Becoming constipated is a common condition that most people will experience at some point in their lives, though for others, it can be a chronic problem. In some cases, constipation may be a symptom of other underlying health conditions, while in others, it is the cause of other problems. One common symptom of constipation is back pain, which may be relieved by addressing constipation. However, this connection can also be a sign of other back issues that require back pain treatment beyond treatment for constipation itself. Read on to learn about how these issues are related and when to be concerned about either.
About Constipation
With about 16 out of every 100 adults in the United States experiencing frequent constipation, it is one of the most common digestive problems in the country. Adults over 60 experience it at twice this rate, making it an even larger issue for certain populations. Constipation refers to having hard, dry bowel movements or passing stool fewer than three times per week.
Each person’s pattern of bowel movements will differ, and there is a range of what is considered normal. The general guidelines for constipation include:
- Less than three bowel movements in a given week
- Passing lumpy, hard, or dry stool
- Straining or pain during bowel movements
- A feeling of fullness, even after having a bowel movement
Constipation may also be accompanied by other symptoms such as stomach aches or cramping, bloating, indigestion, increased flatulence, nausea, a lack of appetite, or a loss of energy.
Most commonly, constipation is caused by either low fiber diets or not drinking enough water and is easily remedied. The frequency and texture of your feces can vary based on things like what you eat and drink, colds or seasonal flu, and other temporary conditions. Usually, the condition resolves quickly or can be relieved with simple home remedies. However, if constipation is chronic or you notice certain symptoms, it can be more concerning or a sign of a greater issue.
Constipation and Back Pain
The digestive tract occupies a large portion of the torso and lower body, which means that when it is disturbed in any way, it may cause issues in other organs and systems. When the bowels are fuller than normal due to constipation, it often has an impact on the lower back, causing a dull or aching pain that may extend to your abdomen. There are two primary reasons that back pain appears during periods of constipation.
Fecal Impaction
Fecal impaction is a serious condition in which stool is unable to pass through the colon or rectum and builds up, causing extreme pressure on the organs surrounding the area. If this is not properly treated and addressed, it can cause severe pain in addition to permanent damage.
Lower back pain is a primary symptom of fecal impaction, but it can also cause bloating, vomiting, nausea, headaches, and incontinence. These symptoms may appear all at one time or gradually, but they will usually worsen until the blockage is addressed.
In most cases, fecal impaction is a result of frequent and untreated constipation. Chronic constipation conditions the colon and rectum to become more restrictive, applying pressure to tighten themselves and causing a significant build-up of stool over time. Fecal impaction then occurs when the mass is significant enough. In rarer instances, medication, surgery, lack of movement, or overuse of laxatives can also be a cause of the condition.
The first treatment for fecal impaction will be enemas, laxatives, water irrigation, or anal suppositories. These should be administered under supervision, not at home, especially if lower back pain has moved to other limbs.
Overlapping Conditions
There are several health conditions that cause both constipation and back pain as symptoms.
- Aging: As people age, the incidence of both back pain and constipation increases. This can be related to a lack of movement, disc degeneration, lifestyle choices, and other conditions. Reduce the risk by exercising regularly to help relieve back pain and constipation.
- Bowel obstructions: A collection of hard stool in the intestine can cause a bowel obstruction, as can something pressing on or constricting the bowel and preventing the stool from moving forward.
- Endometriosis: When the tissue that normally lines the uterus begins to grow in other places in the body, like the fallopian tubes or ovaries, this is endometriosis. The lining can also grow on the bowel or bladder. Common symptoms are back pain, lower abdominal pain, and severe menstrual cramping.
- Fibromyalgia: This condition is characterized by increased sensitivity to pain, pain throughout the body, trouble sleeping, fatigue, and gastrointestinal symptoms. Lower back pain is commonly cited as a symptom.
- Inflammatory bowel disease (IBD): IBD includes conditions like ulcerative colitis and Crohn’s disease, which cause intestinal inflammation and lead to both diarrhea and constipation. IBD can also be connected with ankylosing spondylitis, an inflammatory arthritis that affects the spine.
- Irritable bowel syndrome (IBS): IBS is characterized by constipation, diarrhea, or both, along with abdominal bloating, cramping, and lower back pain.
- Liver disorders: Various conditions of the liver, like cancer, cirrhosis, and hepatitis, can cause symptoms like nausea, constipation, abdominal pain and swelling, and itching. Depending on the exact disorder, the location of the back pain can vary. For example, cirrhosis is commonly linked with lower back pain, while liver inflammation is more likely to cause pain in the upper back on the right side.
- Pancreatic cancer: In the early stages, pancreatic cancer usually has very few symptoms. As the cancer progresses and symptoms appear, they can range and include itching skin, back pain, abdominal pain, and digestive problems. The treatments for pancreatic cancer can also cause constipation.
- Pregnancy: Both constipation and back pain can occur in pregnancy as a result of the fetus growing and placing pressure on the back or constricting the bowels. Increasing progesterone levels are also commonly linked to constipation.
