Lower Abdominal Pain and Back Pain: What Can Cause Both?

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Lower Abdominal Pain and Back Pain: What Can Cause Both?

By Your Health Magazine Health Information Team

A sore back and lower abdomen can result from a problem involving the urinary tract, digestive system, reproductive organs, muscles or spine. Common possibilities include constipation, a urinary tract infection, a kidney stone, menstrual or pelvic conditions, and muscle strain. The pattern of pain and accompanying symptoms often provide useful clues, but new, severe or persistent pain should be evaluated rather than self-diagnosed.

Why Back and Abdominal Pain Can Occur Together

The lower abdomen, pelvis and lower back contain closely connected muscles, organs and nerves. Pain that begins in one location may spread or be felt in another. A kidney stone, for example, can cause pain that travels from the side or back toward the lower abdomen and groin. Pelvic pain may radiate into the back, while tightening the abdominal muscles because of discomfort can make the back feel sore.

It is also possible to have two problems at once, such as constipation combined with a back strain. Pain intensity alone does not reliably identify the cause: some minor conditions are very painful, while potentially serious conditions may initially produce mild symptoms.

Common Causes and Helpful Clues

Muscle and Spine Problems

A strained lower-back or abdominal muscle can produce soreness across both areas, particularly after lifting, an unfamiliar workout, coughing or an awkward movement. Musculoskeletal pain is often affected by posture and movement and may improve when the body is supported or repositioned.

However, abdominal symptoms should not automatically be blamed on a pulled back muscle. The MedlinePlus overview of back pain explains common back-pain causes and warning signs. Back pain accompanied by fever, unexplained weight loss, abdominal throbbing, leg weakness or loss of bladder or bowel control needs prompt medical attention.

Urinary and Kidney Conditions

A bladder infection commonly causes discomfort in the lower abdomen along with burning or frequent urination. Back, side or groin pain—especially with fever, chills, nausea or vomiting—can indicate that an infection has reached a kidney. The National Institute of Diabetes and Digestive and Kidney Diseases describes these bladder and kidney infection warning signs.

Kidney stone symptoms can include sharp pain in the back, side, lower abdomen or groin. Blood in the urine, painful urination, nausea and pain that comes and goes in waves make a stone more likely, although testing is needed to confirm the cause.

In people with a prostate, prostatitis may cause discomfort in the groin, lower abdomen or lower back along with urinary urgency, painful urination, a weak urine stream or pain with ejaculation. Sudden symptoms with fever and chills require immediate evaluation.

Digestive Causes

Constipation can create abdominal pressure and may occur with lower-back discomfort. Clues include hard or difficult-to-pass stools, straining and a feeling that the bowel has not emptied. Irritable bowel syndrome can also cause recurring cramps, bloating and changes between constipation and diarrhea.

More urgent digestive causes include appendicitis, diverticulitis and bowel obstruction. Appendicitis pain often starts near the belly button before moving toward the lower right abdomen, although symptoms vary. Diverticulitis more commonly causes persistent lower-left abdominal pain, often with fever or bowel changes. Inability to pass stool or gas together with vomiting and increasing abdominal swelling may signal an obstruction.

Pelvic and Reproductive Causes

Menstrual cramps frequently affect both the lower abdomen and back. Endometriosis, ovarian cysts, pelvic inflammatory disease and other pelvic conditions may cause similar symptoms. Timing in relation to menstrual periods, pain during sex, unusual vaginal discharge or bleeding can help a clinician narrow the possibilities.

Ultrasound or other imaging sometimes identifies pelvic fluid or an ovarian finding. These results must be interpreted alongside symptoms, pregnancy status and the rest of the examination. Learn more about what free fluid in the pelvis can mean.

If pregnancy is possible, abdominal or pelvic pain with low back pain or vaginal bleeding requires prompt medical guidance. An ectopic pregnancy can initially cause mild one-sided pelvic pain and low back pain, but rupture may lead to sudden severe pain, shoulder pain, dizziness, weakness or fainting. The American College of Obstetricians and Gynecologists provides additional information about ectopic pregnancy symptoms and emergency warning signs.

What Details Can Help Identify the Cause?

Before speaking with a healthcare professional, note:

• Exactly where the pain began and whether it travels
• Whether it is aching, cramping, burning, sharp or wave-like
• What makes it better or worse, including movement, eating, urination or bowel movements
• When it started and whether it is improving
• Any fever, vomiting, bloating, urinary symptoms or bowel changes
• Any vaginal bleeding, missed period or possibility of pregnancy
• Recent exercise, lifting, injury, surgery or new medication

A clinician may perform an abdominal and back examination and order urine testing, blood tests or a pregnancy test when relevant. Ultrasound, CT or other imaging may be considered based on the suspected cause and the examination findings.

When to Seek Care

Seek emergency care now for sudden or severe abdominal pain; a rigid or very tender abdomen; fainting, confusion or difficulty breathing; heavy vaginal bleeding; vomiting blood; bloody or black stools; or pain after a significant injury. Urgent evaluation is also important for possible pregnancy with abdominal pain, bleeding, shoulder pain, dizziness or weakness.

Prompt care is appropriate for fever with back or abdominal pain, repeated vomiting, blood in the urine, inability to urinate, or inability to pass stool or gas. New leg weakness, numbness around the groin or loss of bladder or bowel control with back pain is also an emergency.

Contact a primary care clinician if the discomfort lasts more than a few days, repeatedly returns or interferes with normal activities. Depending on the symptoms, evaluation may involve a gastroenterologist, urologist, obstetrician-gynecologist or musculoskeletal specialist.

For mild discomfort without warning signs, avoid heavy lifting, remain gently active as tolerated and monitor for changes. Do not rely on self-treatment if lower abdomen pain and back pain are worsening or accompanied by new urinary, digestive, reproductive or neurologic symptoms.