Hogeschool van Amsterdam

Urban Vitality

Urinary problems often paired with lower back pain in men

14 Mar 2019 12:09 | Urban Vitality

Ninety per cent of men who go to see a urologist due to difficulty urinating also experience lower back pain. Tom Vredeveld, a physiotherapist and lecturer-researcher at the AUAS, is going to be studying links between these two common symptoms in order to improve future treatments to address both issues. He has been awarded an NWO Doctoral Grant for Teachers to pursue this research.

Urinary problems

A quarter of men aged forty and older have mild to severe urinary problems, and the risk of such problems only increases with age. Symptoms can include weak urine flow, inability to empty the bladder completely and dribbling or leakage. Needing to get up at night to urinate is another frequent symptom as it disrupts sleep, and particularly aggravating.

If the symptoms or cause are severe enough, a GP refers patients experiencing urinary problems to a urologist. The urologist will ask a number of questions and perform a physical exam. Normally, however, they do not ask about back pain.

Lower back pain

Lower back pain is a widespread complaint in the population at large. In most cases, there is no clear cause, so a pragmatic approach is best. That comes down to a set of exercises to improve back strength and mobility. Physiotherapists are enlisted to help in this process. But physiotherapists normally don't ask if patients are having urinary problems.

Linked symptoms


Why is it that, in men, lower back pain and urinary problems so often go hand and hand? The explanation could be simple: both are common complaints, so it's only logical that some men experience both.

Pelvic floor muscles

Alternatively, it could be that both problems are affecting the same muscles, nerves and tendons. For women, there is is already a considerable body of research on pelvic problems and urine loss, but in how far the pelvic floor muscles are also implicated when men have difficulty urinating and back pain has hardly been studied yet. Nevertheless, there are indications that a connection exists.


Furthermore, leaving aside questions of coincidence or causation, the presence of both conditions affects the treatment of each one. For instance, if a man is getting up several times a night to urinate, he is also getting less sleep, which in turn could hamper his lower back recovery.


Tom Vredeveld's main focus is on the symptoms' ramifications. Such as in the example of having to urinate at night. His first step will be to draw up and test a list of questions to get a clear picture of impacts like ‘disrupted sleep’. A questionnaire already exists, but not yet in Dutch.

Using this questionnaire, the next step will be to home in on the connection between lower back pain and urinary problems. Vredeveld's study will look at men in three groups: those with lower back pain only, those with urinary problems only, and those with both, with each group to consist of around one hundred subjects. He hopes the results will yield new knowledge about key factors involved in these health problems, such as lifestyle and emotional factors.

Once he has compiled all this information, Vredeveld will develop a brief set of questions that doctors, physiotherapists and urologists can use to quickly assess if patients are experiencing additional specific symptoms and need targeted assistance.

Determining what kind of assistance is best will be the next stage of his research. Maybe, he conjectures, a combined treatment by multiple healthcare providers working collaboratively would be most effective.


Vredeveld is conducting his research within the Professional Reasoning and Shared Decision-making in Healthcare professorship led by professor Stephan Ramaekers. The project has a duration of four years and is titled ‘Holding out? Lower back pain and urinary problems in men’ (Houdt het op? Lage rugpijn en plasklachten bij mannen). Alongside Vredeveld, four other researchers at the AUAS have been awarded an NWO Doctoral Grant for Teachers.