Why constipation may be causing your back pain (and how physical therapy can help)

As a physical therapist, I have seen countless patients over the past 10+ years who experience lower back pain. Low back pain is incredibly common, but it is also very complex. Most people believe they have low back pain because of things like a “slipped disc”, arthritis in their spine, or because of a family history of back pain. However, it is not uncommon for people who have no lower back pain at all to have arthritis, disc degeneration, and disc protrusions seen on imaging.

What this means is that although these “abnormal” findings may be the cause for low back pain in some patients, most of the time there are other things going on. In fact, we have some evidence that patients who have imaging of their low back actually have worse outcomes than those who do not. There is a lot of fear when it comes to low back pain, and finding out you have a disc herniation or stenosis may compound those fears and make your pain worse.

There are a TON of reasons why you may be experiencing back pain, but in this blog post I want to specifically discuss a cause of low back pain that many people may not know about: constipation.

First - what is constipation?

Symptoms can vary from person to person, but the clinical diagnosis is having 2 or more of the following symptoms for at least 12 weeks (does not have to be consecutive weeks) in the previous 12 months.

1)    Less than 3 bowel movements per week. I think most people think of frequency of bowel movements as being a defining factor in whether or not that are constipated. However, frequency of bowel movements can vary quite a bit from person to person. You can have a bowel movement daily and still be constipated, or you may only go every other day and not be constipated. It really depends on some of the other factors on this list – frequency is just one thing to consider.

2)    Straining during bowel movements – breath holding, bearing down, and pushing hard to pass stool.

3)    Lumpy or hard stool – stool that comes out in small pieces, is hard, and/or is difficult to pass.

4)    Sensation of incomplete evacuation – feeling like you have not fully emptied your rectum.

5)    Sensation of anorectal blockage/obstruction – feeling like there is a blockage preventing the passage of stool.

How can constipation cause low back pain?

There are a few reasons why constipation may cause low back pain, so here is a quick run down of what I often see in my office with patients who are constipated and have low back pain.

1) Constipation may cause increased intra-abdominal pressure. If you are feeling bloated and have slower motility through your intestines, you may have increased intra-abdominal pressure. This increase in pressure can push on your lower back and pelvis and cause discomfort.

2) Straining during bowel movements may affect your pelvic floor muscles. Chronic straining in your pelvic floor muscles can cause increased tension and discomfort. Increased tension (or hypertonicity) in your pelvic floor can cause low back, hip, and pelvic pain.

3) Visceral restrictions may cause lower back pain. Many of my patients have restrictions through their abdominal viscera that are contributing to their low back pain. Your abdominal organs are all covered in fascia and connected to your musculoskeletal system through these fascial connections and ligaments. If there is a restriction in organ mobility or motility, it may cause low back pain. Visceral Manipulation is a helpful technique to improve organ mobility and motility, and ultimately reduce low back pain.

How can pelvic floor therapy help?

Pelvic floor therapy can be key in reducing constipation and addressing low back pain. First, your pelvic floor therapist will talk to you about things like stool consistency, hydration, bowel routines, stress management, sleep, and nutrition. You will work together to determine what daily habits could help reduce constipation, as well as if a referral to another provider is necessary (such as a dietician or functional medicine practitioner).

Your therapist will also do a thorough musculoskeletal evaluation to determine if there are other contributing factors to low back pain, such as pelvic floor dysfunction, joint restrictions, muscle imbalances, and even daily habits that may be increasing low back pain.

If you have seen a provider for low back pain and have not gotten relief, but they did not talk with you about your bowel movements, I highly recommend seeing a pelvic floor therapist to find out if constipation could be contributing to your low back pain.

I see patients in person in Collierville and East Memphis, TN and virtually from anywhere. You can schedule your appointment or free 15 minute evaluation here. You can also check out my tips to reduce constipation here.

Blog post written by Dr. Alexis Hutchison, PT, DPT, OCS, PCES