Abdominal And Back Pain

Causes, Diagnosis & Treatment Of Abdominal And Back Pain

What Is Abdominal And Back Pain?

Abdominal and back pain in a woman with menstrual pain

The combination of abdominal and back pain usually starts with pain in the abdomen. The pain then gradually or rapidly spreads to the back. The most likely cause of such pain is often not difficult to diagnose if the nature, timing, severity, character, as well as the pattern and direction of spread is well noted.

Common causes of pain in the abdomen and back include menstrual pain, pain from ovarian cyst, gall bladder diseases, gallstones, prostatitis, endometriosis and leaking or ruptured abdominal aortic aneurysm.

Are you suffering with abdominal and back pain? Abdominal or stomach pain that spreads through to the back could be a sign of a condition like stomach ulcer, pancreatitis or even cystitis, depending on the exact spot from where the pain starts.

Common Causes of Abdominal Pain Going Through To The Back

Abdominal and back pain occurring together is often a symptom of a:

abdominal aortic aneurysm causing middle back and abdominal pain
  • Disease process or injury to part of the gut that sits deep inside the abdomen like the duodenum
  • Disease involving the stomach, gallbladder and pancreas
  • Injury or disease in one of the large blood vessels that runs deep through the abdomen like the abdominal aorta
  • Problems with the kidney or one of the tubes that runs from the kidney
  • Disease, injury or infection affecting the urinary bladder
  • Injury, disease or infection affecting the reproductive organs like the ovaries (e.g. ovarian cysts) uterus (e.g. menstrual pain, endometriosis, womb cancer and miscarriage) and testicles

There are other rarer causes of abdominal pain spreading to the back, or originating in the back and can be felt in the abdomen.

The Causes of Upper Abdominal And Back Pain

The common causes of abdominal pain that radiates or spreads to the back include:

  • Kidney cancer
  • Ureteric stone
  • Psoas muscle abscess*
  • Tumour of the adrenal gland*
  • Menstrual pain
  • Ovarian cyst (twisted or ruptured or tumour)
  • Labour pain
  • Cystitis
  • Endometriosis
  • Prostatitis
  • Irritable bowel syndrome

* The asterisked causes are reasonably rare and they should not be considered as the first possible cause of an abdominal and back pain occurring together. There are also other causes of abdominal and lower back pain in pregnancy and a few related to pain arising from the womb.

Causes Of Upper Abdominal And Back Pain After Eating

Do you suffer with abdominal pain within minutes of eating or even up to an hour after meals? Does the pain spread through the centre of your upper abdomen to your back between the two shoulder blades? Or is yours the type of pain that starts in the right upper abdomen and spreads through the side and goes to the upper back under your right scapular bone?

If you suffer from any of the symptoms above, the following conditions may be the reasons why you have abdominal and back pain after eating:

1. Biliary Colic

The gallbladder is that green pear shaped organ under the liver here.

Biliary colic is colic or pain due to the contraction of the gallbladder. The gall bladder is a pear shaped sac that lies just under the surface of the liver, about a hands length below your right breast.

This sac is where bile (that green bitter liquid you sometimes see in vomit) is stored. Bile is very important as it helps us digest our food properly. The liver produces bile and stores it in this sac. When we eat, especially rich foods or food rich in fat, the gallbladder contracts to release bile to help emulsify the fat in our food and to aid digestion of vital nutrients for our body.

Sometimes, the salts that make up the bile crystallize and form small stones and this is what is referred to as gallstones.  The pain of biliary colic could arise from:

  1. Strong contraction of the gallbladder to dislodge a sludge (thick deposits of bile salts before they become stones)  or
  2. Strong contractions to dislodge a stone. If a stone moves out of the gallbladder into the neck of the sac or into any of the tubes that connect the gallbladder to our small intestines, it causes some obstruction there.

The symptoms of biliary colic include:

  • Right upper abdominal pain that comes on suddenly or gradually after eating and spreads through the right-hand side to under the right arm and then to the upper back. Many suffers describes the pain as a dull but a severe ache that seems to stay under the tip of the bone in the upper back or scapula
  • Constant pain but with periods of increased severity coming in waves
  • Associated feeling of nausea, sweating 
  • Trying to find a comfortable position by lying in different postures or walking
  • Retching and actually vomiting

With biliary colic the pain typically lasts for a few hours but could continue up to three days in some people. If there is an associated infection of the gallbladder, the sufferer may become hot and cold (feverish) with yellow discoloration of the white part of the eyes (jaundice). This is called cholecystitis and it is a medical emergency. 

