I Have Back Pain & I Can't Pee. What Does That Mean?

Back pain can be painful, frustrating, and sometimes even quite alarming when new symptoms appear (often out of nowhere). If your back pain comes with difficulty peeing or urinary retention, it could signal a more serious underlying condition affecting your nerves or spine.

In this blog we break down what might be happening, when to worry, and what to do next.

Why Can’t I Pee When I Have Back Pain?

Low back pain is incredibly common — affecting around 80% of adults at some point (NIH). But when bladder issues join the picture, doctors pay closer attention. Urinary changes with back pain can mean that the nerves controlling your bladder are being compressed or damaged.

In many cases, this points to a neurologic cause, like neurogenic bladder disorder (NBD) or cauda equina syndrome (CES).

“Difficulty urinating alongside new or worsening back pain is a red flag symptom that warrants urgent evaluation,” — Dr. Richard Deyo, New England Journal of Medicine

Acute vs Chronic Back Pain

Most back pain episodes are generally short-lived and tend to resolve on their own within a few weeks. However, chronic or severe back pain, especially when linked with urinary problems, should not be ignored.

Common causes include:

• Disc herniation or spinal compression

• Degenerative disc disease

• Spinal infections or tumors

• Traumatic injuries

• Cauda equina syndrome

According to the American Association of Neurological Surgeons (AANS), cauda equina is rare but can cause permanent paralysis or bladder loss if untreated.

When Back Pain Is Dismissed — And Why That’s Risky

Because most low back pain cases are benign, emergency departments sometimes underestimate its seriousness. Unlike chest pain (which always triggers a cardiac workup), back pain is often treated with rest and pain medication.

When an emergency room doctor picks up a patient's chart and sees that the main concern 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.

However, missing certain “red flags” can have serious lifelong consequences. Urinary retention—not being able to urinate/pee —is one of the most important warning signs that the back pain being experienced may involve the spinal cord or nerves.

Red Flags to Watch For

If you have low back pain, call your doctor or go to the ER immediately if you notice:

• Inability to urinate or loss of bladder control

• Numbness around the groin or inner thighs (“saddle anesthesia”)

• Leg weakness or difficulty walking

• Fever, chills, or recent trauma

These serious conditions can cause low back pain and are often missed during visits to the emergency department.

“Any back pain accompanied by bladder or bowel changes should be treated as a neurological emergency until proven otherwise.”

 — American Academy of Orthopaedic Surgeons (AAOS)

Conditions That Link Back Pain and Urinary Problems

Condition	How It Causes Urinary Issues
Neurogenic Bladder Disorder (NBD)	Nerve damage affects bladder control, leading to retention or incontinence.
Cauda Equina Syndrome (CES)	Compression of spinal nerve roots causes urinary retention and loss of sensation.
Spinal Stenosis	Narrowing of the spinal canal puts pressure on bladder-controlling nerves.
Herniated Disc	A disc pressing on nerves in the lumbar spine can trigger urinary dysfunction.
Spinal Infections or Tumors	These can damage or compress nerve pathways.

I Have Back Pain And I Can't Pee - What Should I Be Concerned About, Mainly?

1. Neurogenic Bladder Disorder (NBD)

Neurogenic bladder disorder is what happens when the nerves that control your bladder muscles are damaged, often from things like a spinal cord injury, a herniated disc, or a neurological disease.

Common symptoms include:

• Limited or no control over urination

• Urgent urination

• Incomplete bladder emptying

• Leakage due to bladder overfilling

• Frequent trips to the bathroom

  
  

According to the Cleveland Clinic, “Neurogenic bladder can result from any condition that interrupts communication between the brain, spinal cord, and bladder muscles.”

This condition requires medical evaluation, including urine testing, bladder scans, and imaging to identify the cause.

2. Cauda Equina Syndrome (CES)

Cauda equina syndrome is a medical emergency that is caused by compression of the spinal nerve roots at the base of your spine. One in 1,000 patients who suffer from sciatica will develop cauda equina syndrome.

Classic signs include:

• Sudden inability to pee or control your bladder

• Numbness around your buttocks or genitals

• Weakness or numbness in one or both legs

  
  

Cauda equina can develop suddenly (after a disc herniation or trauma) or slowly (from chronic compression).

“Prompt surgical decompression—ideally within 48 hours—can significantly improve outcomes in cauda equina syndrome.”— Journal of Neurosurgery: Spine, 2023

Diagnosis may include:

• MRI scan of the lumbar spine

• Digital rectal exam to assess nerve function

• Bladder catheterization to check urine volume

  
  

The digital rectal exam tests for tone and sensation which is often preferable to using bladder scanners that can be unreliable. A bladder catheter measures how much urine is being produced. If CES is suspected, you should go to the emergency room immediately.

Other Possible Causes

• Spinal infections or abscesses – cause inflammation and nerve damage.

• Tumors or lesions – can compress the spinal cord.

• Traumatic injuries – may bruise or tear spinal nerves.

• Genetic disorders – such as spina bifida.

What To Do If You Can’t Pee and Have Back Pain

If you have new-onset urinary problems and back pain, you should seek emergency care right away.

While mild urinary changes can occur for several different reasons, retention (not being able to pee) may indicate a spinal nerve emergency.

At the hospital, doctors may:

• Perform MRI or CT imaging

• Check for nerve function and reflexes

• Insert a catheter if the bladder is dangerously full

• Consult a neurosurgeon or urologist

“Early intervention can prevent permanent paralysis or incontinence,” says the American College of Emergency Physicians (ACEP).

Key Takeaways

• Back pain plus urinary retention = potential emergency.

• Cauda equina syndrome and neurogenic bladder disorder are the main serious causes.

• Seek care immediately if you can’t pee, feel numbness in your groin, or lose bladder control.

• Early detection and surgery (if needed) can prevent long-term damage.

FAQs

1. What does it mean if I have back pain and can’t pee?It could signal a nerve-related issue like cauda equina syndrome or neurogenic bladder disorder. Both require prompt medical attention to prevent permanent damage.

2. Can a herniated disc cause bladder problems?Yes. If a herniated disc compresses the lower spinal nerves, it can disrupt bladder control. This happens in about 1–2% of lumbar disc herniations, according to StatPearls.

3. How do doctors test for cauda equina syndrome?They may order an MRI, perform a rectal exam for sensation and tone, or measure urine retention using a catheter.

   
   

4. Is urinary retention always serious?Not always—but when it occurs with back pain, it’s a red flag for spinal nerve compression and should be checked urgently.

Conclusion

While most back pain is harmless, the inability to urinate with co-occurring pain should never be ignored. These symptoms can point to rare, but serious, neurological conditions that require rapid diagnosis and treatment.

If you notice any urinary retention or numbness with back pain, go to the ER or contact your healthcare provider immediately.

Written by the LivaFortis Editorial Team. All content is created and reviewed by experts in biotechnology, translational medicine, and digital health innovation. Learn more about our editorial standards.