What is the relationship between constipation and lower back pain?

From the Guidelines

Constipation can cause lower back pain due to the physical pressure exerted by accumulated stool in the colon, and addressing the underlying constipation is essential to relieve this type of back pain. When stool builds up, it creates pressure on surrounding tissues and nerves in the lower abdomen and pelvic region, which can radiate to the lower back. The colon sits in close proximity to the spine, and when it becomes distended with hardened stool, it can directly press against spinal structures. Additionally, the straining that often accompanies constipation puts extra stress on back muscles, potentially causing muscle spasms or exacerbating existing back issues. The body's inflammatory response to prolonged constipation may also contribute to generalized discomfort in the lower back region. According to the American Gastroenterological Association Institute guideline on the medical management of opioid-induced constipation 1, constipation is a common and debilitating gastrointestinal effect of opioids, and some degree of constipation is near universal in patients taking opioid medications. To relieve this type of back pain, increasing water intake, consuming more dietary fiber, regular physical activity, and establishing consistent bathroom habits are essential. Over-the-counter options like docusate sodium, polyethylene glycol, or bisacodyl can provide short-term relief while lifestyle changes take effect.

Some key points to consider:

• Constipation can cause lower back pain due to physical pressure exerted by accumulated stool in the colon 1
• The colon's proximity to the spine allows it to press against spinal structures when distended with hardened stool
• Straining during constipation can put extra stress on back muscles, potentially causing muscle spasms or exacerbating existing back issues
• The body's inflammatory response to prolonged constipation may contribute to generalized discomfort in the lower back region
• Addressing the underlying constipation is essential to relieve this type of back pain, and lifestyle changes such as increased water intake, dietary fiber, and regular physical activity can help alleviate symptoms.

It's worth noting that while the guideline on the medical management of opioid-induced constipation 1 provides valuable insights into the effects of constipation on the body, the diagnosis and treatment of low back pain is a complex issue that requires a comprehensive approach, as outlined in the joint clinical practice guideline from the American College of Physicians and the American Pain Society 1. However, in the context of constipation-induced lower back pain, addressing the underlying constipation is the most effective way to relieve symptoms.

From the Research

Constipation and Lower Back Ache

• Constipation can cause lower back ache due to various mechanisms, including:
  • Straining during bowel movements, which can put pressure on the lower back muscles and joints 2
  • Pelvic floor dysfunction, which can lead to poor posture and put strain on the lower back 3
  • Colonic sensorimotor disturbances, which can cause abdominal bloating and discomfort that may radiate to the lower back 2
• The relationship between constipation and lower back ache is complex and may involve multiple factors, including:
  • Defecatory disorders, such as dyssynergic defecation, which can cause chronic straining and lead to lower back pain 3
  • Slow-transit constipation, which can cause abdominal bloating and discomfort that may radiate to the lower back 3
• Treatment of constipation may help alleviate lower back ache, including:
  • Dietary fiber supplementation, which can help regulate bowel movements and reduce straining 4, 5
  • Osmotic laxatives, such as polyethylene glycol, which can help soften stool and reduce straining 5
  • Stimulant laxatives, such as senna, which can help increase bowel movements and reduce straining 5
• Further research is needed to fully understand the relationship between constipation and lower back ache, and to develop effective treatments for this common problem 2, 3