Back pain can be super painful and super scary. And, as if that isn’t enough, it can also come with some seriously strange symptoms. While some people experience constipation and wonder how that might be connected to low back pain, there is another type of bathroom function that people wonder about with low back pain: peeing. What does it mean if you have back pain and can’t pee?
Acute vs Chronic Back Pain
Back pain is a very common condition that ends up affecting around 80% of the population at some point in their lives. It is also quite a mysterious condition as there are many types of conditions and causes that are linked to it. Acute injuries, bone and disc degeneration, pregnancy, infections, cancer, and various inflammatory diseases can all be potential causes of low back pain. Fortunately, for most people, low back pain tends to go away on its own after a few weeks, but for an unlucky part of the population, the pain can become chronic and debilitating.
The Risks Of Undertreating Low Back Pain
The self-resolving nature of most low back pain cases and the difficulties that physicians have in diagnosing chronic low back pain have made low back pain something of a mystery to healthcare providers. This has to a tendency to under-treat the condition in some cases, with many people not realizing that there are some very serious conditions linked to low back pain.
When an emergency room doctor picks up the chart and sees that the main concern of the patient is low back pain, many have a similar response: they may think that nothing can be done for the patient, or they might suspect that they have a drug-seeking individual on their hands. Because most cases of low back pain are benign, most physicians feel that there is probably nothing that they can do for the patient. This can lead to a sense of complacency about an individual's experience of low back pain.
Back Pain vs Chest Pain
An interesting comparison, however, is viewing low back pain in a similar light to chest pain. While 80% of back pain cases will resolve on their own and are benign, the same can be said for chest pain. Only around 10 - 15% of chest pain presentations turn out to be serious. The treatment of the two are very different however. Chest pain patients will have a whole plethora of tests performed to rule out myocardial infarction, aortic dissection, or a pulmonary embolism. Typically speaking, chest pain patients receive a very different response from healthcare providers than back pain patients do.
Checking For Red Flags
What does this have to do with going to the bathroom, you ask? Well, when it comes to serious conditions that are linked to low back pain, doctors should not forget to rule out concerns such as fractures, infections, disk herniations, or cauda equina syndrome. These serious conditions can cause low back pain and are often missed during visits to the emergency department.
While excess imaging for low back pain is definitely not recommended in the absence of red flags, it is important for physicians to remember to ask for a detailed history of the patient and cover symptoms, such as difficulty urinating, especially if this isn’t their first visit to the emergency room for back pain.
Conditions Associated With Urinary Issues And Low Back Pain
So what conditions are associated with urinary issues and low back pain?
Cauda Equina Syndrome
The sacral plexus is a network of nerves that extends from the lower part of the spine. These nerves receive information from the pelvis and the leg and help to control movements in these areas. If the sacral nerves are damaged (such as with an injury - lumbar disc protrusions can affect the nerves in 1-15% of cases) then problems with the bladder and the bowel might start to arise. Urinary retention is one of the most common symptoms associated with this type of damage.
Injuries to the spine are often linked to something called Neurogenic Bladder Disorder (NBD). These types of accidents can cause bruising or constrict the blood flow along the spinal cord, damaging the body’s ability to transmit important nerve signals. When a person has NBD the nerves that control the bladder, and the muscles that support it, tend to be either overactive or under-active.
Symptoms of NBD:
Limited or involuntary control over urination
Sudden urges to urinate
Inability to completely empty the bladder
Frequent bathroom visits
Bladder can’t hold urine - overfills and urine leaks.
Cauda Equina Syndrome
Cauda Equina Syndrome (CES) is a very serious medical condition that requires urgent medical attention/ surgery. Individuals with CES have something that is compressing on their spinal nerve roots, and sensation and movement can be cut off. Urgent surgery might be needed to prevent lasting damage such as permanent paralysis of the legs or incontinence.
Cauda equina syndrome can happen slowly, over time, or it can happen suddenly. The most common cause of acute urinary retention issues with cauda equina compression is a lumbar disc herniation. One in 1,000 patients who suffer from sciatica will develop cauda equina syndrome. CES can be diagnosed if the patient has :
Urinary retention and/or rectal dysfunction and/or sexual dysfunction
Saddle/anal anesthesia or hypesthesia
This makes it vitally important for anyone who is experiencing any type of urinary retention (inability to pee) to be tested for saddle anesthesia (reduced sensation in the perineum, buttocks, anus, groin and upper thighs). A digital rectal exam can test for tone and sensation and is preferable to using bladder scanners that can be unreliable. A bladder catheter can also measure urine output.
While many people (especially women) might be familiar with urinary incontinence, basically bladder leak, urinary retention is not as common. And, while bathroom issues may not seem like a big deal, when they come with other key red flags or symptoms, they should tell you to head straight to the ER or your healthcare provider.
While most cases of low back pain are not cause for alarm and will go away on their own, this is not always the case. Your doctor should be able to check you out fairly quickly and make sure that nothing more serious is going on. For more information about red flags and how they relate to more serious issues, check out our blog on 'Red Flags For Low Back Pain'.
Many people are familiar with the term “urinary incontinence” which refers to the involuntary emptying (voiding) of the bladder, or frequent urination. According to the National Association for Continence, more than 25 million adult Americans experience either temporary or chronic urinary incontinence which may be the result of an underlying medical condition.
As we mentioned above, when someone is experiencing low back pain that affects the sacral nerves, the stimulation or irritation of these nerves can make it difficult to pee - urinary retention. It can also cause constipation.
Spinal stenosis and sciatica can also result in a lack of ability to pee.