Can irritable bowel syndrome cause back pain?

Back pain may not immediately come to mind as a symptom of irritable bowel syndrome (IBS), but it’s a symptom that many people experience.

After the digestive issues that define IBS – like abdominal cramps, constipation, bloating and diarrhoea – back pain is one of the most common symptoms.

Scientists don’t fully understand what causes IBS back pain, but it may involve your diaphragm muscle, other related health conditions or ‘referred’ pain from elsewhere in your body. 

Several things can help with IBS back pain, including medication, psychological approaches and physical therapies. If your pain continues, it’s important to speak with your doctor.

We’ll explore all of this in more detail below. We’ll also look at the role diet and probiotics can play in treating IBS, and what else could be causing your back pain. 

IBS and pain

When people talk about IBS pain, they generally mean pain or cramps in their abdomen or gut. 

Flare-ups of these and other symptoms can be worse after you eat, and your symptoms often get better once you poo.

But you may also have IBS pain elsewhere, including your back. 

About 50% of people with IBS have symptoms beyond their gut, in addition to gut symptoms. This is true across all IBS subtypes. 

Non-gut symptoms may stem from factors such as hypersensitivity (or amplified sensitivity) to food or stress. 

Alternatively, the symptoms may result from the low-grade inflammation linked to IBS. Other health conditions associated with IBS may also play a role.

Here are some symptoms of IBS and other health conditions associated with it: 

• stomach pain or cramps
• constipation
• diarrhoea
• bloating
• back pain
• chest pain
• pelvic pain
• pain in the lower jaw
• headaches
• increased tiredness or fatigue
• fibromyalgia, which causes pain all around the body
• bladder pain syndrome, also called interstitial cystitis
• anxiety or depression

Three out of four people with IBS have frequent abdominal pain. 

Meanwhile, studies suggest that as many as 81% of people with IBS experience back pain, while up to 88% have pain in the lower back.

Also, people with IBS back pain may be more likely to have headaches, chronic fatigue and pain in other areas, like the pelvis or lower jaw. 

Possible causes of IBS back pain 

Experts are still working to understand the links between IBS and back pain. There are a number of possible causes, including:

• Diaphragm issues: Your diaphragm is a large muscle between your chest and abdomen. You use it to breathe, and it’s also important for posture and movement, helping to stabilise your lower back.
  
  If you have IBS, your diaphragm may not contract and relax as effectively as it should, especially after you eat. If the diaphragm is dysfunctional, it may result in lower back pain.
  
  
• Referred pain: This means that pain in one area causes pain somewhere else. Scientists don’t fully understand how referred pain works, but some believe that it involves a mix-up of signals passing along the nerves in your spine.
  
  As a result of these ‘crossed wires’, pain in your gut due to cramping or bloating from IBS may lead to referred pain in your back.  

• Other health conditions: Some people with other health conditions, like fibromyalgia or rheumatoid arthritis, may be more likely to develop IBS. Back pain is a symptom of both fibromyalgia and rheumatoid arthritis.  

The gut-brain connection and IBS

Your gut and brain communicate via a series of pathways known as the gut–brain axis. This axis includes nerve impulses, hormones and signals from your immune system.

The gut-brain axis works in both directions: your brain can affect what happens in your gut and vice versa.

Your gut microbiome is the community of bacteria and other microorganisms that live in your gut. 

This microbiome plays an important part in the dialogue between your gut and brain, and it can affect your hormones and immune system. 

Studies suggest that more than 70% of people with IBS have an unbalanced and less diverse gut microbiome.

This issue is called dysbiosis, and it can disrupt the way that your brain and gut communicate.

This, in turn, can lead to changes, including changes to the speed at which food is moved through your gut. As a result, you may have pain. 

How to manage IBS back pain

The best way to manage IBS symptoms, including back pain, can vary from person to person. 

Here are some strategies that can help. But if you have any questions about the right approach, it’s a good idea to talk to your doctor.

• Psychological approaches: Stress can increase IBS symptoms and back pain, so relaxation techniques like meditation, breathing exercises and yoga may help.
  
  Also, cognitive behavioural therapy (CBT), a form of talking therapy, has been shown to improve IBS symptoms and back pain for many people.
  
  
• Physical therapies: There’s evidence that acupuncture can reduce abdominal pain from IBS, as well as chronic back pain.
  
  A chiropractor or physiotherapist – who uses their hands to help with muscle, bone and joint problems – may be able to improve back pain and some symptoms of gut conditions, including IBS.
  
