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The link between back pain and an enlarged prostate

Dr Roger Henderson
Reviewed by Dr Roger HendersonReviewed on 13.10.2023 | 10 minutes read
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Back pain is a very common problem, as is an enlarged prostate (known as benign prostatic hyperplasia or BPH), in older men. Although the two things may seem unrelated, there can sometimes be a connection between them, involving anatomical, physiological, and lifestyle factors. In this article we look at possible links between an enlarged prostate gland and back pain.

Understanding back pain

Back pain is a common health issue that can affect individuals of all ages and is characterised by discomfort or pain in the upper, middle, or lower back. Back pain can be acute or chronic and may result from various factors, including muscle strains, ligament sprains, herniated discs, and degenerative conditions such as osteoarthritis.

Understanding the prostate gland

The prostate is a small gland located below the bladder and in front of the rectum in men. Its primary function is to produce seminal fluid that nourishes and transports sperm. As men age, the prostate can undergo changes, including enlargement, which can cause various problems such as:

  • Benign Prostatic Hyperplasia (BPH)

BPH is the most common condition associated with an enlarged prostate and involves the non-cancerous growth of prostate cells, leading to an increase in the size of the gland. It is caused by increasing age but other risk factors include a family history and obesity. Common symptoms of BPH include increased frequency of urination, urgency, difficulty starting or maintaining a urine stream, incomplete emptying of the bladder, and nocturia (frequent urination at night).

  • Lower Urinary Tract Symptoms (LUTS)

This is a broad term that encompasses various urinary symptoms associated with conditions affecting the lower urinary tract, including the prostate gland. Symptoms include storage symptoms (frequency, urgency, nocturia), voiding symptoms (poor stream, hesitancy, straining), and post-voiding symptoms (dribbling). BPH is a common cause of LUTS.

  • Acute Urinary Retention (AUR)

This is a sudden inability to pass urine, which is a medical emergency and BPH is a leading cause. The enlarged prostate can obstruct the urethra, leading to the sudden inability to urinate. Immediate treatment is required, usually involving catheterization to relieve the obstruction and allow urine to flow out of the bladder.

The link between back pain and an enlarged prostate gland

There are several risk factors common to both back pain and an enlarged prostate, including getting older (both conditions are more prevalent in men aged over 50), a sedentary lifestyle, and being overweight or obese, as excess weight can increase the risk of back pain and may be associated with an increased likelihood of an enlarged prostate.

Because the prostate is situated near the lower back, any enlargement can exert pressure on nearby structures, potentially contributing to back pain. Its anatomical proximity to the lower back raises the possibility of a shared impact on the nerves and musculoskeletal structures in that area.

An enlarged prostate gland may compress nerves in the pelvic region, leading to referred pain or discomfort in the lower back and this nerve compression can cause sensations of pain, tingling, or numbness in the lower back and surrounding areas. If you notice any swelling, it may be prostatitis.

Chronic urinary symptoms associated with an enlarged prostate, such as straining during peeing, can also contribute to muscle tension and altered posture that in turn may contribute to the development or exacerbation of back pain.

What are the symptoms of an enlarged prostate gland?

Enlargement of the prostate can result in various symptoms, including:

  • increased frequency of urination

  • urgency to urinate

  • difficulty initiating or maintaining a urine stream

  • incomplete emptying of the bladder

  • nocturia (frequent urination at night)

These symptoms are mainly due to the enlarged gland pressing against the base of the bladder as well as squeezing the urethra - the tube that runs from the bladder to the end of the penis.

Can prostate cancer cause back pain?