- Other cancers: If cancer has metastasized to the bone, which is common in forms like breast cancer, back pain may be more common.
General Constipation
The more common cause of lower back pain is constipation itself, when the fecal matter in your digestive tract presses on the muscles and nerves of your body. Since the bowels are located in the lower torso, they naturally have the most impact on the spine. This can cause a feedback loop of sensations as the build-up grows.
When to See a Doctor
Both constipation and back pain are normal occurrences for most people and, when they resolve easily, may not require any medical attention. But because constipation can be linked to more serious conditions, you should seek medical care if:
- You have not had a bowel movement in over 7 days
- There is blood in your stool or from your rectum
- Your back pain does not resolve after a bowel movement
- There is constant pain in your abdomen
- You are unable to pass gas
- You have a fever or are vomiting
- You have had recent unexplained weight loss
Diagnosing Constipation
While constipation has a simple definition, doctors will usually want to rule out any underlying conditions, including those that may be causing your back pain. You will usually be asked to share your symptoms, medical history, and any relevant information, such as a log of your bowel movements. From there, a physical examination or rectal exam may be conducted, and blood tests can also be used to check your electrolytes and thyroid function.
If the doctor suspects there are additional factors at play, they may recommend one of the following tests.
Marker Study
Also known as a colorectal transit study, this test identifies how food moves through your colon. You will be asked to eat a high fiber diet for a period, then swallow a pill with tiny markets that can be detected by x-ray. Numerous x-rays are taken over a period of days to help visualize how food moves through your colon and how effective your intestinal muscles are.
Anorectal Manometry
An anorectal manometry is a test used to evaluate anal sphincter muscle function. A provider will insert a thin tube with a balloon tip into the anus, then inflate the balloon and slowly pull it out. This allows them to measure the strength of your anal sphincter muscles and determine if they are contracting properly.
Barium Enema X-Ray
This test is designed to examine the colon. The night before testing, you will drink a special liquid to clean out the bowel. Once the test begins, a dye called barium is inserted into the rectum through a lubricated tube. The barium highlights the rectum and colon area, allowing them to be better viewed on an x-ray.
Colonoscopy
This test allows a doctor to examine your colon via a colonoscope, which is a tube fitted with a camera and light source. You will need to be on a liquid diet for 1-3 days prior to the test and may need to take a laxative or enema the night before to clean out the bowel.
Treatment Options for Constipation
If constipation is the cause of your back pain, treating the root cause is most important as it should resolve the pain. The first line of treatment for constipation is changing what you eat, and adding more fiber and more water to your diet. This can quickly make your stool softer and easier to pass, relieving constipation. Physical activity can also be helpful as it may cause movement within your bowels.
Some tips for relieving constipation at home include:
- Drink between 1.5 and 2 quarts of unsweetened fluids, like water, every day in order to properly hydrate the body.
- Limit consumption of alcohol and caffeinated drinks, which cause dehydration.
- Focus on fiber-rich foods in your diet, with your daily intake ideally between 20 and 35 grams of fiber. Recommended foods include raw fruits and vegetables, whole grains, beans, prunes, and bran cereal.
- Reduce the amount of low-fiber foods you eat. These include meat, milk, cheese, and processed foods.
- Strive for about 30 minutes per day of moderate exercise at least 5 times per week. Walking, swimming, and biking are all good options.
- Don’t delay bowel movements if you feel the urge. Waiting can cause the stool to become harder and more difficult to pass.
- Talk with your doctor about bowel training to get your body used to passing stool 15 to 45 minutes after your first meal of the day.
- When having a bowel movement, use a footstool to raise your knees so you are in a squatting position.
- Relax your muscles and do not rush when using the restroom.
- Use laxatives only when necessary. It is best to use enemas and other medications when recommended by a doctor for a short period of time. Your body can develop dependence over time and make the problem worse.
- Speak with your pharmacist about any medications you take that could cause constipation.
- Consider adding probiotics to your diet. These can be found in yogurt or kefir with live active cultures or taken through supplements.
If home remedies do not work, a provider may recommend over-the-counter options. These can include fiber supplements, osmotic agents like Milk of Magnesia, stool softeners, lubricants like mineral oil, and stimulants. Medication can also be prescribed if these do not work. Common prescriptions include:
- Lubiprostone, which increases the level of fluid in the intestine
- Linaclotide or plecanatide, which helps to make bowel movements more regular for people with long term constipation or IBS
- Pricalopride, which helps the colon to move stool
When further intervention is needed, a provider may recommend:
- Biofeedback therapy to help retrain your muscles
- Enemas
- A procedure to manually remove feces
- Surgery to remove blockages
- Long-term treatment for chronic conditions
Once the constipation is addressed, it should relieve any back pain that was caused by constipation. If back pain persists, you may visit a chiropractor to determine what the cause is and address that independently.
If you are concerned about back pain or any other chronic pain, contact AICA Jonesboro today to work with our team of experts and find relief.