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

Back pain can be super painful and super scary. And, as if that isn’t enough, it can also come with some seriously strange symptoms.

While some people experience constipation and wonder how that might be connected to low back pain, there is another type of bathroom function that people wonder about with low back pain: peeing.

What does it mean if you have back pain and can’t pee? What is Neurogenic Bladder Disorder? Let's find out!

Acute vs Chronic Back Pain

Back pain is a very common condition that ends up affecting around 80% of the population at some point in their lives. It is also quite a mysterious condition as there are many types of conditions and causes that are linked to it.

Acute injuries, bone and disc degeneration, pregnancy, infections, cancer, and various inflammatory diseases can all be potential causes of low back pain.

Fortunately, for most people, low back pain tends to go away on its own after a few weeks, but for an unlucky part of the population, the pain can become chronic and debilitating.

Not Taking Things Seriously

The self-resolving nature of most low back pain cases and the difficulties that physicians have in diagnosing chronic low back pain have made low back pain something of a mystery to healthcare providers. This has led to a tendency to under-treat the condition in some cases, with many people not realizing that there are some very serious conditions linked to low back pain.

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.

Also, because most cases of low back pain are benign (not too serious) most physicians feel that there is probably nothing that they can do for the patient. This can lead to a sense of complacency about an individual's experience of low back pain.

How People With Back Pain Get Treated vs Those With Chest Pain

An interesting comparison, however, is viewing low back pain in a similar light to chest pain. While 80% of back pain cases will resolve on their own and are benign, the same can be said for chest pain. Only around 10 - 15% of chest pain presentations turn out to be serious.

The treatment of the two conditions are, however, often quite different.

Chest pain patients will have a whole host of tests performed on them to rule out things like myocardial infarction, aortic dissection, or a pulmonary embolism. Back pain patients might get an MRI and a prescription for pain meds.

The Importance Of Checking For Red Flags

What does this have to do with going to the bathroom, you ask? Well, when it comes to serious conditions that are linked to low back pain, doctors should not forget to rule out concerns such as fractures, infections, disk herniations, or something called cauda equina syndrome. These serious conditions can cause low back pain and are often missed during visits to the emergency department.

While excess imaging for low back pain is definitely not recommended in the absence of red flags, it is important for physicians to remember to ask for a detailed history of the patient and cover symptoms, such as difficulty urinating, especially if this isn’t their first visit to the emergency room for back pain.

Conditions Associated With Urinary Issues And Low Back Pain

So what conditions are associated with urinary issues and low back pain?

1. Spinal cord injuries

2. Spinal Stenosis

3. Herniated discs

4. Spinal Fractures

5. Infections

6. Spinal Lesions

7. Lumbar tumors

8. Genetics

9. Cauda Equina Syndrome

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

1. Physical Injuries And Bladder Problems - NBD

When it comes to back pain an incontinence physical injuries are often the first place doctors should explore. The sacral plexus is a network of nerves that extends from the lower part of the spine. These nerves receive information from the pelvis and the legs and help to control movements in these areas.

If the sacral nerves are damaged (such as with an injury - lumbar disc protrusions can affect the nerves in 1-15% of cases) then problems with the bladder and the bowel might start to arise. Urinary retention is one of the most common symptoms associated with this type of damage.

Injuries to the spine are often linked to something called Neurogenic Bladder Disorder (NBD). These types of accidents can cause bruising or constrict the blood flow along the spinal cord, damaging the body’s ability to transmit important nerve signals. When a person has NBD the nerves that control the bladder, and the muscles that support it, tend to be either overactive or under-active.

Symptoms of NBD:

• Limited or involuntary control over urination

• Sudden urges to urinate

• Inability to completely empty the bladder

• Frequent bathroom visits

• Bladder can’t hold urine - overfills and urine leaks.

2. Cauda Equina Syndrome

Cauda Equina Syndrome (CES) is a very serious medical condition that requires urgent medical attention/ surgery. This condition is rather rare so doctors typically won't start off by suspecting something like this for bladder issues and low back pain.

Individuals with CES have something that is compressing on their spinal nerve roots, and this can cause sensation and movement to be cut off. Urgent surgery might be needed to prevent lasting damage such as permanent paralysis of the legs or incontinence.

Cauda equina syndrome can happen slowly, over time, or it can happen suddenly. The most common cause of acute urinary retention issues with cauda equina compression is a lumbar disc herniation. One in 1,000 patients who suffer from sciatica will develop cauda equina syndrome.

Diagnosing CES:

1. Urinary retention and/or rectal dysfunction and/or sexual dysfunction

2. Saddle/anal anesthesia

3. MRI

4. Myelogram

This condition means that it is vitally important for anyone who is experiencing any type of urinary retention (inability to pee) to be tested for saddle anesthesia (reduced sensation in the perineum, buttocks, anus, groin and upper thighs).

Some other ways doctors can test for this condition include a digital rectal exam to test for tone and sensation which is often preferable to using bladder scanners that can be unreliable. A bladder catheter can also be used to measure how much urine is being produced.

Conclusions

While many people (especially women) might be familiar with urinary incontinence, basically bladder leak, urinary retention is not as common. And, while bathroom issues may not seem like a big deal, if you have lower back pain along with difficulty urinating (or any other key red flags or symptoms), they should tell you to head straight to the ER or your healthcare provider.

While most cases of low back pain are not cause for alarm and will go away on their own, this is not always the case. If you have back pain and are not peeing your doctor should be able to check you out fairly quickly and make sure that nothing more serious is going on. For more information about red flags and how they relate to more serious issues, check out our blog on 'Red Flags For Low Back Pain'.