Treatment of biliary colic is with the use of strong pain killers, like a combination of Paracetamol or acetaminophen (Tylenol) and Diclofenac (Volterol). The two are safe to take together, provided you do not suffer with asthma or stomach ulcer. Always check with your doctor before taking medicines..

If there is evidence of infection (cholecystitis), acute admission into the hospital would be required and treatment with intravenous antibiotics and pain killers. In some cases an emergency operation may become necessary.  

2. Peptic Ulcer

Irritation of the stomach wall leads to stomach ulcer and abdominal pain piercing through to the back

The phrase peptic ulcer refers to any ulcer resulting from acid irritation to part of the bowel leading to the formation of holes or ulcer pits like those shown in the diagram to the right.

Peptic ulcers commonly occur in the stomach and duodenum (the first part of your small intestine just after the stomach). Peptic ulcers can also be found in the jejunum, ileum and merkels diverticulum (these are all parts of the small intestine).

A combination of excessive acid production, stress, and sometimes other factors like infection of the stomach by a bug called helicobacter pylori or prolonged intake of pain killers like ibuprofen, aspirin or diclofenac could lead to the formation of ulcers in the stomach or intestine.

Where there is an existing peptic ulcer, eating leads to the production of acid in the stomach. This in turn brings about the irritation of the sore or raw ulcer leading to abdominal pain. This condition usually happens more in a stomach ulcer than in any other form of ulcer.

The symptoms of peptic or stomach ulcer include:

  • Upper middle abdominal and back pain after eating
  • Pain which starts as a dull ache or sharp pain like the piercing of a knife in the upper middle abdomen and spreads through to the upper back
  • Pain which could start soon after eating or within a few minutes to an hour after a meal
  • The suffer developing a fear of food over time which leads to weight loss
  • An associated feeling of bloating, nausea or actual vomiting

The use of antacids, like gaviscon or mix magnesia may help calm down the pain.

If you are over 50 years of age and suffer with any of these symptoms, it is very important that you get checked immediately with your doctor to exclude conditions such as stomach cancer.

Treatment after appropriate investigation including endoscopy or barium swallow would include the use of antacids and medications like ranitidine and losec or omeprazole, lansoprazole or pantoprazole.

Avoidance of spicy foods, fried foods, alcohol, smoking and stressful situations would also be advised.

3. Pancreatitis

The pancreas is a banana shaped organ that lies behind the stomach in the upper abdomen. It is the gland where a number of very powerful digestive enzymes are produced and stored. It is also where insulin that helps in the regulation of sugar in our body is produced.

Pancreatitis is the inflammation of the pancreas. Any injury, infection, obstruction or exposure to certain types of situations can lead to pancreatitis. Gallstones and excessive alcohol consumption are very common causes of pancreatitis.

The symptoms of pancreatitis include:

  • Severe upper abdominal pain that spreads through to the back
  • Pain following eating rich food, fatty food or food with lots of protein
  • Pain which tends to be worse on lying down but slightly better by leaning forward
  • Associated nausea and vomiting 
  • Generally feeling unwell 

Pancreatitis is a very serious illness. It can mimic gastritis, stomach or duodenal ulcers. If you suspect that you may be having pancreatitis, please seek medical attention immediately.

4. Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome is a life-long condition where the bowels are very sensitive to certain foods and stressful situations. It causes abdominal discomfort which gets better on going to the toilet.  It is a condition three times more common in women than in men.  The abdominal pain of irritable bowel syndrome or IBS is more often in the left lower abdomen.

The pain may be associated with constipation and the passage of mucus in the stool or diarrhoea. You may feel bloated in the abdomen, weary or always tired always with backache and sometimes an increase in frequency of passing urine or waking up to pass urine at night.

You could also have lower abdominal and back pain after eating with IBS.

Causes Of Middle Abdominal And Back Pain

Do you have pain in the central part of your abdomen around or just below the umbilicus? There aren't many causes of pain in the middle of the abdomen that spreads to the back. The main causes are: 

1. Abdominal Aortic Aneurysm

This is the dilatation of the wall of the large blood vessel that brings blood from the heart into the abdomen (called the aorta). If the aorta balloons or dilates for any reason it could start to leak blood in small amount and this leads to middle or lower abdominal pain that spreads to the back.

The condition is likely in middle or elderly man or woman who have smoked in the past. The pain is often gradual or sudden and there is associated dizziness on standing. Many sufferers collapse and faint with this pain if bleeding significantly

You can read more about symptoms of ruptured abdominal aortic aneurysm here.

