Is there a link between back pain and urinary symptoms?

Abstract

To identify epidemiological studies of mechanical low back pain and urinary dysfunction, and to identify potential evidence supporting a mechanism for this relationship. A systematic online search was conducted of EmBASE, Medline, CINAHL, and PEDro databases. We excluded studies where an obvious link between low back pain and urinary dysfunction exists (such as cauda equina syndrome). Two reviewers used inclusion/exclusion criteria to screen the articles. Data were extracted and summarised with a narrative review, and study quality was assessed. We included 22/930 studies. Twelve studies addressed the epidemiological link between low back pain and urinary symptoms. The studies all found a statistically significant association between the diagnosis of urinary incontinence or urinary symptoms and low back pain, (aOR's 1.1 to 3.1). Results were consistent when stratified by sex, age, and when adjusted for confounders. The study quality was good in 4/12. Eight studies reported on an assessment/intervention related to pelvic floor function, urinary symptoms and low back pain. Pelvic floor dysfunction was common in women with low back pain, however randomized studies and pre-post studies reported mixed results for pelvic floor physiotherapy improving low back pain. The study quality was good in 3/8. Low back pain and urinary incontinence are associated in large epidemiological studies, and the presence of one condition seems to predispose the development of the other. There is limited evidence to suggest pelvic floor interventions are useful for low back pain in this patient population, therefore the mechanism for this relationship is still unclear.