Yes it can, but this usually only happens when prostate cancer is at an advanced stage. Prostate cancer is often slow-growing and may not cause noticeable symptoms in its early stages. However, as the cancer progresses, certain symptoms may develop. It's very important to note though that these symptoms are often associated with non-cancerous (harmless) conditions, and experiencing these symptoms does not mean you have prostate cancer. Nevertheless, if you have any of the following symptoms, we advise that you seek medical attention for a proper evaluation and diagnosis:

Urinary Symptoms

  • Difficulty with starting or stopping urination (peeing). Because prostate cancer can cause the prostate gland to enlarge, this can lead to difficulty in starting or stopping the flow of urine. There may also be a weakened or diminished urine stream.

  • Frequent urination. An increased frequency of urination - especially during the night - can be a sign of prostate problems, including prostate cancer.

  • Urgency. If there is a sudden and urgent need to pee, even if the bladder is not full, this can be a symptom sometimes associated with prostate cancer.

  • Incomplete bladder emptying. Difficulty in fully emptying your bladder after peeing may indicate some degree of obstruction, which could be due to an enlarged prostate or a tumour.

  • Blood in the urine or semen. Haematuria (blood in the urine) or blood in the semen (haematospermia) can be a symptom of various prostate conditions, including prostate cancer.

Pain or Discomfort

  • Pain in or around the pelvis. Discomfort or pain in the pelvic area, perineum (the area between your genitals and your bottom), legs or lower back may be associated with advanced prostate cancer.

  • Bone pain. If prostate cancer spreads to the bones, it may cause bone pain, particularly in the hips, lower back and spine, and pelvis.

Erectile Dysfunction

  • Prostate cancer (and its treatments) can affect sexual function, leading to difficulties achieving or maintaining an erection. Occasionally a very enlarged non-cancerous prostate gland can also cause this problem.

  • Weight loss and fatigue. Unexplained weight loss and tiredness can be symptoms of advanced prostate cancer, particularly if the cancer has spread to other parts of the body.

Common causes of back pain

There are many common causes of back pain that are far more likely than prostate problems. In fact, more than 80% of people will experience back pain at some time in their lives. The usual reasons for this include:

Muscle strains

Overusing your muscles or not using them properly can lead to strains or sprains in your back and is a common cause of acute back pain.

Poor posture

Having a poor posture over time, such as slouching or sitting in a hunched position, can strain the muscles and ligaments of your back.

A slipped disc

A herniated or ‘slipped’ disc occurs when the soft inner core of a spinal disc protrudes through the tough outer layer, irritating nearby nerves and causing back pain.

Degenerative disc disease

As we get older, the discs between our backbones lose water content and become less flexible. This can lead to disc degeneration, causing pain and stiffness in the back.

Spinal stenosis

This is a condition where the space that runs down the middle of the backbones narrows, putting pressure on the spinal cord and nerves and resulting in back pain.

Osteoarthritis

Sometimes called ‘wear and tear’ arthritis, osteoarthritis is the degeneration of joint cartilage and the underlying bone. When this affects the spine, it can lead to back pain.

Scoliosis

The term scoliosis refers to a curvature of the spine. Depending on the degree of this curvature, it may cause back pain, especially in more severe cases.

Spondylolisthesis

In this condition, one vertebra slips forward over the vertebra below it. This can compress the nerves there and cause back pain.

Osteoporosis

Osteoporosis is a condition where the bones thin and lose their strength. Compression fractures of the spine due to osteoporosis can result in back pain, which is sometimes severe.

Muscle weakness

Weakness or imbalance in the muscles that support our spine can trigger back pain and this is most often seen in people who have a sedentary lifestyle and who do not take exercise.

Injuries and trauma

Accidents, falls, or sports injuries can cause trauma to the spine, resulting in back pain. In such situations, fractures, dislocations, or soft tissue injuries may all occur.

Medical conditions

Certain medical conditions, such as kidney stones, infections, or endometriosis, can cause back pain as a secondary symptom linked to them.

Lifestyle factors

A sedentary lifestyle, being overweight or obese, and lack of regular exercise can contribute to back pain. In such situations, weak core muscles (such as abdominal muscles) may fail to support the spine adequately and so back pain may occur as a result.

