If you are suffering from chronic cystitis or interstitial cystitis and you also experience lower back pain – read on. Lower back problems can be at the root of bladder problems. I call this the bladder-back-connection. Seem a bit far-fetched? Let me explain…
According to Larrian Gillespie, former urologist and author of the book ‘You Don’t Have to Live with Cystitis’:
‘Spinal problems are the most frequent cause of bladder pain.’
In an interesting study from 1991, Gillespie et al studied ten patients consistent with the symptoms of interstitial cystitis.
All of them had also suffered from lower back pain, although this had been overshadowed by the pain caused by their interstitial cystitis. Upon further examination, all patients had a spinal compression of the nerve connecting the bladder to the brain. Decompression of the nerve led to immediate relief of bladder pain in 9 out of 10 patients .
The bladder and its nerves
The bladder is connected through nerves to the brain via the spine.
Through these nerves, the bladder sends signals to the brain telling it that it is full and needs to empty. When we decide to go to the toilet, the brain sends signals back to the pelvic floor muscles telling them to relax. When the process of urination begins, the external sphincter of the bladder opening (urethra) relaxes and the bladder muscle contracts. The reverse happens at the end of urination.
A large group of nerves to the bladder originates from between two vertebrae in the lower spine (called the lumbar fourth and fifth interspace).
The nerves exit the inside of the spine through a space in the backbone (the entrance zone), underneath the bony bridge (the pars articularis) and then out of the skeleton through the facet joint.
Most nerves have both a motor and a sensory branch in the same tube. The motor nerves control muscle contraction and the sensory nerves control blood flow, pressure and pain.
Spine problems and cystitis (UTIs)
As we’ve learned, many of the nerves to the bladder originate between the lumbar fourth and fifth interspace. A compression of the disk in this area can hinder messages to the bladder from being transmitted.
The neurotransmitter responsible for transmitting messages over the bladder nerves is called acetylcholine. If the transmission of acetylcholine is cut short by spinal compression, the nerves may not build up enough ‘current’ for the bladder to contract efficiently.
This could lead to the bladder not emptying properly, leaving residual urine.
This would be ideal breeding ground for infectious bacteria.
Cystitis can be the end result.
Spinal problems and interstitial cystitis
As we’ve seen above, both motor and sensory nerves exit the spine through three points. Each of these three points can be prone to injury.
If there is damage to the spine at any of these points, the nerves can be compressed.
For the nerves to function optimally, they need to be connected to the ‘mother cells’ in the spine or to the central nervous system and they must have a continuous oxygen supply.
Any compression or damage to the nerve can cause it to lose these connections and it may start to function abnormally.
The end result could be a wide spectrum of changes to the bladder – as seen in interstitial cystitis.
As shown in Gillespie et al’s study, this seems to be the case especially when the fifth lumbar nerve is compressed.
Unfortunately there has been a lack of more studies into the bladder-back connection. Two chiropractic papers have looked into the connection between the spine and interstitial cystitis and have found that manipulation of the spine alleviated interstitial cystitis symptoms in most cases [3, 4].
Up to 90% of adults in the US alone are expected to have lower back problems at some point in their life. Because it is such a common problem, the bladder-back connection should not be ruled out.
Stay tuned for PART 2 in which I’ll look at causes and solutions for bladder issues related to back problems.
Now I’d like to hear from you: are you suffering from back problems on top of cystitis? Has anything helped you? Let me know in the comments!
Pin ‘The Bladder-Back-Connection’ for later:
- Gillespie, Larrian You don’t have to live with cystitis (New York: Avon Books, 1996), p. 89
- Gillespie, Larrian et al Lumbar Nerve Root Compression and Interstitial Cystitis-Response to Decompressive Surgery British Journal of Urology 1991 [68:361-364]
- Cashley, Mark et al Chiropractic care of interstitial cystitis/painful bladder syndrome associated with pelvic lumbar spine dysfunction: a case series Journal of Chiropractic Medicine (2012) [11, 260–266]
- Mikkelsen, Dorthe Chiropractic treatment of cystitis: a possible mechanism. BJC 1998 [1 (2): 16-17]
Gillespie, Larrian You don’t have to live with cystitis (New York: Avon Books, 1996)
Gillespie, Larrian et al Lumbar Nerve Root Compression and Interstitial Cystitis-Response to Decompressive Surgery British Journal of Urology 1991 [68:361-364]
Pontari, Michel Interstitial Cystitis Current Opinion in Urology 1993 [3: 40-44]
Misti wilsonFebruary 14, 2018
Yes, have severe burning, feeling like acid is on low left back and radiates around to underneath left rib and down to bladder
Peter EvansApril 23, 2020
I have suffer with back problems for 40 years, I’m 73 now. For the last 3 years I have been diagnosed with interstitial cystitis, also BPH.
40 year ago I had a slipped disc at L4 and suffer back pain. Sometime my back goes into spasm. Very interesting that my IC could be from my back.
MelOctober 31, 2020
Yes, I do not have “Interstitial Cystis” at least not that I’ve been diagnosed yet. It’s taken 1 year and 8 months to get a diagnosis of diverticulitis and arthritis in my back. I’ve NEVER had back issues until now. After my flare I ended up with a severe pain in lower right back and hip and it feels like a nerve and this morning is the first time I felt the pain in the front that felt like it was connected to my bladder. One of the issues they figured out during my illness period was I had an inflamed bladder, they said it had nothing to do with diverticulitis. No one has said another thing about my bladder. I’ve also had potassium dumps for the same amount of time, over 10 of them sending me to ER and needing potassium. I’m just starting to put things together on my own. This is something I feel strongly about because I’m 50 and I’ve been physical all my life. Dancing(ballet), hiking, walking, working on a PVM as a deckhand. I’ve genuinely never been down with any illness or accident over 6 months, this has been the worst. Thank you for your referenced article 🙂
LisaApril 10, 2021
Absolutely! I was born with 3 ureters one tried to work and screwed everything up ..
At 42 I had reimplantation and bladder repair. All was much better until my L4 L 5 got screwed up.. it was only my left leg and lower left back affected until I agreed to physical therapy.. it’s made it much worse now pain on right side too down to mid thigh and bladder spasms?. Not happy