Referred Back Pain – Causes & Facts
Sometimes back pain is not strictly related to spinal structures, back pain comes from other places, specifically internal organs. In a process called referred pain, internal organs can send pain signals to other parts of the body. For example, when someone is experiencing a heart attack, the left arm may ache. Nothing is wrong with the arm but this limb hurts because the heart is referring pain to it. The neck, mid-back and lower back are also potential targets for referred back pain. The pancreas may refer pain to the back and here are two examples when “back pain” has nothing to do with spinal problems.
The gallbladder isn’t an organ that gets a lot of attention, unless it’s causing you pain. The gallbladder is a little sac that stores bile from the liver, and it’s found just beneath your liver. The gallbladder releases bile, via the cystic duct, into the small intestine to help break down the foods you eat — particularly fatty foods.
The gallbladder is connected to the liver via ducts that supply bile to the gallbladder for storage. These bile ducts then form the common hepatic duct that joins with the cystic duct from the gallbladder to form the common bile duct that empties into the GI tract (duodenum). In addition, the pancreatic duct usually merges with the common bile duct just before it enters the duodenum. Hormones trigger the gallbladder to release bile when fat and amino acids reach the duodenum after eating a meal which facilitates the digestion of these foods.
Within this internal organ problems can arise like a blockage from a stone, an infection or just an inflamed gallbladder attack. Sometimes the symptoms clearly point to a problem with the gallbladder. These classic symptoms include right upper quadrant abdominal pain just underneath the right chest wall, nausea, gas and pain with a deep breath. Many times these classic symptoms occur at night or just after a meal. At first you may think that the problem is just indigestion until the symptoms progress. However, sometimes the symptoms are a little more elusive and gives a murky picture of vague discomfort and pain.
There are two major causes of pain that either originate from the gallbladder or involve the gallbladder directly. They intermittent or complete blockage of any of the ducts by gallstones or gallstone sludge and/or inflammation that may accompany irritation or infection of the surrounding tissues, when partial or complete obstruction of ducts causes pressure and ischemia (inadequate blood supply due to a blockage of blood vessels in the area) to develop in the adjacent tissues.
Gallstones usually form in the gallbladder, but may form in any of the ducts. When the gallbladder is compressed (squeezed by musculature), bile usually goes out through the ducts into the GI tract however, if gallstones or gallstone sludge is present, there can be partial or complete blockage of the ducts with pressure on the surrounding tissue, sometimes enough to cause local ischemia. Other processes such as trauma can cause gallbladder pain. Infection of the biliary ducts and the gallbladder, usually occurring after gallstone obstruction also can cause pain.
Specific symptoms may vary based on what type of gallbladder condition you have, although many symptoms are common among the different types of gallbladder problems. But most gallbladder symptoms start with pain in the upper abdominal area, either in the upper right or middle.
Below are common symptoms of gallbladder conditions:
- Severe abdominal pain
- Pain that may extend beneath the right shoulder blade or to the back
- Pain that worsens after eating a meal, particularly fatty or greasy foods
- Pain that feels dull, sharp, or crampy
- Pain that increases when you breathe in deeply
- Chest pain
- Heartburn, indigestion, and excessive gas
- A feeling of fullness in the abdomen
- Vomiting, nausea, fever
- Shaking with chills
- Tenderness in the abdomen, particularly the right upper quadrant
- Jaundice (yellowing of the skin and eyes)
- Stools of an unusual color (often lighter, like clay)
Some gallbladder problems, like simple gallstones that are not blocking the cystic duct, often cause no symptoms at all. They’re most often discovered during an X-ray to diagnose another condition, or even during an abdominal surgery.
The gallbladder doesn’t seem like such a big deal until it’s causing you severe pain. If you spot the symptoms of gallbladder trouble, head to your doctor for a diagnosis and prompt treatment to get your digestive tract running smoothly again.
The bladder is the hollow organ in the lower abdomen that stores urine. As the bladder fills, muscles in its walls relax so that it can expand. As the bladder empties during urination, the muscles contract to squeeze the urine out through the urethra. Several different bladder problems can cause pain. The three most common causes of bladder pain are interstitial cystitis, urinary tract infection and bladder cancer.