Psychological factors

Stress, anxiety, and depression may all contribute to, or exacerbate, back pain. Our mind-body connection plays a crucial role in how we perceive and experience pain.

Occupational factors

Jobs that involve heavy lifting, repetitive movements, or prolonged periods of sitting may all contribute to back pain.

How should back pain and an enlarged prostate be managed?

The management of back pain and an enlarged prostate often involves doing a number of things including:

  • Modifying your lifestyle. Encouraging physical activity, maintaining a healthy weight, and adopting proper ergonomic practices to help prevent occupational back pain can all benefit both conditions.

  • Medication. Painkillers and nonsteroidal anti-inflammatory drugs can help to treat back pain, while medications such as alpha-blockers or 5-alpha reductase inhibitors can help to ease urinary symptoms associated with an enlarged prostate.

  • Physical treatments. Exercises aimed at strengthening the core and pelvic muscles may help provide relief for both back pain and prostate-related symptoms.

  • Surgery. In some cases, surgery may be considered for severe back pain or an enlarged prostate that does not respond to conservative measures.

What are the ways back pain can be managed?

Managing back pain often involves a combination of self-care strategies, lifestyle modifications, and, in some cases, medical interventions. The various approaches to back pain management include:

Simple lifestyle modifications

  • Rest: While short-term rest may be necessary, prolonged bed rest is generally not recommended. Gentle activities, such as walking, may also help significantly.

  • Ice and heat. Applying ice or heat to the affected area can help reduce inflammation and alleviate pain. Use ice for acute injuries and heat for chronic conditions. Never put ice directly onto the skin as it may damage it - always wrap it in a towel or cloth.

  • Over-the-counter medication. Non-prescription painkillers such as paracetamol or nonsteroidal anti-inflammatory drugs (NSAIDs), can help manage pain and inflammation. Always follow the dose instructions and consult with a healthcare professional if needed.

  • Maintain a healthy weight. Being overweight or obese can strain the back and contribute to back pain. Adopting a healthy diet and exercise routine can help manage your weight and improve overall health. If you are obese and would like to know more about our Wegovy weight loss plan, click here.

Exercise and physical activity

  • Core strengthening. Strengthening your core muscles such as the abdomen and lower back, can provide better support for your spine and reduce the risk of future back pain.

  • Low-impact aerobic exercise. Activities such as swimming, walking, or cycling can improve your overall fitness and help manage your back pain. Consult with a healthcare professional before starting any exercise program.

  • Flexibility exercises. Stretching exercises, yoga or Pilates can all improve your general flexibility and reduce stiffness in the muscles and joints of your back.

Posture and ergonomics

  • Maintain good posture. Always be aware of your posture while sitting, standing, and lifting. Use ergonomically designed furniture and equipment to support proper alignment if possible.

  • Take regular breaks. If you have a sedentary job - such as one that involves sitting all the time - take breaks to stand, stretch, and move around regularly.

Medical interventions

  • Physical therapy. A physiotherapist can design an individual exercise and stretching programme for you and offer education on proper body mechanics.

  • Medication. Depending on the type and severity of back pain, your doctor may recommend prescription medications, such as muscle relaxants or pain relievers.

  • Injections. In certain cases, corticosteroid injections into the affected area may help reduce inflammation and provide relief although these are not viewed as first-line treatments here.

Cognitive behavioural therapy (CBT)

  • CBT can help individuals manage chronic pain by addressing negative thought patterns, coping strategies, and emotional responses to pain.

Conclusion

Although the link between back pain and an enlarged prostate is often a complex one, understanding the potential connections between these conditions is crucial for effective diagnosis and management. If you feel you are experiencing symptoms of back pain or an enlarged prostate, always seek medical attention for a thorough evaluation so that a treatment plan can be tailored to your specific needs.

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Dr Roger Henderson
Reviewed by Dr Roger Henderson
Reviewed on 13.10.2023
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