Low back pain and urinary incontinence. A hypothetical relationship.

STUDY
DESIGN: An apparent association of low back pain with urinary incontinence was observed. Sixteen patients were investigated for organic neurologic and genito-urinary disease or deficit, which could provide a conventional explanation for the incontinence.
OBJECTIVES: The unusual association of low back pain alone, with urinary incontinence, should be brought to the attention of clinicians, in the search for neurologic mechanisms to explain the phenomenon. SUMMARY OF BACKGROUND DATA: Over 5 years, a spinal practice reviewed 5000 new patients, most presenting with low back pain. Sixteen low back pain patients had urgency incontinence of urine, of varying severity but sufficient in all cases to cause daily distress and disruption of routine. Twelve of the sixteen patients had surgery (spinal fusion in 11 and total hip replacement in one), and four are awaiting surgery. Follow-up ranged from 1 to 4 years.
METHODS: Plain radiography, detailed neurologic examination, myelography, or computed tomography scanning of lumbar spine, urine culture, and urodynamic studies were the investigations used, with a few exceptions relating to those patients whose urinary symptoms were revealed retrospectively.
RESULTS: When surgery reduced low back pain successfully (11 of 12 patients), the urgency incontinence was cured or improved. In one patient, the low back pain continued, associated with a pseudarthrosis in the fusion mass, and the urinary symptoms were unchanged. In the four patients awaiting surgery, the urinary symptoms are unchanged. The investigations did not reveal any neurologic or genito-urinary pathology in any patient.
CONCLUSION: A rare association between severe low back pain and urgency incontinence of urine, not explained on the basis of any conventional neurologic or genito-urinary pathology, should be recognized.