Interstitial Cystitis? Your Bladder Pain May Be Coming From Your Low Back

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The concept of interstitial cystitis (also known as painful bladder syndrome) having a connection to lower back pain would sound foreign to most physicians. That’s because connecting the bladder to the low back involves two different specialties – one that treats the bladder and the other that treats the spine. Sadly, many patients with interstitial cystitis bounce around from specialist to specialist like a pinball because no one has the expertise to connect the dots.

The Story of My Burning Bladder and Interstitial Cystitis Diagnosis

There’s the old adage of the elephant and the blindfolded men, which describes what often happens in modern medicine. You probably know the allegory… three men wearing blindfolds and standing around an elephant are asked to describe what they feel. The guy at the front thinks the trunk is a fire hose, the guy at the leg thinks it’s a tree trunk, and the guy at the tail thinks he has a rope.

I had burning in my bladder and was 100% convinced that I had some sort of urinary tract infection or prostate issue. I went to the urologist who performed his exam and tests and announced I had “interstitial cystitis”, which for a urologist is like saying, “I don’t have a clue what’s causing your bladder pain”. It was a few weeks later when my low back sciatica fired up and one of my partners gave me an epidural injection using the growth factors from my own blood platelets that I noticed my bladder pain suddenly dissipated. Researching the anatomy, it became obvious to me why this worked. Since then, I’ve since seen countless patients with bladder burning who get million dollar workups and end up getting dubious alternative medicine treatments despite it being clear that their low back is the culprit. These poor patients represent the elephant that each specialist evaluates and interprets in his own way, but like our blindfolded men, each misses the mark by a wide margin.

How can the Low Back and the Bladder be Connected?

interstitial cystitis low back pain

+ Click to Enlarge

The diagram to the left shows the sacral nerves coursing by the L5-S1 disc in the low back. These then head toward the bladder and act as a conduit for bladder sensation. Without any pressure on the nerves, they function normally to allow the sensation from the bladder to reach the brain through these spinal nerves.

interstitial cystitis low back pain 2

+ Click to Enlarge

The second diagram to the right shows what happens when an L5-S1 disc bulge or “slipped disc” places pressure on the sacral nerves. These irritated nerves in turn cause pain in the bladder as well as spasm. They can also make the patient believe the bladder is full when it’s not. All of this happens because the electrical impulses that represent bladder sensation get disrupted by the irritated sacral nerves.

What’s even more interesting is that only some patients who have bladder burning, spasm, and pain and get diagnosed with interstitial cystitis will have back pain. Many patients don’t have that symptom even though the trouble spot is in the spine. So whether you have back pain or not, your sacral nerves being irritated by a disc bulge can still cause bladder issues.

What Can be Done about a Burning Bladder due to Irritated Sacral Nerves?

The good news is that despite all of the run around that interstitial cystitis patients go through to try to find effective treatment, the fix is usually simple if sacral nerve irritation is causing the issue.

We use an injection of the growth factors isolated from the patient’s own platelets and delivered through a precise fluoroscopy guided caudal epidural to help calm down the irritated sacral nerves. This can also be combined with physical therapy to get the stabilizer muscles back on-line and to help strengthen the pelvic floor.

The upshot? Interstitial cystitis patients often lose hope given that multiple specialists have prescribed everything from ineffective antibiotics to pelvic floor physical therapy. For some reason, most physicians never put 1 and 1 together to look into the lower back as a possible cause for the burning bladder. If your sacral nerves are causing your bladder to burn, then the solution may be very simple!

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26 thoughts on “Interstitial Cystitis? Your Bladder Pain May Be Coming From Your Low Back

  1. Fay Cridland

    I have recently been diagnosed with IC . 3 years before I had my L5S1 fused, I have continued to have chronic back pain and IC (Interstital Cystitus) my neurosurgeon will not operate on my back again, I am on Endep for the bladder it still leaks and I have being to doing hydro therapy, Pilates, physio therapist and pain specialist all the pain pain specialist wants to do is install a Nevro spine stimulator after many operations all ready I am relectuant for anymore possible failed surgeries and injections on my spinal cord. So what to you do? Currently I have become a non-complaint patient because I don’t want undergo further treatments. The medical model is crap and lacks any kind of consideration of the patient just that you become an ATM to the medical model.

