Back or Belly Pain Over 60: Abdominal Aortic Aneurysm Warning Signs

You're in your late sixties, you've been a smoker for years, and lately there's been a deep, nagging ache in your lower back. Some days you feel it in your belly too. You put it down to getting older, or to the long drive to the cottage.

Most back pain after 60 really is the spine: stiff joints, worn discs or tight muscles. But there is one cause that is rare, often silent and very serious, and it's worth knowing about: an abdominal aortic aneurysm, or AAA.

What is an abdominal aortic aneurysm?

Your aorta is the main blood vessel that carries blood from your heart down through your chest and belly. It runs right in front of your spine. An aneurysm is a spot where the wall of that vessel becomes weak and starts to balloon outward.

Most AAAs grow slowly and cause no symptoms at all. Many are found by accident on a scan done for something else. The danger is that a large aneurysm can burst (rupture). A ruptured AAA causes serious internal bleeding and is often fatal, which is why finding one early matters so much.

Because the aorta sits so close to the spine, an aneurysm that is growing can cause a deep ache in the back or belly. That's how it can end up looking like an ordinary back problem.

Who is most at risk?

• Being 65 or older
• Being male (men get AAAs much more often than women)
• Smoking now or in the past (the strongest risk factor)
• High blood pressure or high cholesterol
• A parent, brother or sister who had an AAA
• Heart disease, other artery disease or COPD

Warning signs to know

An AAA may be worth ruling out if you notice:

• A deep, constant ache in your belly or the side of your belly
• Back pain that doesn't really change with movement, posture or rest
• A throbbing or pulsing feeling near your belly button
• Belly or back pain that doesn't go away, or keeps coming back
• A lump you can feel in your belly

Many people with an AAA have none of these signs, which is why screening is so important.

When to call 911

Call 911 right away if you or someone else has:

• Sudden, severe pain in the belly or back, which may feel like ripping or tearing
• Pale, grey or clammy skin, dizziness or fainting
• A racing heart or trouble breathing
• Loss of consciousness

A ruptured aneurysm is a life-threatening emergency. Don't wait to see if it settles, and don't drive yourself to the hospital.

When to see your family doctor

Book an appointment with your family doctor if you have belly or back pain that doesn't go away or keeps coming back, if you feel a pulsing in your belly, or if you have several of the risk factors above.

Ontario now has an Abdominal Aortic Aneurysm Screening Program. A one-time abdominal ultrasound is advised for men aged 65 to 80. Screening is also recommended for women in that age range, especially those who smoke, have a family history of AAA or have heart or blood vessel disease. Starting in September 2025, Ontario began mailing invitations to people turning 65. The scan is quick, painless and uses no radiation. Your family doctor makes the referral and follows up on the results.

If you take medicine for blood pressure or cholesterol and have questions about it, talk to your doctor or pharmacist.

Why your physiotherapist asks about this

At Vaughan Physiotherapy Clinic, back pain assessments for older adults always include screening for causes that aren't coming from the spine. That's why we may ask:

• Whether you smoke or used to smoke
• About your blood pressure, heart health and family history
• Whether the pain changes when you move, sit, stand or lie down, or stays the same no matter what
• Whether you've noticed any pulsing or throbbing in your belly

A Canadian case report described a 71-year-old man with a history of heart disease whose low back pain looked a lot like a typical spine problem. Imaging found an aneurysm, and he was referred to vascular surgery. Cases like this are a reminder that a back can look "mechanical" on exam and still have something more serious behind it.

A hands-on exam can't rule out an AAA. Only imaging, such as an ultrasound, can. So if your age, risk factors or symptoms raise the question, we stop, explain our concern, and refer you to your family doctor, or tell you to call 911 if it's urgent. We also avoid strong manual techniques on the spine and belly until an aneurysm has been ruled out.

What physiotherapy can and can't do

Physiotherapy can't treat or shrink an aneurysm. Massage, manual therapy, exercise or needling won't change it. AAAs are monitored and treated by your doctor and a vascular surgeon.

What we can do:

• Treat back pain from the spine once an aneurysm has been ruled out
• Help you stay active safely, within any limits your doctor or surgeon sets
• Support your recovery and return to daily activities after aneurysm repair, once your surgical team clears you

Key takeaways

• An AAA is a bulge in the main blood vessel in your belly. It often causes no symptoms until it's large or bursts.
• Men over 65, smokers and people with a family history are at highest risk.
• Deep back or belly pain that doesn't change with movement, or a pulsing in your belly, needs a visit with your doctor.
• Sudden, severe tearing pain in the belly or back means call 911.
• If you're 65 to 80, ask your family doctor about a one-time AAA ultrasound.

Related reading: You may also find our guides to mechanical low back pain and 5 things you need to know about back pain helpful.

Once your doctor has ruled out an aneurysm, our team can help you manage back pain and keep moving. Learn more about how we approach chronic low back pain.

Call: 905-669-1221

Visit: 398 Steeles Ave W #201, Thornhill, ON

Book online: vaughanphysiotherapy.com

Sources

Hadida, C., & Rajwani, M. (1998). Abdominal aortic aneurysms: Case report. Journal of the Canadian Chiropractic Association, 42(4), 216 to 221. https://www.chiropractic.ca/wp-content/uploads/2014/07/Abdominalaorticaneurysms-casereport.pdf

Mayo Clinic Staff. (n.d.). Abdominal aortic aneurysm: Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/abdominal-aortic-aneurysm/symptoms-causes/syc-20350688

National Health Service. (n.d.). Abdominal aortic aneurysm. NHS. https://www.nhs.uk/conditions/abdominal-aortic-aneurysm/

Ontario Health. (2025). Ontario Abdominal Aortic Aneurysm (AAA) Screening Program: Clinical guidance document for healthcare providers. https://www.ontariohealth.ca/content/dam/ontariohealth/documents/oaaasp-clinical-guidance.pdf

This article is for general information and isn't medical advice. If you have any of the warning signs above, call 911 or contact your doctor right away.