The experience of simultaneous back pain and stomach pain can be unsettling, prompting a search for answers about their connection. While a strained or “pulled” muscle in the back can cause discomfort felt in the abdominal area, it is important to understand that this symptom combination often signals other, potentially more serious, conditions. Recognizing the difference between musculoskeletal pain and pain originating from internal organs is the first step toward appropriate medical attention.
The Musculoskeletal Explanation
A severe strain in a deep back muscle can manifest as pain that feels surprisingly like it is coming from the abdomen. This occurs because certain core muscles anchor the spine and extend toward the front of the body, making an injury feel less localized. The psoas major muscle, a deep hip flexor, attaches directly to the front of the lumbar vertebrae. Severe tightness or a tear in the psoas can cause pain that radiates into the groin and lower abdominal region.
The quadratus lumborum (QL) is another muscle situated in the lower back, connecting the lowest rib, hip, and lumbar spine. A spasm in the QL, often called a “pulled back muscle,” can generate a deep ache sometimes mistaken for abdominal discomfort or a kidney issue due to its location.
How Pain Signals Cross Over
The phenomenon known as referred pain offers a neurological explanation for why an issue in the back can be felt in the front of the body. Referred pain occurs when the brain mistakenly interprets a signal from one location as coming from another, due to shared neurological pathways. Nerves from both the back and internal organs converge onto the same segments of the spinal cord before relaying signals to the brain.
The thoracic spinal nerves (T9 to T12) supply sensation to the mid-to-lower back and the abdominal wall. Irritation or compression of one of these nerve roots, such as from a herniated disc, can cause thoracic radiculopathy. Because the T12 nerve root supplies the lower abdomen, the brain may perceive the irritation in the back as pain felt distinctly in the stomach.
Serious Conditions that Combine Both Pains
While a pulled muscle or nerve irritation can link the symptoms, it is important to consider visceral conditions where the back pain is not muscular, but rather a symptom of an internal organ problem. Serious illnesses affecting abdominal organs frequently cause pain that radiates or is referred to the back, rather than the back being the primary source. The quality and location of the pain often provide crucial clues to the source, distinguishing a muscular issue from an organ-related one.
Acute Pancreatitis
Acute pancreatitis, an inflammation of the pancreas, typically causes severe upper abdominal pain that radiates straight through to the middle or upper back. This pain is often constant and worsens after eating, reflecting the pancreas’s role in digestion. The pancreas is located behind the stomach, making it a source of pain easily felt in the back.
Kidney Issues
Kidney stones or a kidney infection (pyelonephritis) produce pain that begins in the flank or lower back and moves toward the groin or abdomen. Kidney stone pain is often described as colicky, meaning it comes in intense waves or spasms. This is frequently accompanied by symptoms like blood in the urine or painful urination, unlike the steady ache of a muscle strain.
Abdominal Aortic Aneurysm (AAA)
An abdominal aortic aneurysm (AAA) is an enlargement of the main artery in the abdomen. As the aneurysm grows or begins to leak, it can cause a deep, constant pain in the lower back or abdomen. A ruptured AAA is a life-threatening medical emergency characterized by a sudden, severe, “ripping” or “tearing” pain in the abdomen and back.
Warning Signs Requiring Emergency Care
The combination of back and stomach pain warrants immediate medical evaluation if accompanied by specific red flag symptoms, as these indicate a potentially life-threatening emergency. Any sudden, severe pain in the abdomen or back that feels like the worst pain ever experienced requires emergency care without delay, as this can signal a ruptured organ or an aortic aneurysm. Other symptoms that should prompt an immediate trip to the emergency room include signs of systemic illness or organ dysfunction:
- High fever or chills.
- Persistent vomiting that prevents keeping down fluids.
- Blood noted in the urine or stool.
- The inability to pass urine or stool, or the sudden loss of bladder or bowel control.
- Lightheadedness, dizziness, or a racing heart rate, which may indicate internal bleeding or shock.