    1. Regenexx Team

      Fay,

      It would be frustrating if it was about buying a car. The fact that it is about seeking medical care brings it to a whole new level. This was a recent experience with the current medical system: http://www.regenexx.com/blog/steady-decline-good-doctoring/: Unfortunately your situation is not unusual. http://www.regenexx.com/nejm-back-neck-fusion-surgeries-not-needed/ Given the location of the Fusion, not sure that we can help. But if you would like us to take a look to evaluate you for a Procedure to see if there is some way we can, please submit the Candidate form: http://www.regenexx.com/the-regenexx-procedures/back-surgery-alternative/

  2. Darren Andreason

    I have classic IC (as defined by the presence of Hunner’s ulcers). I also have chronic low back pain (bulging disc, L4/L5). I have had both for over 15 years. Interested if they are related my IC predates my back pain.

    1. Regenexx Team

      Darren,

      They could be. There can be a lot simmering in a back affecting other things before pain develops. .

  3. Tina

    This article is what I’ve been searching high and low for, trying to connect the dots that numerous doctors simply have not been able to. Here’s a brief background of my condition: 38-year-old female with a pretty significant hx of UTI’s throughout course of adulthood, with accompanying low back pain that I’ve noted since at least twenty. I wake up after 38, prime of my life, literally a gym rat who took extreme care in what I put into my body (i.e lifted, etc). I explain all of this bc I want to make it clear that at any point in my life when I should have gotten sick, or was in a position health wise to be so, this was not it. I was healthy. Any who, I wake up to extreme burning of the lower back region, which had been burning for on and off months but nothing to the extreme it was then. My feet and legs were also burning something terrible. Absolutely unbelievable pain!

    Doctors, emergency room visits, Neurological exams and visits and a list long procedures performed and I’m told I have peripheral neuropathy of the lower extremities and fibromyalgia. But, something just doesn’t sit right to with that diagnosis. For one, I continually get UTI’s. I’ve had 9 in 2016 alone. My Urologist performed a procedure wherein a camera was placed inside the bladder = nothing. Perfect bladder. Aside of a 1 inch section Thai was healing from an accidental clip from hysterectomy. I’m thinking, and praying and searching, that the UTI’s and the burning feet and especially the lower back pain are all connected. By the way, I did have a CT scan of my pelvis and I believe (I’ve got it stored) it said something about a minimal bulge in lower region of the “L” something????

    I’m currently taking the highest dosage of Lyrica my doctor says I can take, or will prescribe and I still have almost unimaginable paid : 150 x’s 3 a day, plus I have a 50mg fen patch and takeep pain meds as needed. My life as an active woman is no more….no gym. No weights. This disease has taken everything from me and I’m still not certain I know what it is bit my gut tells me and my intelligence agreed as well, that things don’t add up. Any, absolutely advice or direction, or if you knew if any physician’s in AR that specialize in an area of expertise as this would be so greatly appreciated.

    Thank you in advance to all and I truly hope that everyone that comes here finds relief from their pain.

  4. Diana Robinson

    This all sound perfectly familiar. I get very strange looks from doctors when I relate the two (bladder spasm, back pain) But you don’t say what the solution is. I have been taking Norco for 8 years to keep me from constant pain. But the bladder ebs and flows making the constant back pain worse. I also get spasms in my buttox and down both inner and outer thigh.

    1. Regenexx Team

      Diana,
      It’s certainly worth looking into as the fix is usually simple if sacral nerve irritation is causing the issue. We use an injection of the growth factors isolated from the patient’s own platelets and delivered through a precise fluoroscopy guided caudal epidural to help calm down the irritated sacral nerves. This can also be combined with physical therapy to get the stabilizer muscles back on-line and to help strengthen the pelvic floor. Please see: http://www.regenexx.com/the-regenexx-procedures/back-surgery-alternative/

  5. Naomi allison

    I began suffering IC when I was 15. Im 38 now. When I was 23 I had an mri showing a bulge on l4 and hemangioma on l5. Carry forward years and years of bladder pain and extreme frequency. Mri on back shows bulging discs from c3 to s1 arthritis in l1/l2 hemangioma on l5. I have ribs that pop out along thoracic spine causing “devils grip” pain. Im desperate for pain bladder to end. I do pft and she adjusts my si joint every session. I can feel it roll and pop out. I suffer nerve pain tingling in left foot pain in left calf pain right hip constantly and mri of hip showed bursitis in hip. During last pregnancy 9 years agomy ligaments in pelvis tore away from pubic bone. I pretty much live in constant agony. I rotate tylenol aspirin and motrin. Recently had shoulder surgery and doctor said my cartilage is severely inflamed. Feel lost about what I should do. Feel as if an ostomy is my only choice.