2. Heart Attack

Yes. Heart attack can start as abdominal pain! Typically, the pain is usually in the middle upper abdomen, above the umbilicus and below the breastbone.

The pain will come on suddenly which could be a small discomfort or severe ache, like a heavy load or pressure on the chest. The pain could spread up to the left arm and neck or jaw and there could be associated sweats, nausea and vomiting. The pain could last a few minutes or up to an hour or two before it goes away.

If you have a pain which is described above then seek urgent medical help. You may be having a heart attack.

3. Kidney Stones

Abdominal and back pain due to a kidney stone is usually straightforward to diagnose. The nature of abdominal and back pain arising from kidney stones largely depend on which part of the urinary tract the stone is located in, it's size and whether there is an associated infection or not.

The symptoms of kidney stone pain include:

  • Sudden onset upper loin or side pain that spreads in an oblique pattern to the groin
  • Associated retching or feelings of nausea
  • Rolling or walking about to find a position of comfort
  • Increased frequency of passing urine
  • In the event of associated infection, feeling hot and cold and even vomiting
  • Blood in the urine (though this is not often visible)

The pain of kidney stones in the ureter has been described as the most severe pain ever.

Causes Of Lower Abdominal Pain That Spreads To The Back

Do you suffer with lower abdominal and pack pain? One of the following could be responsible:

1. Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a common cause of lower abdominal pain especially in women.

The symptoms of IBS pain include:

  • Pain occurring in the left lower abdomen which could be intermittent
  • Pain which spreads to the lower back
  • Associated feelings of abdominal distention or bloating and constipation. For some, diarrhoea is the predominant symptom
  • Passage of mucus or slime within the stool
  • Unexplained tiredness most of the time
  • An increase in the frequency of passing urine, even waking up several times at night to pass urine

The symptoms are often made worse by stressful experiences and can last for months and years. 

2. Cystitis

With cystitis you often feel more tired than usual, you pass urine more often and when you do, it has a bit of a stinging feeling. You also:

  • Suffer with a dull ache in your lower abdomen around or just below your bikini line
  • The pain becomes worse when you bend forward
  • The pain spreads to the lower back and sometimes to one side of your back
  • You feel sick or perhaps lose your appetite
  • Your urine becomes more coloured, with perhaps a strong smell

Until proven otherwise, you almost certainly have an urine infection or cystitis as a cause of your abdominal and lower back pain.

3. Ovarian Cysts

Ovarian cyst is a common cause of right or left lower abdominal pain that spreads to the lower back in a woman, especially between the ages of 13 and 53. The pain of ovarian cyst typically:

  • Starts on one side of the lower abdomen and spreads to the hip on that side and to the lower back, and upper thigh
  • Is a continuous pain which tends to have periods of increased severity
  • May occur a few days after menstruation or two weeks thereafter
  • Lasts for a few hours and becomes very bad within days
  • Lead to vomiting and abdominal bloating and severe pain if the ovary is twisted.

4. Menstrual Pain

This is the most common cause of lower abdominal and back pain in women of child bearing age, especially in the early years of their menstrual life. Menstrual cramps cause a dull intermittent lower abdominal pain along the bikini line, that spreads to the back. It could be so severe that in some women, it disrupts their day and brings their life to a halt.

The pain is followed a few days later with a vaginal bleed. The pain tends to get better after the bleeding has gone on for a few days.

You can read more on menstrual cramps, the causes and how to control it here.

References

Heathline.com, What are abdominal bloating and back pain?, http://www.healthline.com/health/abdominal-bloating-and-back-pain (Accessed: September 2016)

Enkivillage, Lower Back and Stomach Pain, http://www.enkivillage.com/lower-back-and-stomach-pain.html (Accessed: September 2016)

New Heath Guide, Lower Back and Abdominal Pain, http://www.newhealthguide.org/Lower-Back-And-Abdominal-Pain.html (Accessed: September 2016)

SpineHeath.com, Abdominal Aortic Aneurysm, http://www.spine-health.com/conditions/lower-back-pain/abdominal-aortic-aneurysm (Accessed: September 2016)

Universiry of Maryland Medical Centre, http://umm.edu/health/medical/reports/articles/peptic-ulcers (Accessed: September 2016)

Have A Concern Or Comment On Abdominal Pain Spreading To The Back?

Are you suffering with abdominal pain that radiates to the back? Or do you have a past history with "stomach pain" that spreads to your back? If so, please share your experiences with our online community.

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