<s>[INST] HI I had a back ache and Hemerroids during August of the last year.I have gone through the surgery for piles and was recovering and there were no symptoms of back ache too. But now all of a sudden the back ache increased, which includes a slight pain in the penile and perenium while sitting, Also tingling in the legs. Please suggest [/INST] As per your explanation looks like your pain is related to your back disc issue at lumbar level, or it may be sciatica. However it may be possible both are interrelated. When I get patient with similar symptoms I suggest them to do MRI of back. And based on report if there is severe disc problem or disc degeneration then will also to visit orthopedic and will advise them to start with medication as directed and suggested by orthopedic. For conservative management in physiotherapy I will suggest going for ultrasound therapy which helps for healing and reducing inflammation in soft tissue. As well the inter martial therapy can also be given on pain full area and on nerve for nerve block effect. Here this thing will help for mainly pain relief. Now to have permanent relief from pain and tingling most important thing is you have to do regular back strengthening, stretching, and twisting exercises. This will help to build strength and staining of spinal muscles. You can also use hot pack regularly to have some more pain relief by relaxing soft tissues. At any time you feel pain is increasing in terms of intensity and more frequent do take surgical opinion from orthopedic doctor also. Take care. </s>