    1. Regenexx Team

      Naomi,
      That’s a lot to go through. NSAIDS only make inflammation worse and disrupt the production of healthy cartilage. Injecting the SI ligaments, symphysis publis, and a platelet lysate epidural may be helpful. If you’d like us to take a look, please submit the Candidate form on Blog.

  6. Genevieve Cline

    I have suffered with bladder pain since I was 17 years old. I have been to many many doctors who just say it’s a bladder uti! without showing any evidence of bacteria! In 1998 I was diagnosed with IC even though the doctor said when he finished the test? Probably your uterus. When I went back for the results he said I have Interstitial cystitis! I couldn’t believe it! He said here look at what the lab came back with. I stayed with the urologist for several years, test after test and the only thing that relief was he prescribed a suppository to put in and immediately the pain left! Then he stopped prescribing those. I asked to be referred to another specialist from New York who was at WVU Ruby Memorial Hospital. He tried this and that and nothing worked! I asked then to be referred to a pain clinic and I got relief for as long as the doctor would inject into my sacrial nerves. Then he stopped. I went back to the pain clinic to see another doctor who has got to where I am today! Now? The DEA has stepped in and wants all pain patients off the medications! I’m tapering off Opana Er 40 mg. I’m on 10 mg. It’s killing me!!! I’m now 62 years old! I have been diagnosed with sciatica nerves impengment because my lumber disc are damaged! I sincerely need help!!! Please?!

    1. Regenexx Team

      Genevieve,
      As covered in the blog, we have expereince with these issues. We’d be glad to take a look. Please submit the Candidate form to the right of the blog, so you can upload a recent MRI and we can speak by phone about your specific case.

  7. TIFFANY MCMILLEN

    Can you elaborate on the pain in the lower back possibly not being IC? I was diagnosed with IC 8 years ago. I thought it was your typical UTI but nothing was coming back on my cultures as a UTI. Finally did a cystoscopy. My bladder is damaged inside. Red like a tomato. So since my bladder is in fact damaged inside I most likely am suffering from IC then right? Not my sacral spine? Because I have the worst lower back pain you can think of. I am having a “flare” is what they call it so bad right now that I am having urgency, pelvic pain and inflammation and I feel like I have to urinate right after I go. As if a bowling ball was sitting on my bladder. But I know I don’t have to go because I just went. I was checked for a UTI again and did a bladder scan to make sure I am not retaining urine. All came back ok. I just have never had a flare like this if that is what is going on. The pressure on my bladder is mind numbing and unbearable. I am going for another cystoscopy on 7/3/17 to be sure its still my IC giving me issues and not something worse. But the back pain is concerning me as well since I am having the bladder issues. What do you think?

    1. Regenexx Team

      Tiffany,
      It’s certainly worth a look, as the solution would be relatively simple if it is your back. Do you have a recent MRI of your lower back, or have a Doctor locally who can order one?

  8. Despina

    Although I can understand the connection between IC and low back pain as far the frequent urination or bladder pain is concerned, I cannot understand how the low back pain affects the sensitivity of the urinary bladder to certain foods. To be more specific, almost none of IC sufferers can eat acidic foods, drink alcohol e.t.c. without having a flare up. Could you please explain the connection? Thank you.

    1. Regenexx Team

      Despina,

      It doesn’t. The nerves when compressed cause the bladder to over react generally. In that “over reactive” state, acidic foods, which are inherently irritating to the bladder are simply much more irritating.

  9. Debbie Spencer

    I have suffered from severe IC for almost 20 years. I have had the Interstim ( removed due to severe staff infection), had numerous Cysto/Hydro, bladder installations and I take pain medication. Nothing has helped me except pain medication and even that doesn’t take away all the pain. I use a catheter as a method to rest the bladder at times and I am admitted to the hospital a couple times a year for pain control. This depilating pain has destroyed my life. I find this article so interesting since I have had disk problems at times in my life. The only thing I question is why heredity appears to play a role with IC. My daughter also has IC, as well as one of my neices. Wouldn’t this blow the disk theory?

    1. Regenexx Team

      Debbie,
      We’re not saying that all IC is a disc problem, only that a lot of disc patients have IC symptoms. It might make sense to rule out a disc issue before embarking on the surgical route.

