Abdominal And Back Pain
Causes, Diagnosis and Treatment

Abdominal and back pain in a woman with menstrual pain

What Is Abdominal And Back 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 and Back Pain

Abdominal and back pain occurring together can be indicative of:

  • Disease or injury to the part of the gut that sits deep inside the abdomen, like the duodenum

  • Disease of 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 of the reproductive organs like the ovaries (e.g. ovarian cysts), uterus (e.g. menstrual pain, endometriosis, womb cancer and miscarriage), and testicles

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

Upper Abdominal And Back Pain

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. There are also other causes of abdominal and lower back pain in pregnancy and a few related to pain arising from the womb.

abdominal aortic aneurysm causing middle back and abdominal pain

Aftre Eating

Abdominal and back pain that begin within minutes of eating can have several causes:

Biliary Colic

Biliary colic is pain due to the contraction of the gallbladder, which 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 rich foods or foods high 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)
  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 begins 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, 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 
  • 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 requires immediate medical attention.

Doctors use strong pain killers like a combination of Paracetamol or acetaminophen (Tylenol) and Diclofenac (Volterol) to help patients manage the pain of biliary colic. The two are safe to take together, provided you do not suffer with asthma or stomach ulcer.

If there is evidence of infection (cholecystitis), hospitalization is recommended for treatment with intravenous antibiotics and pain killers. In some cases, an emergency operation may be necessary.  

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

Peptic Ulcer

Peptic ulcers are holes or pits that form in the bowel from acid irritation.

Peptic ulcers commonly occur in the stomach and duodenum (the first part of your small intestine just after the stomach). Peptic ulcers also occur in the jejunum, ileum, and merkels diverticulum.

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.

The stomach produces acid when we eat, which irritates existing ulcers and leads to abdominal pain.

The symptoms of peptic or stomach ulcer include:

  • Upper middle abdominal and back pain after eating
  • Pain (either a dull ache or sharp pain) in the upper middle abdomen that spreads through to the upper back
  • A feeling of bloating, nausea, or actual vomiting

The use of antacids such as gaviscon or mix magnesia may help soothe the pain of stomach ulcers, but sufferers should be careful. Stomach cancer can have similar symptoms. Often, people who are plagued with stomach ulcers will eat less over time for fear of triggering ulcerous pain.

Treatment for peptic ulcers includes the use of antacids and medications like ranitidine and losec, omeprazole, lansoprazole, or pantoprazole.

Sufferers should avoid spicy foods, fried foods, alcohol, smoking and stressful situations.

Pancreatitis

The pancreas is a banana-shaped organ that lies behind the stomach in the upper abdomen. It is the gland that produces insulin to regular sugar in the body and the powerful enzymes that helps the body to digest its food.

Pancreatitis is the inflammation of the pancreas and can be caused by gallstones, excessive alcohol consumption, cystic fibrosis, high triglycerides, and hereditary disorders, amongst other triggers.

The symptoms of pancreatitis include:

  • A general feeling of dis-ease
  • Nausea and vomiting 
  • Severe upper abdominal and back pain
  • Pain that occurs after eating rich foods, fatty foods, or foods with lots of protein
  • Abdominal and back pain that worsens when lying down and gets slightly better by leaning forward

Pancreatitis is a serious illness that can mimic gastritis, stomach ulcers, or duodenal ulcers.

Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome is a life-long condition in which the bowels develop a sensitivity to stressful situations and certain foods. IBS is a condition three times more common in women than in men.  The abdominal pain of irritable bowel syndrome is often experienced by people as abdominal pain on the left side.

IBS can be associated with constipation, the passage of mucus in the stool, or diarrhoea. Sufferers may feel abdominal bloating, weariness, fatigue, backaches, and sometimes an increase in frequency or urgency of urinating.

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

Middle Abdominal and Back Pain

For pain in the middle abdomen that spreads to the back, the causes are well-defined. The main causes are: 

Abdominal Aortic Aneurysm

Abdominal aortic aneurysm is the dilatation of the wall of large blood vessel that bring 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 amounts. This leads to middle or lower abdominal pain that spreads to the back.

This condition occurs in middle-aged or elderly men and women who have smoked in the past. The pain is often accompanied by dizziness upon standing. Sufferers can collapse or faint with this pain if bleeding is significant.

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

Heart Attack

Heart attacks can start as abdominal pain. Typically, the pain begins in the middle upper abdomen, above the umbilicus and below the breastbone.

Heart attack pain that starts in the abdomen tends to come suddenly either as mild discomfort or severe ache. Patients describe the feeling of more severe heart attack pain as a heavy load or pressure on the chest. Heart attack pain that starts in the abdomen could spread up to the left arm, neck, and jaw. It is often accompanied by sweats, nausea, and vomiting. The pain could last a few minutes or up to an hour or two before it goes away. If it goes away.

Kidney Stones

Abdominal and back pain caused by a kidney stone is usually easy to diagnose. The nature of abdominal and back pain arising from kidney stones largely depends on the part of the urinary track in which the stone is located, the size of the stone, and whether infection is present.

The symptoms of kidney stone pain include:

  • Sudden upper loin or side pain that spreads in an oblique pattern to the groin
  • Associated retching or feelings of nausea
  • Increased frequency of passing urine
  • Feverishness if infection is present
  • Vomiting
  • Presence of blood in the urine

Sufferers of kidney stones usually describe the pain as quite severe. 

Lower Abdominal Pain That Spreads To The Back

For pain in the lower abdomen that spreads to the back, there are several possible causes, including irritable bowel syndrome. The other causes include: 

Cystitis

Cystitis is a common and treatable infection of the kidneys, bladder, or urethra. It is often characterised by inflammation in the bladder. Those who suffer from cystitis tend to feel more tired than usual, pass urine more often, and experience burning or stinging during urination.

Cystitis can also cause:

  • A dull ache in the lower abdomen around or just below the bikini line
  • Pain that worsens when leaning forward
  • Pain that spreads to the lower back and sometimes to one side of your back
  • A feeling of sickness and loss of appetite

Darker urine, often accompanied by a stronger odour 

Ovarian Cysts

  • Ovarian cysts are a common cause of abdominal and back pain on the right side, and abdominal pain on the lower left side in women 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 Continues but occasionally increases in severity Occurs a few days after menstruation, and for two weeks thereafter Lasts for a few hours but can become very bad within days Lead to vomiting and abdominal bloating and severe pain if the ovary is twisted

Menstrual Pain

Menstrual pain is the most common cause of lower abdominal and back pain in women of child-bearing age. This is especially true 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. Menstrual pain can be so severe that in some women, it disrupts their daily activities and renders bedridden.

Menstrual 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?

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