Constipation and Back Pain—How the Two Are Connected

Constipation is an extremely common condition that can affect anyone. About 16% of all adults in the United States live with constipation, and it becomes more common as people age. It is typically temporary, but it can cause discomfort such as back pain.

In general, constipation means that food is moving too slowly through your digestive system. Symptoms of constipation include having hard, lumpy, or dry stools that often are difficult to pass. Being constipated also may mean having infrequent bowel movements—fewer than three per week—or feeling like you were not able to get all of the stool out.

Many health conditions and situations can lead to constipation. For example, pregnancy, certain medications, and certain underlying diseases are among the common causes of constipation. Short-term situations such as traveling or becoming dehydrated also can cause occasional constipation.

The Link Between Constipation and Back Pain

Back pain, especially lower back pain, is another common symptom of many conditions. Most people will experience back pain at some point in their lives. Sometimes, back pain is related to constipation.

Constipation Causing Back Pain

Research has shown that constipation can lead to lower back pain. In one survey study, people who were constipated had more severe lower back, lower limb, and whole-body pain. The researchers suggest an imbalance in gut bacteria makeup (called the gut microbiome) can cause both constipation and increased perception of pain.

Also, when stool does not pass out of the body quickly enough, it backs up in the colon. This causes the colon to swell, which can put pressure on the nerves in the lower back. 

Over time, chronic constipation can result in fecal impaction. In this condition, a hard lump of stool becomes stuck in the rectum. Lower back pain may be one result of fecal impaction.

Back Pain Causing Constipation

In some cases, back pain can lead to constipation. If trying to pass stool is painful due to a back injury or neurological disease, you may delay going to the bathroom in order to avoid the pain. This leads to stool buildup in the colon. 

Having back pain also may make you less likely to exercise, and lack of exercise can lead to constipation. Finally, certain medications used to treat back pain, especially opioids, can cause constipation as a side effect.

Conditions That Can Lead to Constipation and Back Pain

Back pain and constipation can be symptoms of many health conditions. Here are a few of the most common conditions that may lead to both.

Pregnancy

Pregnancy causes several hormone changes, including an increase in progesterone. This hormone relaxes the intestinal muscles, which can lead to constipation. Many pregnant people also take an iron supplement, which can cause constipation.

Back pain is very common during pregnancy. The pain is due to the uterus expanding to accommodate the fetus, which changes your posture. Also, carrying more weight puts more pressure on your back muscles.

Neurological Disease

Neurological diseases affect the nerves, brain, and spinal cord. Multiple sclerosis (MS) and Parkinson’s disease are common neurological diseases. These conditions frequently cause pain, including back pain.

People with a neurological disease, stroke, or spinal cord injury also may develop a condition called neurogenic bowel dysfunction. This happens when the nerves that control the bowels are damaged, so the body is not able to pass stool normally. This often leads to constipation. Two-thirds of people with MS report having constipation or inability to control their bowels.

Irritable Bowel Syndrome (IBS)

Constipation is one of the hallmark symptoms of IBS, along with abdominal pain and diarrhea. IBS is a type of functional gastrointestinal disorder, a condition in which the gut and the brain do not work together as they should. People with IBS often live with chronic pain, which may occur all over or in specific parts of the body.

Endometriosis

In endometriosis, tissues similar to the tissues in the uterus grow outside of the uterus, where they should not grow. This tissue can lead to many complications, including back pain and digestive problems like constipation. Back pain may be chronic. Digestive problems may get worse during menstruation. 

Anyone who menstruates can develop endometriosis. Based on available information, experts think that over 10% of women have the condition.

Cancer

Although it is not common, several types of cancer can lead to back pain. Tumors in the back can put pressure on the spinal cord or nerves, causing pain. Cancer of the spine or bone marrow also can damage the bone, leading to spinal fractures.

Colorectal cancer also may lead to widespread pain or pain in the buttocks. Also, one of the primary symptoms of colorectal cancer is bowel changes, including constipation.

