Experencing back pain during pregnancy is common and is caused by many factors.
These factors – which are due to the anatomical, postural, vascular and hormonal changes that take place naturally during the course of pregnancy – tend to develop simultaneously and cause pain in the woman’s body.
Most of the time, pregnancy back pain is normal.
But you should still be aware of some causes of pregnancy back pain that may indicate a more serious situation.
In fact, in some rare cases, they can be life-threatening.
How it begins
A pregnant woman will go through changes in the mechanics of her lower back, creating discomfort and making any existing conditions worse.
The types of back pain a pregnant woman can expect to experience are:
- Lower back pain
- Pelvic pain
- Thigh pain
- Back and hip pain
- Abdominal cramps
Some musculoskeletal causes of back pain during pregnancy are:
Higher oestrogen and relaxin hormone levels widen the pelvis.
This starts at the 10th or 12th week of pregnancy, causing the pelvis size to increase typically by about 10mm.
Muscles and soft tissues in the lower back are affected due this change in pelvis size, which can affect your gait and create pain while walking.
The pain can worsen in the later stages of pregnancy, extending to the thighs.
Concentrated levels of oestrogen also increase tissue and joint flexibility in the lower back.
This causes the sacroiliac joints to become lax, disrupting the stability of the pelvis.
Weight tends to shift from the spine to the legs when laxity occurs, and the loosening of joints can also affect posture.
As your baby grows, so does the size of your uterus.
Your spine also begins to change in shape, particularly in the lower back area where it becomes noticeably curved.
Muscles that help stabilise the pelvis are shortened, increasing the curved shape and creating pain.
Other causes of back pain during pregnancy include:
Peripheral nerves in the thigh and pelvis region may become stretched, compressed and lose their blood supply, making them a source of pain.
The swelling of soft tissue causes additional pressure on these nerves, causing pain in the thighs, lower back and pelvis.
Medical conditions like diabetes and obesity also increase the risk of peripheral nerve pain in the legs.
Increased strain on the lower skeletal system affects the spinal discs and causes herniation.
The nearby nerve roots may be affected, resulting in sciatica symptoms that can move down the thighs, legs, and even to the feet.
It often affects one side of the body, and can become aggravated during pregnancy.
Some pregnant women may develop osteoporosis during their third trimester.
The reason why it occurs is still a mystery, but the symptoms usually appear gradually, affecting the tissues of the hip joint, which causes pain and limits movement.
Another condition that affects the hip region – avascular necrosis of the femoral head – may occur due to biological changes in pregnancy.
These changes include weight gain and high levels of natural steroids, which can affect the bone tissue in the top part of the thigh bone (femoral head), and cause groin and lower back pain.
Although uncommon, some obstetrical conditions like spontaneous abortion, ovarian cysts, pelvic or uterine adhesions, fibroids, or fluid collection, may cause lower back pain in pregnancy.
Severe lower back and groin pain may occur when the fallopian tube ruptures due to an ectopic pregnancy.
This condition is a serious medical emergency and occurs in early pregnancy – typically within the first few weeks or first trimester.
In some pregnancies, the placenta is located near the posterior wall of the uterus, where it can potentially cause back pain.
Limited research indicates that a posterior placenta may also cause poor pregnancy outcomes and preterm labour.
You may want to seek treatment for your pregnancy back pain if the condition worsens.
But treatment depends on the underlying causes, stage of pregnancy and other medical conditions.
You need to consult with the appropriate medical specialists to determine the right treatment.
They’ll evaluate posture, range of motion in the lower extremities, leg-length inequality, tendon reflexes, gait pattern, joint pain and the degree of curvature in the lower spine.
The options for treatment usually include postural correction or physical therapy.
In more serious cases, medical management and surgical intervention may be required.
One way to reduce a considerable amount of strain off the lower back is by maintaining an ergonomically-supported posture throughout the day.
Your doctor may advise you to reduce high impact activities, and perform stretches and exercises to build strength in the pelvis, hips and lower back.
Most women find sleeping on their side with additional supportive pillows the most comfortable during pregnancy.
Place a pillow between your knees and ankles while sleeping.
This puts the top of the knee on the same level as the hip, thus reducing stress on the lower back.
You can support your upper arm by resting it on a vertical pillow in front of your abdomen and upper body.
To support your head and neck, try placing a small rolled-up towel inside the pillowcase.
Another tool that may be of help is a lumbar roll.
Placing this behind the small of the back to help support spinal curvature while sitting for extended periods can help decrease the frequency and intensity of back pain.
It may also help reduce the pelvic pain that occurs from a sit-to-stand position.
Get an inflatable lumbar roll to help accommodate the changes in body size and posture as the pregnancy progresses.
Exercise and physical therapy involves stretching, movements to strengthen the back, and posture modifications.
Seeing a trained therapist can help pregnant women focus on the right set of exercises to strengthen soft tissues and muscles in the lumbar spine area.
Flexion exercises (bending forward) help make the abdominal muscles stronger, improve core strength and decrease the lumbar curve.
Extension exercises (bending backward) help increase strength in the paraspinal muscles that provide stability to the spine.
Low-impact exercise options include pelvic tilts, knee-to-chest stretch, straight leg raise, curl-ups, side-lying leg raise, and even Kegel exercises.
Taking short breaks throughout the day from standing, moving, walking or sitting in a tensed position at a desk for long periods of time helps ease muscle spasms and relieves acute pain.
While sitting, keep both feet elevated to help bend the hips and decrease the curvature in the lower spine.
You can also use a heat patch in the lower back area or rear pelvis to further reduce soreness, decrease muscle spasms and improve blood circulation while resting.
The heat source must be used for 15 to 20 minutes at a time and cannot be too hot.
Adding a barrier, such as a towel, is advisable to avoid burns.
Take drugs with caution
Drugs are not typically recommended for pregnant women right away.
Most are not safe for the foetus as they can cause developmental harm or death if taken.
Only a certain number of pain medications can be used during pregnancy.
But even these must be avoided in the first trimester, and are only safe to take in the second and third trimesters.
For pregnancy back pain and pelvic pain, paracetamol is considered relatively safe and used as a first-line drug.
For nerve pain, such as in sciatica or radiculopathy, anticonvulsants (gabapentin) or antidepressants (amitriptyline) may be prescribed with caution for short term use.
For debilitating or severe pain, opioid medications may be recommended, but the dosage and regimen are prescribed with caution to avoid opioid withdrawal in the newborn.
Always consult a physician before taking any medication while pregnant, including supplements, over-the-counter medication, ointments, and even inhalers.
Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician and gynaecologist, and a functional medicine practitioner. For further information, email email@example.com. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.