Low Back Pain and Pelvic Floor Disorders

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Original Editors

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Search Strategy

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

Keywords: Low Back Pain, Pelvic Floor Disorders, Incontinence

Search Dates: 4/6/2011 - 4/29/2011

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 shows that 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
  
• Urinary Tract Infection

Examination

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Medical Management (current best evidence)

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Key Research

Eliasson et al. (2008). Urinary Incontinence in Women with Low Back Pain

The purpose of this study was to explore the occurrence of UI in women with LBP and to compare this group with a reference group with similar demographics.  The study used previously collected original data for the reference group.  Two hundred women with LBP completed a validated questionnaire; subject inclusion criteria included LBP, female, not pregnant, age between 17 - 45 years old.  Study results found 78% of women with LBP reported UI.  Compared to the reference group, the prevalence of UI and signs of PFD were significantly increased in the LBP group (p <.001). 

Arab et al. (2010). Assessment of Pelvic Floor Muscle Function in Women with and without Low Back Pain Using Transabdominal Ultrasound

The purpose of this study was to investigate the PFM function in women with and without LBP using transabdominal ultrasound.  A cross sectional design was used to compare 40 nonpregnant women between the ages of 20 and 50 years (20 with LBP; 20 without LBP); subject inclusion criteria for the LBP group included LBP >6 week, on/off back pain and had experienced at least 3 episodes each lasting at least a week.  Each participant underwent transabdominal ultrasound normalized to their calculated BMI; PFM function differs according to each individuals BMI.  Baseline was established as the base of the bladder before contraction, and the change in distance of the base of bladder from pre and post contraction was used to determine significance of findings. Study results found a significant difference of (p = .04) in the transabominal ultrasound measurements of PFM function btw subjects with LBP and those without LBP.  Participants with LBP  displayed a pattern of decreased pelvic floor function when measured with transabdominal ultrasound.

Resources

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Clinical Bottom Line

Transabdominal ultrasound has proven that the PFM and trunk musculature co-contract to provide stability to the lumbar spine and pelvis.  Lack of neuromuscular control in the PFM can be associated with trunk instability which results in LBP.^{1,4, 13,14,15,16,17}  It is important for the physical therapist to consider pelvic floor dysfunction when evaluating and treating patients with LBP.  Although recent research has made many gains in relating LBP and PFD, much more progress is needed to definitively establish the relationship between the two conditions and identify successful intervention techniques.  

Recent Related Research (from Pubmed)

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References

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