Endometriosis happens when tissue similar to the uterine lining grows outside the uterus. This misplaced tissue can trigger inflammation, irritation, and pain in different parts of the body—including the lower back.
Back pain related to endometriosis is more common than many people realize. Because of this lack of awareness, it often goes unrecognized or is mistaken for other musculoskeletal issues, which can delay endometriosis diagnosis and treatment.
The Link Between Endometriosis and Back Pain
Endometriosis is often associated with pelvic pain, but it can also cause discomfort in other areas, like the lower back.
This kind of referred pain is more common than many people realize and can be easily misattributed to other causes.
Endometrial growths can attach to pelvic organs like the ovaries, fallopian tubes, bladder, or bowel, and in some cases, extend beyond the pelvic region.
Each month, this tissue responds to hormonal changes by thickening, breaking down, and bleeding. But unlike menstrual blood, this blood has nowhere to go, which can lead to inflammation, scarring, and the formation of adhesions (bands of scar tissue that can bind organs together).
Why Endometriosis Causes Back Pain
There are several reasons endometriosis might cause lower back pain:
- Nerve irritation: When endometrial tissue grows near or behind the uterus, it can irritate nearby nerves that connect to the lower back. This often leads to referred pain—pain felt in the back, even though the source is in the pelvis.
- Inflammation and muscle tension: Chronic inflammation from endometriosis can trigger muscle spasms or tightness in the lower back. This is a protective response from your body, but it can add to overall discomfort.
- Adhesions: Scar tissue can pull on pelvic organs or connective tissue near the spine, leading to a sense of pressure or stiffness in the back.
- Bowel or bladder involvement: Endometriosis affecting these organs can create digestive or urinary symptoms, which may also present as lower back pain due to shared nerve pathways.
It’s also worth noting that the intensity of endometriosis pain (whether in your back or elsewhere) doesn’t always match the extent of the disease. Some people with minimal endometrial growths experience significant back pain, while others with more widespread lesions may have little to no back discomfort. Pain severity is influenced by a number of factors, including the location of the tissue and individual pain sensitivity.
What Kind of Back Pain is Related to Endometriosis?
Back pain linked to endometriosis is typically felt in the lower back or sacral area—the region just above the tailbone and below the waist. For some, the discomfort stays localized; for others, it may radiate across the lower back or down into the buttocks and legs.
In less common cases, endometrial growths near the diaphragm or affecting nerve pathways may cause referred pain in the upper back or shoulders.
People often describe endometriosis-related back pain in a few distinct ways:
- A deep, dull ache in the lower back
- Cramping or muscle spasms
- Sharp, stabbing pain that comes and goes
- Throbbing pain that spreads across the back and pelvis
- Stiffness or tension that limits movement
This kind of pain often intensifies around menstruation, when hormonal changes trigger inflammation in the endometrial tissue. It may also get worse with certain activities, like sitting for long periods, lifting heavy objects, or doing high-impact exercise. On the other hand, light movement and stretching may offer some relief.
Because these symptoms can overlap with other conditions, such as sciatica, muscle strain, or disc problems, endometriosis-related back pain is often misdiagnosed.
When Does Endometriosis Back Pain Usually Happen?
Endo-related back pain often follows a cyclical pattern, worsening around your period.
Many people notice pain a few days before menstruation that continues through their period, driven by hormonal changes that cause endometrial growths to break down and bleed. This leads to inflammation and discomfort.
Some also experience back pain around ovulation, though this is less common.
In more advanced cases, pain may be constant rather than cyclical. This can happen when scarring or adhesions affect nearby nerves or muscles.
Tracking when your back pain occurs—and how severe it is—can help your healthcare provider identify patterns and guide treatment. Dr. Jessica Opoku-Anane suggests a simple symptom diary as a helpful starting point.
Signs Your Back Pain May Be Caused by Endometriosis
Back pain is common with endometriosis, but it rarely occurs alone. Other symptoms often appear alongside it, helping to identify if endometriosis is the cause.
Common accompanying endometriosis symptoms include:
- Painful periods (dysmenorrhea): Severe cramps that often start before and continue through your period.
- Pain during or after sex (dyspareunia): Deep pain, especially if endometrial growths are near the vagina or lower uterus.
