The Sneaky Link Between Low Back Pain and Urinary Leaks
If you’ve dealt with low back pain, you know it can be a tricky thing to fix. But what if in addition to low back pain, you also suffer from urinary leakage – or incontinence – when you sneeze, laugh, box jump, run, or jump rope?
This most likely signifies a deeper, less obvious cause. Your pelvic floor.
What’s A Pelvic Floor?
If your pelvic floor muscles are not aligned or able to function properly due to injury, posture, childbirth, or muscle tension – things can slowly fall apart leading to pain and poor function such as the inability to hold your bladder.
Your low back, diaphragm, pelvic floor, and deep abdominal muscles are the intertwined system which stabilizes your body. Whether looking at posture, exercise, or body functions like pooping and peeing, the pelvic floor and low back are influencing each other.
There are multiple structures holding your back and pelvic floor together:
- Spinal column comes down and attaches to the pelvic ring creating the scaffolding for your muscles and ligaments
- Abdominal muscles in the front
- Pelvic floor underneath supports muscles under the pelvis like a hammock
- The lumbar spine multifidus has your back behind the spinal column
- Respiratory diaphragm rounding out the top
A Strong Structure Means Optimal Functioning
In addition to your low back, your pelvic floor supports your abdominals and help maintain intra-abdominal pressure.
Think of a beer can. A thin layer of aluminum which is strong due to its structure and because of the pressure being exerted by the contents inside and carbonation. Your low back and pelvic floor muscles are the strong structure holding your internal contents – organs, bodily fluids, etc. But instead of being carbonated, your breath helps dictate the internal pressure.
When the structure and pressure work well – the beer stays in the can. But if you put a hole in the can, all bets are off and you’ve committed a party foul. The structure becomes weak, causing pressure to be distributed elsewhere and makes a mess.
The same is true for your core. If your core structures and pressure are dysfunctional many interconnected messes can occur such as:
- Low back pain
- Pelvic pain and pelvic muscle dysfunction
- Pain with sex
- Breathing issues
- Urinary incontinence (which is arguably worse than spilled beer)
If you have low back pain or struggle with urinary incontinence – your pelvic floor may be to blame. Pelvic health isn’t always everyone’s first thought, but learning how it supports you in almost every movement can save your back (and your shorts).
Learning You Have a Pelvic Floor Is the First Step!
The pelvic floor is dynamic like your biceps, glutes, and hammies. You flex your bicep and curl that dumbbell. You practice your squat in the mirror to increase your max weight or improve stability.
Have you ever seen yourself do a Kegel exercise? Probably not, so how do you know if you’re flexing or more importantly – relaxing your pelvic floor?
To restore the health and use of the pelvic floor you must start with awareness. Many people think if they tighten or hold their pelvic floor muscles – they will become strong and fix their problems. The issue is this gripping will not make you continent or help reduce back pain. It actually fatigues your muscles, reduces blood flow and in general makes your pelvic muscles angry and unable to function properly.
How Your Breath Affects Your Pelvic Floor
A great way to practice relaxing your pelvic floor is by focusing on your breathing. In addition to the soda can, picture your body as a building. The pelvic muscles are its elevator.
At rest, your pelvic muscles should be sitting on the ground floor of the building. When you inhale, your pelvic floor muscles move down to the basement with pressure from your diaphragm and abdominal contents as your lungs fill with air. You aren’t pushing them – you are allowing them to move free of contraction or force. The following exhale then allows your pelvic floor muscles to come back to the ground floor.
Spending time routinely to increase your awareness of where your pelvic floor is positioned can help increase blood flow and optimize function. Slowly this conscious effort will transform into muscle memory and help improve your low back pain or prevent urinary leakage.
Posture, Posture, Posture
Your pelvic floor muscles are also at the mercy of their literal position, in the same ways posture affects your neck, shoulders, and back.
Just one example. If you tend to have lumbar lordosis (or sway back) – your pelvis is tilted forward and your ribs are thrust out – making optimal pelvic floor function a lot more difficult.
This turns the building of your core into a parallelogram and pulls the cables of your elevator at a skewed angle instead of directly up and down. By keeping your ribs stacked over your pelvis, you help stabilize your core and subsequently the pelvic floor.
Putting It All Together
By bringing a new awareness to what your pelvic floor is doing when you breathe as well as your posture – whether it be at rest or during exertion – can help restore pelvic floor function. A well-functioning pelvic floor will support your low back properly to eliminate pain and help keep your bladder function intact.
A happy and healthy pelvic floor is key to managing and preventing low back pain and keeping your shorts dry!
Written by Amanda Hayes Fugate MPT, owner of Pelvic Forward Physical Therapy in Asheville, NC
Amanda is the local pelvic health guru in Asheville, North Carolina. If you’re a marathon runner, Crossfit athlete, weekend warrior, or new mom – Amanda is your solution to all things related to pelvic health. She works with patients who struggle with pelvic pain affecting their athletic performance or disrupting their sex life. She helps new moms manage the complex changes and restore pelvic floor function in a safe and comforting environment. She also collaborates with gyms and fitness-focused businesses in Asheville to provide educational workshops throughout the community. In addition to her private practice, Amanda is on faculty with the Herman and Wallace Pelvic Rehab Institute.