Can Constipation Cause Back Pain?
“Does my back hurt because I’m constipated?”
“… Or is my digestive system going haywire because of my back pain?”
It’s a (totally valid) question a patient asked me last week at Ascent Chiropractic.
The connection is easy to miss, especially if you’re in the throes of dealing with tummy issues, but the answer is that back problems can be both a direct result and cause of even short-term bouts of constipation. Bowel problems and lower back pain are inextricably linked.
In other words, it’s possible for a musculoskeletal problem that causes lower back pain to also lead to gastrointestinal dysfunction, and it’s possible for constipation to cause lower back pain.
Constipation Types & Symptoms
The Bristol Stool Form Scale makes it easier to understand and talk about constipation. The scale helps assess how long stools have been in the bowel by assigning them a number based on their size, shape, and consistency.
Type 1 stools have spent the most time in the bowel; type 7 have spent the least. Stools resembling types 1-2 indicate constipation, types 3-5 are typically considered normal bowel movements, and types 6-7 are diarrhea.
Sudden or short periods of difficult, infrequent bowel movements (fewer than 3 per week) of type 1-2 stool are categorized as occasional constipation.
Occasional constipation affects about 16% of adults and is usually (but not always) the result of easily-identifiable causes, such as a diet low in fiber, dehydration, lack of physical activity, or medications that cause constipation as a side effect. This includes over-the-counter medications like antacids or iron supplements, and many medications prescribed for high blood pressure, Parkinson’s, and depression. It also includes many of the most commonly prescribed pain medications like opioids – more on that in a minute.
Constipation symptoms that keep coming back or seem to last for a long time – more than 3 months – are known as chronic constipation. If chronic constipation is accompanied by bloating and abdominal pain or discomfort, it’s called IBS-C (or irritable bowel syndrome with constipation).
Chronic constipation can be a symptom of a range of medical conditions, including problems in your spine.
Spinal Health is Closely Connected To Your Bowels
The muscles and nerves around your large intestine, rectum, and anus all need to work together for your digestive system to perform peristalsis – the wave-like muscle contractions that move food through the digestive tract.
Most of the peripheral nerves that control these muscles exit your spine in your lower back – specifically, from levels T9-L3 and S2-S4. So problems that cause lower back pain, such as disk bulges, spinal stenosis, and facet inflammation, can also affect the nerves that dictate whether you’re able to go #2 … or not.
The more severe a hot disk or swollen facet joint gets, the greater likelihood the adjacent nerve roots will start to feel the effects. And depending on which specific nerve fibers are being affected and where those nerves ultimately connect, symptoms can vary considerably. If the problem is in your neck and the nerve happens to go to the fingers, you’ll likely get numbness, tingling, or weakness down your arm and hand.
If the problem’s in your lower back, you might get similar symptoms down your leg … or you might experience bloating and constipation because your gastrointestinal system isn’t receiving the stimulation being sent by your central nervous system.
It doesn’t have to be full-blown neurogenic bowel (in which nerves are physically damaged leading to loss of bowel function), either. A little swelling of a facet joint capsule or intervertebral disk can be enough to lead to real problems in the structures supplied by those spinal nerve roots.
In fact, a study by the University of Colorado demonstrated that just the weight of a dime (2.2 grams) on a spinal nerve can reduce nerve conduction by up to 60% in as little as 15 minutes. It’s no surprise that if your bowels are only getting 40% of their normal nerve supply you’ll end up constipated.
To compound the problem, many of the pain medications prescribed by doctors for lower back pain directly contribute to constipation symptoms. The digestive tract has receptors for opioids, and studies have shown that constipation occurs (or worsens) in roughly 41% of people taking opioids for pain.
Constipation Can Be The Cause of Back Pain, Too
The cause-effect relationship works the opposite way, too. When you’re constipated, the build-up of fecal matter, bloating, and straining to defecate all lead to an increase in intra-abdominal pressure. This extra pressure can cause pain-signaling nerve endings in your lower back to fire.
If you already have a pre-existing back injury, this can lead to a nasty positive feedback loop in which your back pain causes constipation and your constipation, in turn, amplifies your back pain.
The good news is that if your back pain is actually resulting from constipation, it should begin to feel better as soon as bowel function normalizes. Self-management with the tips below is usually enough without having to see a specialist, though changing habits and lifestyle may be required to prevent future flare-ups.
Prone to constipation that’s causing lower back pain? Here are a few easy habits to add to your daily routine to help prevent it:
1. Get Hydrated – Constipation can be a result of dehydration. Make sure you get enough water in the day by choosing to drink liquids often. We’ve all heard the advice that we should drink eight 8-ounce glasses of water a day (or 1.9 liters). That’s an easy, reasonable goal to remember, but that’s a little low and we can get more dialed in than that. Here’s our guide to adequate daily fluid intake based on age and sex.
2. Bulk Up on Fiber – Adding more fiber to your diet can help keep you regular. You can do this by eating more fresh fruit and vegetables and whole-grain foods or by taking a fiber supplement. If you go with a supplement, choose a soluble fiber like psyllium which absorbs water and stays intact in the digestive system, keeping stool softer so it moves more easily through the colon.
For men under 50, the daily recommended amount of fiber is 38 grams; for women, it’s 25 grams. For men and women 51 and older, the recommendation is 28 grams and 22 grams, respectively.
3. Use Probiotics – Probiotics help introduce good bacteria into the gut. While its direct effect on constipation alone has yet to be verified, there’s evidence that it is helpful with IBS-C and thus can also serve to remove one of the related issues that can trigger constipation.
4. Take a Magnesium Supplement – Magnesium is a critically important mineral that is lacking in up to 50% of Americans’ diets. Magnesium deficiency can cause constipation as well as painful muscle spasms. A magnesium supplement can help – the suggested supplemental dose for adults is 350 mg per day.
5. Exercise – Getting more movement throughout your day helps improve both bowel and lower back function. Exercise isn’t optional – making time for it has to be among the things you consider non-negotiable. Even short 10-minute walks following a meal can help.
Treating Lower Back Pain
Suffering from low back pain that’s contributing to constipation? Based on the latest research, chiropractic (by itself or combined with active physical therapy) might be your best – and most cost-effective – bet for low back pain relief.
A 2017 review published in the Journal of the American Medical Association found that, compared to other popular mainstream medical treatments, spinal manipulation may be your best choice for chronic low back pain. That’s backed up by the 2011 Cochrane review on chronic low back pain that concluded spinal manipulation was effective in reducing pain and improving patients’ functional status. And that’s without the constipating side effects pain medications can cause.
Those with acute back pain (less than 4 weeks duration) or subacute back pain (between 4-12 weeks duration) fared even better in those studies. In a 2013 trial published in SPINE journal, over 73% of people with acute or subacute back pain who saw a chiropractor in addition to their medical doctor found significant or complete relief from their pain, compared with 17% in the standard-medical-care-only group.
Add to that the fact that chiropractic care is by far more cost-effective than traditional medical care for back pain. According to data published in 2014 that looked at 3.7 million patients, those suffering from low back pain spent almost 500% more when they took the orthopedic route for treatment compared to those who saw a chiropractor first instead.
In fact, for most patients, the combined out-of-pocket cost for imaging, diagnosis, and a complete corrective treatment plan at Ascent Chiropractic is a fraction of the cost for just an MRI alone.
The Ascent Chiropractic Difference
Looking at the excellent clinical track record of what we do at Ascent Chiropractic, it’s an easy decision. To get started, make an appointment by calling 262-345-4166 or schedule an appointment with our online scheduling app.