  
• Hot and cold treatments: If you need quick relief, applying an ice pack – or bag of frozen peas wrapped in a tea towel – to the painful area may help. Alternatively, a heat pack or hot water bottle can reduce muscle stiffness.
  
  
• Medication: Antispasmodic drugs like Buscopan, or those containing alverine citrate, mebeverine hydrochloride or peppermint oil, can help ease stomach cramps caused by IBS.
  
  Also, ibuprofen, which you can buy over the counter, may ease back pain. But there’s some evidence that taking tablets can make IBS symptoms worse. So, rubbing an ibuprofen gel into the painful area could be a good alternative.

Is physical activity good for IBS back pain?

Because much about IBS back pain remains a mystery, there’s no clear guidance about physical activity.

While the NHS recommends getting plenty of exercise to help manage IBS symptoms, scientists note a lack of evidence that physical activity can help with IBS pain. 

When it comes to back pain, the NHS advises you to stay active, and it recommends some exercises that may help strengthen your back and improve mobility. 

But the cause of your pain will influence what kind and how much exercise you should do. A doctor can advise about what will be best for you.

Diet, probiotics and IBS

Eating a wide variety of plants is generally good for your health, and it can improve the balance and diversity of your gut microbiome. 

But certain plants and other foods contain sugars known as FODMAPs. These may make symptoms worse for some people with IBS.

FODMAPs exist in many common ingredients, such as wheat, onions, garlic, beans and certain artificial sweeteners. 

A doctor or dietitian may recommend a low-FODMAP diet if you have IBS. This approach has revolutionised IBS management: clinical trials have reported response rates of 50–80%.

If you decide to follow this temporary diet, it’s important to receive ongoing guidance from a healthcare professional who is trained in it, such as a gastroenterology dietitian.

A low-FODMAP diet is restrictive, and a specialist doctor or dietitian can make sure your diet remains diverse and meets all of your nutritional requirements. 

The good news is that many people with IBS only have a problem with certain FODMAPs. Keeping a diary of what you eat and when your IBS symptoms flare up can help you identify what triggers them.

Another approach that may help ease IBS symptoms is adding probiotics to your diet. 

Probiotics are live, ‘friendly’ bacteria and other microbes that can have health benefits if you take adequate amounts. They’re available in supplements, which may be powders, liquids or capsules. 

Looking at a range of research into probiotics, scientists have found that certain strains may help relieve IBS symptoms, including abdominal pain, bloating and wind.

Health guidelines in the United Kingdom suggest trying a probiotic for between 4 and 12 weeks to see if it improves symptoms. Not all probiotics will work for everyone with IBS, however.

Some fermented foods, like certain yoghurts, also contain probiotics. But some of these foods, including sauerkraut and yoghurt, are high in FODMAPs.

As we’ve seen, these sugars may trigger IBS symptoms in some people, though everyone’s tolerance level is different.

What else could back pain be?

Often, back pain results from an injury, like a pulled muscle. This pain generally gets better within a few weeks. 

Back pain that continues for longer could be due to another, ongoing health condition. Some possible causes of back pain include:

• a strained muscle or tendon
• a sprained ligament
• a slipped disc
• sciatica (a trapped nerve)
• a misaligned vertebra in your spine (spondylolisthesis)
• a fractured vertebra
• scoliosis (curved spine)
• ankylosing spondylitis, which involves inflammation of the spine

As you get older, you may be more prone to degenerative disc disease, the wearing down of discs in your spine, and osteoporosis, a weakening of bones.

Very rarely, back pain stems from either a tumour or an infection.

When to seek help

Back pain often gets better by itself, but it's a good idea to see a doctor if:

• The pain hasn’t improved after a few weeks.
• It’s preventing you from doing day-to-day activities.
• The pain is very bad or getting worse.
• You’re worried about the pain.

Summary

Back pain is a common symptom of IBS. It can accompany pain in other areas, including your pelvis or jaw.

Scientists still have a lot to learn about IBS back pain. But some possible causes include problems with your diaphragm, referred pain and overlapping health conditions, such as fibromyalgia.

Medications, including antispasmodics, may help ease stomach pain from IBS, while ibuprofen gel can treat back pain directly.

Reducing stress through relaxation techniques or CBT may also help. Plus, you might try hot or cold packs and consider seeing an acupuncturist or chiropractor.

If your back pain is relatively new, it could stem from an injury, which could get better on its own. But if the pain continues, it’s a good idea to consult a doctor. 

To learn more about IBS and other gut health topics, visit Symprove’s Gut Hub.

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