an enlarged spleen
When back pain results from splenomegaly, treatment focuses on resolving the underlying cause of spleen enlargement. This may include:
- Antibiotics or antivirals to treat infections
- Chemotherapy or radiation for cancers affecting the spleen
- Blood transfusions for severe anemia
- Corticosteroids or immunosuppressants to reduce spleen inflammation
- Surgery to remove the spleen (splenectomy), if medications do not reduce the size
Once the underlying condition is treated, the enlarged spleen and associated back pain generally resolve. To help manage back pain, your doctor may also recommend over-the-counter pain relievers and applying heat packs to the area.
Outlook and prevention for back pain from splenomegaly
The outlook for back and abdominal pain caused by an enlarged spleen depends on the underlying cause and how soon it is diagnosed and treated. With prompt and appropriate treatment, most cases of splenomegaly improve or resolve, along with associated back discomfort.
Preventing back pain from splenomegaly involves staying up to date on vaccinations, avoiding infections through handwashing and safe food handling, and managing any medical conditions that increase spleen enlargement risk. Stay alert for abdominal or back pain that may require medical evaluation. Monitoring underlying medical conditions and maintaining preventive care is key.
When to seek emergency spleen care
In some cases of extreme splenomegaly, the enlarged spleen is at risk for rupture. Seek immediate emergency care if you experience:
- Sudden, severe pain in the upper left abdomen or back
- Fainting or dizziness
- Rapid heart rate
- Pallor or clamminess
- Confusion or disorientation
These may signal a splenic rupture, which causes severe internal bleeding and requires surgery. Splenic rupture is rare but is a medical emergency requiring prompt treatment to stop bleeding.
Conclusion
In summary, it is possible but uncommon for an enlarged spleen to cause back pain under the left ribs. Splenomegaly most often results in abdominal fullness or discomfort instead. Seek prompt medical care for sudden, severe back or abdominal pain, which could indicate a serious issue like spleen rupture. Mild enlargement of the spleen may cause minimal back pain that generally resolves once doctors treat the underlying cause of splenomegaly. With appropriate medical care, most cases of splenomegaly and associated back discomfort can be effectively managed.