Post: Correlation Between Back Pain & Urinary Incontinence
Back pain and urinary incontinence are two extremely common conditions seen in pelvic floor physical therapy. They can significantly impact a person’s quality of life not only because of the physical symptoms but because of the biopsychosocial factors that accompany them.
According to the World Health Organization, back pain is one of the leading causes of disability worldwide, with an estimated 80% of people experiencing back pain at some point in their lives.
Similarly, urinary incontinence is a common condition that affects both men and women, and it can be caused by a variety of factors, including pregnancy, childbirth, obesity, and aging. In fact, 1 in 3 postpartum moms experience some kind of urinary incontinence according to a PubMed article.
While each condition has a high prevalence individually, a research article in the Physical Therapy and Rehabilitation Journal found that having urinary incontinence doubles a person's risk for having back pain.
The question is, why is this so?
This relationship could be a result of a lack of muscular control and function in the core and pelvic floor to provide adequate postural and internal organ support.
We know that when the pelvic floor isn’t functioning optimally, it can lead to poor coordination of the urinary sphincters and thus the ability to hold back urine. We also know that the pelvic floor is integral to the intraabdominal pressure system that provides support and optimal function of the diaphragm.
We have also seen in a study by Kohler, that when back pain is present, the diaphragm will often engage as a postural support muscle, instead of primarily focusing on breathing. Since the diaphragm is integral in the function of the intrabdominal pressure system, we can safely reason that this alteration in the diaphragm’s normal function can lead to pelvic floor dysfunction.
Recently there was also a study in the Journal of Diagnostics in 2022 that used ultrasound imaging to “study the relationship between the musculature of the anterolateral wall of the abdomino-pelvic cavity, the pelvic floor muscles, and the diaphragm muscle and their implication in people with low back pain.” The results from this study showed that people with low back pain have significant changes in the movement of the pelvic floor and the thickness of the diaphragm and abdominal muscles, further correlating the relationship between low back pain and incontinence.
And let’s not forget about the biopsychosocial aspects of pain and incontinence. Increased stress caused by these symptoms and a lack of sleep will cause someone’s system to be in a high cortisol state. And when the system is saturated in cortisol, nothing works efficiently and we can’t make a positive change until it is decreased.
And then there is the emotional aspect of these conditions. Fear-avoidance is a strong factor to consider when treating people with these conditions.
This is why as pelvic floor physical therapists we need to look beyond just the symptomology.
It is our job to dig down deep into the foundation to figure out what is going on and make a change there to get the symptoms to improve.