  10. SANDY SPEARS

    June of 2018 I will have suffered 6 years from chronic back pain and ic and pain management was the only thing that helped me even tolerate the pain. Now I’ve had cystoscopy with hydro and it helped 2 whole days and now it’s worse. The government has made it impossible if u have untreated pain but medicare and medicaid don’t pay for regenexx. That’s why so many people are overdosing on heroin. There’s a peripheral nerve surgeon in Nevada who’s the only doctor that is proven to help such problems. The government created the opioid epidemic. They think we are brainless.

    1. Chris Centeno Post author

      Sandy, I doubt that a surgery on your nerves is the answer…

  11. Steven Jones

    Hi,
    Can you help me?
    Approx 10 years ago i displaced L5 on thr right hand side.
    I had a discectamy 12 months later.
    About 2 hrs after the injury I started urinating evey 20 mins ( bladder spasms).
    Ever since the injury I have needed to urinate whenever I have 150 – 200ml of urine in my bladder.

    I have taken mri to a neurologist who can see no impingement on nerves associated with my bladder.

    I had a urodynamic study which told the urologist i have flow problems. I had this flow issue prior to the injury.
    I tried bladder retraining but it didn’t work at all.

    Im convinced that my bladder relates to my back injury but no specialist can find a link or solution.
    I would appreciate youre feedback
    Regards
    Steven Jones

    1. Regenexx Team

      Steven,

      We could read the MRI images in a Candidacy Evaluation, but ultimately, we’d need to examine you. Please let us know if you would like to do that.

  12. Beth

    I am so glad that I found this article. 3 years ago I had a herniated disk. I was living abroad(china) so treatment was nonexistent. Last year I hurt my back while in the USA. Around the same time severe urethral pain. Like someone thumping on it. Go to ER, no uti send me to urogynocologist. I explain back and ureatheral pain start at same time. I am diagnosed with IC.Pain is so bad I take 2 semester leave of absence from my university job. Take elmiron, bladder instillation, Percocet- nothing worked. Last week I saw a neurologist. He prescribed gabapentin and medrol. Within 12 hours the urethral pain was gone. I don’t know which medication has solved it or if both. A bit scared as tomorrow last day of steroid. The last 4 days have been first pain free days in a year. Dr ordered am MRI and is doing an ENG test(I think that is what it is called). I asked 9 doctors if back and bladder could be connected and got shrugs. When I saw a picture of pudenal nerve and where it reaches-every spot I have pain- I wasn’t sure to laugh or cry. If you have any advice-please give it to me. I am leaving the country for work in 3 months.

    1. Regenexx Team

      Beth,
      We’d need to examine you. Let us know if you’d like us to help set that up in your time frame.

  13. Jessica

    I am so happy to have stumbled upon this article. A month ago I began having extreme pain in my bladder, bladder spasms, difficulty urinating and frequent urination all with clean UTI tests. I also was just diagnosed with bilateral spondylolysis with grade 1 spondylolisthesis at L5/S1, which is causing extreme back pain as well. So far all I have is an xray, as insurance requires 2 weeks of physical therapy before they will allow an MRI to be completed. I also have an appointment with a urologist next week. It will be interesting to hear what the urologist says when I ask if the two could be connected. My PCP did suggest that it could be a possibility.

  14. Savita Iyer

    In November 2018, I woke up one morning with what I thought was a UTI. Went to ob/gyn, they said no infection, but ran me through a battery of tests, since I had almost constant bladder pain and burning (except when urinating, no pain then). I had both ob/gyn and urology ultrasounds, X-rays and a bladder cystoscopy. All were normal. About three weeks into bladder symptoms, I suddenly began experiencing extreme pins and needles in the buttocks. I could not sit for more than 15 minutes at a stretch. I was sent to physical therapy, did that, chiropractic and one session of acupuncture. Felt a bit better but not 100% normal and there are times when pins and needles from buttocks will press onto bladder and cause deep burning. I finally got into orthopedist, who did an X-ray and came up with exactly what you have said above: Spondylolisthesis grade 1 of L5/S1. He says this can cause both bladder and buttocks symptoms that I am having. He has prescribed 4-6 weeks of physical therapy. What is your view? Thank you, SAVITA

    1. Regenexx Team

      Hi SAVITA,
      Spondylolisthesis is when one disc slides over the other upon movement, which is different than a slipped disc which is a common name for a herniated disc, and different than a disc bulge, both mentioned in the Blog. Physical therapy to get the stabilizer muscles back on-line and to help strengthen the pelvic floor can be helpful. We’d need to examine you to rule your Spondylolisthesis in or out as the cause of your Bladder and Buttock pain. To do that, please submit the Candidate form here: http://www.regenexx.com, or give us a call at 855 622 7838.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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