The bladder is the all important organ in the pelvis that collects and hopefully empties urine at the right time. Many problems can arise here like infections, cancer, interstitial cystitis and arguably the worst problem, a “fallen bladder” (a.k.a. Prolapsed Bladder, Cystocele). That’s right the bladder can literally fall out. Varying degrees of a prolapsed bladder exist starting with Grade 1, where just a little portion of the bladder pokes into the vagina, all the way to Grade 4, where the entire bladder is fallen out into and through the vagina. Now that condition can be as painful as it sounds and looks. Pain from the prolapsed bladder can be felt in the lower back, sacrum and pelvic region.
Often misdiagnosed as a urinary tract infection, interstitial cystitis can take up to four years to be properly diagnosed. Once it is diagnosed, your doctor can offer you treatment for it and its symptoms, including bladder burn. According to the National Institute of Diabetes and Digestive and Kidney Diseases, interstitial cystitis, a medical condition that causes inflammation of the bladder wall, affects 1.3 million Americans, 1 million of whom are women. Symptoms include mild or burning pain in the bladder and pelvic area, frequent urges to urinate and pain during sexual intercourse. Interstitial cystitis (IC) is a chronic condition in which the bladder becomes inflamed and irritated. The inflammation stiffens the bladder wall, and makes it difficult for the bladder to fully expand when filling with urine. IC may be caused by a defect in the bladder lining. Women are much more likely than men to have the condition.
A main symptom is pain, which is strongest when the bladder fills and eases when the bladder empties. Pain may also be felt more generally in the lower back, abdomen or groin. People with this condition may also urinate more frequently or feel an urgent need to urinate, yet they may only pass a little bit of urine each time. Sexual problems may also be related to interstitial cystitis.
Your urinary tract is the system that makes urine and carries it out of your body. It includes your bladder and kidneys and the tubes that connect them. When germs get into this system they can cause an infection.
Most urinary tract infections are bladder infections. A bladder infection usually is not serious if it’s treated right away. If you don’t take care of a bladder infection, it can spread to your kidneys. A kidney infection is serious and can cause permanent damage.
Usually, germs get into your system through your urethra, the tube that carries urine from your bladder to the outside of your body. The germs that usually cause these infections live in your large intestine and are found in your stool. If these germs get inside your urethra, they can travel up into your bladder and kidneys and cause an infection.
For reasons that are not well understood, some women get bladder infections again and again.
You may have an infection if you have any of these symptoms:
- You feel pain or burning when you urinate.
- You feel like you have to urinate often, but not much urine comes out when you do.
- You have pain in your lower belly and back.
- Your urine is cloudy, looks pink or red, or smells bad.
- You have pain on one side of your back under your ribs. This is where your kidneys are.
- You have fever and chills.
- You have nausea and vomiting.
Call your doctor right away if you think you have an infection and:
- You have a fever, nausea and vomiting, or pain in one side of your back under your ribs.
- You have diabetes, kidney problems, or a weak immune system.
- You are older than 65.
- You are pregnant.
Your doctor will ask for a sample of your urine. It is tested to see if it has germs that cause bladder infections.
If you have infections often, you may need extra testing to find out why.
If a woman has lower back pain with the “usual” urinary incontinence, a mild prolapsed bladder can be mistaken as just “lower back pain.” As the bladder falls further and the pain gets worse, the prolapsed bladder becomes more obvious. After a little “nip, tuck and sling,” the bladder can be put back into place and the back pain magically disappears. Other female organs can prolapse and cause back pain besides just the bladder. So, women with back pain might want to consider having a full pelvic exam especially if urinary incontinence is present. Back pain may not be all that it seems.
Back pain is an easy diagnosis to throw around and sweep under the rug because it is so common. But other common problems can be mistaken as just typical back pain, particularly gallbladder and bladder problems. These internal organs are especially problematic for women. Women with back pain should be aware of these cases of mistaken identity and mistaken diagnosis. Unfortunately for some women, it can take years to find the real reason for so called “back pain.” A bit more thoroughness can uncover an unhappy internal organ and possibly a better solution. If you think that you may have another reason to have back pain, talk with your doctor and ask for some more investigation. Because your health and life matters!