Managing Constipation-Induced Back Pain

The first step to managing constipation and back pain is treating any underlying health condition that is causing the symptoms. If your back pain is a result of constipation, treating the constipation directly may resolve the pain. You can typically treat constipation at home with the following methods:

• Eat more fiber: The U.S. Dietary Guidelines for Americans suggest that adults get 22-34 grams (g) of fiber daily. Good dietary sources of fiber include whole grains, fruits, vegetables, beans, and nuts. You can also take a fiber supplement, but consult your healthcare provider before starting new supplements.
• Drink plenty of water: Constipation can result from dehydration, so drinking enough fluids to stay hydrated is key. Along with water, you can try clear soups, herbal tea, or naturally sweetened fruit juices.
• Get regular exercise: Inactivity is a risk factor for constipation. You can help keep your bowels working smoothly by getting moderate exercise several times weekly.
• Consider bowel training: You can create a bathroom routine to teach your body to have a bowel movement at the same time each day, such as after breakfast. Give yourself enough time on the toilet and try using a footstool to get into a more comfortable position. Ask your healthcare provider for additional bowel training tips.
• Stop taking medications that cause constipation: Your healthcare provider can advise you about which drugs have constipation as a side effect. They may be able to help you stop or switch drugs that are constipating you.
• Take a stool softener or laxative: If your healthcare provider recommends it, an over-the-counter (OTC) medication may help you pass stool more easily. There are several types of these medications to choose from. However, pregnant people should be cautious of taking these drugs, as they can cause muscle contractions and dehydration.

If your constipation persists, your healthcare provider may prescribe a stronger medication to help relieve it. Sometimes, healthcare providers use warm mineral oil enemas or suppositories to prevent stool from becoming impacted. They also may need to break up stool that is stuck in the rectum with their fingers. In severe cases, surgery may be necessary.

If your back pain is not related to constipation, other at-home treatments can likely help it resolve. Resting for a few days, using cold and hot therapy, and taking OTC pain medication are the primary treatments. If these methods do not work, your healthcare provider may recommend physical therapy, massage, or an epidural injection to treat the pain.

Other Potential Causes of Back Pain

Back pain can have many causes that are not related to constipation.

Spinal Injury

Most cases of back pain involve the spine or its surrounding tissues. Injury to the spine is a common cause of lower back pain. Lifting something too heavy, falling down, or getting hit in the spine can all lead to injury.

Herniated or Slipped Disc

The spine is made up of bones called vertebrae and spongy discs that sit between them. When a disc breaks open or slips out of place, it puts pressure on the nerves around it. This can result in back pain.

Inflammatory Conditions

Several health conditions can create inflammation in the back. This inflammation then puts pressure on the spinal nerves that causes pain. Possible causes of inflammation in the lower back include infections, osteoarthritis, and spinal stenosis (narrowing of the spinal canal).

Curvature of the Spine

In some skeletal conditions, the spine is curved. For example, scoliosis is when the spine curves to the side and kyphosis is when the spine is curved in a hunchback shape. This curvature can strain the back muscles and ligaments, leading to pain in the back.

Non-spinal Causes

In some cases, back pain is not related to the spine. Problems with several internal organs can lead to back pain. For example, damage to the kidneys, gallbladder, or ovaries can feel like pain in the lower back.

When to Contact a Healthcare Provider

Constipation and back pain are both typically temporary, and you can usually treat both at home. If either symptom does not go away after trying at-home treatments, you should contact your healthcare provider. They can evaluate you for potentially serious underlying causes.

If you have constipation, call your healthcare provider right away if you also have any of the following symptoms:

• Blood in your stool
• Constant abdominal pain
• Fever
• Inability to pass gas
• Vomiting
• Persistent lower back pain
• Losing weight without trying

If you have back pain, call your healthcare provider right away if you also have any of the following symptoms:

• Severe pain, especially after a fall or accident
• Blood in the urine
• Trouble controlling your bladder or bowels
• Pain that moves down into the leg past the knee
• Numbness or weakness below the back
• Pain that gets worse when you lie down
• Fever
• Redness or swelling at the site of the pain

A Quick Review

Most people will experience constipation or back pain at one point or another. Neither is typically cause for concern. Sometimes, the two conditions are related: constipation can lead to back pain, and back pain can lead to constipation. This may be due to one directly causing the other or an underlying condition causing them both. 

While both conditions will typically resolve with time and at-home treatment, contact your healthcare provider if either symptom persists or becomes severe.