Low Back Pain and Pelvic Floor Disorders

Welcome to Texas State University's Evidence-based Practice project space. This is a wiki created by and for the students in the Doctor of Physical Therapy program at Texas State University - San Marcos. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors

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Search Strategy

Search Databases: CINAHL, PubMed, GoogleScholar, PT Journal, Medline

Keywords: Low Back Pain, Pelvic Floor Disorders 

Search Dates: 4/6/2011 - 4/19/2011

Definition/Description

Low back pain (LBP) is a condition of localized pain to the lumbar spine with or without symptoms to the distal extremity whose etiology is commonly unknown.⁵  Pelvic floor disorders (PFD) include urinary incontinence, pelvic organ prolapse, fecal incontinence, and other sensory and emptying abnormalities of the lower urinary and GI tracts.²   Current evidence has shown individuals with low back pain have a significant decrease in pelvic floor function compared to individuals without low back pain.¹ 

Epidemiology /Etiology

Low back pain (LBP) is one of the most common musculoskeletal conditions; approximately 70-80% of the population will experience at least one episode of LBP during his/her lifetime.  Causes of LBP range from specific trauma to poor postural habits, which contribute to its heterogenous origins.  LBP can be attributed to a definite pathology in only about 15% of cases; there is also a poor correlation between the pathology and associated pain/disability. (look at ortho article)

Studies estimate that over 25% of all women and more than a third of women over the age of 65 experience PFD.  The true prevalence of PFD is underestimated for several reasons: heterogeneity in populations studied, lack of standardized definitions, and under-reporting symptoms of sensitive nature.  Even though PFD is a physiological problem, the psychosocial impact can be much more detrimental to the patient’s quality of life. Chronic health problems associated with PFD are estimated to increase by 50% over the next 30 years due to the increasing numbers of women reaching age 65.³  PFD typically does not have one specific cause; there are many risk factors that have been correlated with the development of PFD.  The major risk factors are: pregnancy/childbirth, age, hormonal changes, obesity, lower UTI, and pelvic surgery.  The development of PFD likely comes from multiple components involving: anatomical, physiological, genetic, reproductive and lifestyle^3,5.  

Weak core musculature is often a culprit in individuals with LBP and PFD.

Differential Diagnosis

PFD is difficult to diagnose because it presents many challenges because of poor association between pathophysiology, poor patient reported signs and symptoms, and anatomical evidence.³ 

• Cauda Equina Syndrome

• Sexual Dysfunction
  

Examination

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Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Key Research

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Resources

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Clinical Bottom Line

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Recent Related Research (from Pubmed)

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References

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