- Painful bowel movements or urination: Abdominal pain or other kinds of discomfort during these activities, often worsening during menstruation if the bowel or bladder is affected.
- Heavy or irregular bleeding: Heavy periods or bleeding between cycles.
- Infertility: Difficulty getting or staying pregnant.
If your back pain occurs alongside these symptoms, it’s important to discuss endometriosis with your healthcare provider. Tracking your symptoms—when they happen, their intensity, and other details—can provide useful information for diagnosis.
Managing Back Pain Caused by Endometriosis
Back pain from endometriosis can be managed through a combination of medical treatments and lifestyle strategies. The right pain relief approach depends on your pain severity, the extent of endometriosis, and your overall health.
Medical Treatments
- Pain relievers: Over-the-counter options like ibuprofen (Advil or Motrin) or acetaminophen (Tylenol) can ease mild to moderate pain. For more intense pain control, your doctor may prescribe other medications.
- Hormonal therapies: Birth control methods (pill, patch, ring) reduce endometriosis tissue growth and pain. Other options, like GnRH agonists, may also be prescribed.
- Surgery: In some cases, removing endometrial growths and adhesions surgically can improve pain and fertility.
There are a few ways to treat endometriosis and manage symptoms. Your doctor can guide you in choosing the most appropriate treatment and will help you stick to the plan for the best results.
Self-Care and Lifestyle Changes
- Heat therapy: Using a heating pad or taking warm baths can relax muscles and ease pain.
- Gentle exercise: Activities like walking, swimming, or yoga improve flexibility, reduce pain, and support mood.
- Stress management: Stress can worsen pain. Techniques like deep breathing, meditation, or counseling may help.
- Healthy diet: Reducing sugar and unhealthy fats while focusing on a balanced diet may lower inflammation and ease symptoms.
Physical Therapy
A physical therapist can:
- Strengthen the muscles supporting your back and pelvis
- Improve flexibility and range of motion
- Reduce pain and stiffness
- Enhance posture and alignment
Staying generally active can also be helpful. Regular movement can help maintain muscle strength and flexibility, reduce stiffness, and improve your overall well-being. However, be sure to listen to your body and avoid any activities that worsen your pain.
When to See a Healthcare Provider for Back Pain
- Your pain is severe or limits daily activities
- Pain doesn’t improve with self-care
- You have other symptoms of endo like painful periods, pain during sex, or fertility issues
- New or worsening symptoms appear, such as bowel or bladder incontinence or numbness and tingling in your legs
Managing Your Pain With Endometriosis
Endometriosis is a complex condition that can cause a variety of frustrating symptoms, which can include back pain.
Managing this pain can be difficult, but there are strategies that can help you feel more like yourself again. It’s a good idea to work closely with your healthcare provider when it comes to incorporating self-care practices and paying attention to how your body responds to different treatments. When handled correctly, a solid plan can help you reduce pain and improve your quality of life.
Sometimes, simply understanding your body better can be helpful.
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Frequently Asked Questions (FAQ):
What does endometriosis back pain feel like?
Endometriosis back pain usually presents as a deep, aching sensation in the lower back. It can be constant or come in waves, often intensifying during menstruation. Over-the-counter options like ibuprofen (Advil) or acetaminophen (Tylenol) may help with pain relief. If you experience severe pain, prescription medications can be discussed with your healthcare provider.
What are the 5 stages of endometriosis?
Endometriosis is classified into four stages based on severity: Stage 1 (minimal endometriosis), Stage 2 (mild endometriosis), Stage 3 (moderate endometriosis), and Stage 4 (severe endometriosis). These stages take into account the amount, depth, and location of endometrial tissue growth, which helps guide treatment decisions.
What are the symptoms of endometriosis flare-up?
A flare-up can cause severe pelvic pain, increased menstrual bleeding, pain during intercourse, fatigue, and digestive issues such as bloating or constipation. Effective treatments for back pain during flare-ups often include hormonal therapies like Orilissa, laparoscopic surgery, and physical therapy, depending on your specific situation.
What are the worst symptoms of endometriosis?
The most challenging symptoms can include debilitating pelvic pain, excessive bleeding during your period, severe fatigue, and pain during or after sex. These symptoms can significantly affect daily activities and mental well-being. If you experience chronic pelvic pain or pain that follows your menstrual cycle, it may indicate endometriosis-related back pain.
