Back pain isn't part of the IBS definition, but it turns up much more often in people with IBS than in people without it.[1] Two things explain much of the link. Pain from an oversensitive bowel can be felt outside the abdomen, including in the back, and IBS often comes with other chronic pain conditions.[2][3][4]
Does IBS cause back pain?
It's a well-recognized association. In a study comparing 100 people with IBS with 100 controls matched for age, sex and social class, back pain was one of the non-gut symptoms most clearly more common in IBS, along with tiredness and bladder symptoms.[1] UK NICE guidelines note that backache, lethargy, nausea and bladder symptoms are common in IBS and can support the diagnosis.[5] In a Norwegian general-practice study, people with IBS reported 20 of 22 other health complaints more often than controls.[6]
Why does IBS cause back pain?
- Referred pain from the bowel. In a classic study that inflated a balloon in the lower colon, 8% of the people who felt pain located it in the back or elsewhere outside the belly.[2] Balloon tests along the whole colon showed that pain from the IBS bowel can be referred to several sites outside the abdomen.[3] Altered "viscerosomatic referral," meaning gut sensations felt in other parts of the body, was one of the forms of altered gut sensation found in 94% of people with IBS in another study.[7]
- Overlapping chronic pain conditions. IBS commonly coexists with fibromyalgia, chronic pelvic pain and temporomandibular (jaw) joint disorder.[4] A systematic review found people with IBS have about twice as many other physical conditions as controls, with fibromyalgia, chronic fatigue syndrome and chronic pelvic pain in up to 65%.[8] In a US study that followed adults for chronic pain, low back pain, IBS, fibromyalgia, jaw disorders and headache frequently overlapped. Back pain linked most closely with the musculoskeletal conditions, and less closely with IBS.[9]
So for some people, back pain is part of a wider pattern of pain sensitivity rather than something the bowel is directly causing.
Is it IBS lower back pain or something else?
IBS pain is, by definition, linked to bowel movements or changes in stool.[10] Clues that your back pain may be connected:
- It rises and falls with your gut symptoms, such as bloating, cramps or a flare-up.
- It comes with belly pain and eases when the gut settles.
- You've had it checked and nothing else explains it.
Clues that something else is going on:
- Fever or feeling hot, cold, shivery or generally unwell[11]
- Pain in your lower back or side with a high temperature, burning when you pee, or dark or cloudy urine, which can mean a kidney infection[12]
- Pain that doesn't improve with rest, is worse at night, or is worse when you sneeze, cough or have a bowel movement[11]
- Pain between your shoulder blades rather than in your lower back[11]
- Pain that has no link at all to your bowel habits or belly symptoms
What helps?
If your back pain tracks your gut, treating the IBS is the logical place to start. For IBS pain, UK experts suggest antispasmodics or peppermint oil first, then low-dose tricyclic antidepressants, and gut-directed psychological therapies such as CBT or hypnotherapy if medicines don't help enough.[13] Getting more active helps too: in a randomized trial, people with IBS who increased their physical activity improved their symptom scores significantly more than those who didn't.[14] See how IBS is treated and why IBS hurts so much.
To find out whether your back pain moves with your gut, log both for a few weeks, along with meals and stool type. A food and symptom diary makes the pattern easier to see, and it's useful to show your doctor.
When to see a doctor
See your doctor if back pain hasn't improved after a few weeks, stops you doing everyday things, or comes with weight loss you can't explain, a lump or swelling, or a change in the shape of your back.[11] Get urgent advice if you feel feverish or unwell, or the pain is severe, sudden or quickly worsening.[11] If you might have a kidney infection, get an urgent appointment if you have a very high temperature, blood in your urine, or pain in your back just under the ribs.[12]
Call emergency services or go to the emergency department if back pain comes with pain, tingling, weakness or numbness in both legs, loss of feeling around your genitals or anus, new difficulty peeing or loss of bladder or bowel control, or chest pain.[11]
Also see a doctor for any IBS alarm feature, such as blood in your stool, anemia, fever or symptoms that wake you at night.[15] Read more about IBS red flags.