Back Pain in Pregnancy

ExitCare ImageBack pain during pregnancy is common. It happens in about half of all pregnancies. It is important for you and your baby that you remain active during your pregnancy. If you feel that back pain is not allowing you to remain active or sleep well, it is time to see your caregiver. Back pain may be caused by several factors related to changes during your pregnancy. Fortunately, unless you had trouble with your back before your pregnancy, the pain is likely to get better after you deliver.

Low back pain usually occurs between the fifth and seventh months of pregnancy. It can, however, happen in the first couple months. Factors that increase the risk of back problems include:

  • Previous back problems.

  • Injury to your back.

  • Having twins or multiple births.

  • A chronic cough.

  • Stress.

  • Job-related repetitive motions.

  • Muscle or spinal disease in the back.

  • Family history of back problems, ruptured (herniated) discs, or osteoporosis.

  • Depression, anxiety, and panic attacks.

CAUSES

  • When you are pregnant, your body produces a hormone called relaxin. This hormone makes the ligaments connecting the low back and pubic bones more flexible. This flexibility allows the baby to be delivered more easily. When your ligaments are loose, your muscles need to work harder to support your back. Soreness in your back can come from tired muscles. Soreness can also come from back tissues that are irritated since they are receiving less support.

  • As the baby grows, it puts pressure on the nerves and blood vessels in your pelvis. This can cause back pain.

  • As the baby grows and gets heavier during pregnancy, the uterus pushes the stomach muscles forward and changes your center of gravity. This makes your back muscles work harder to maintain good posture.

SYMPTOMS

Lumbar pain during pregnancy

Lumbar pain during pregnancy usually occurs at or above the waist in the center of the back. There may be pain and numbness that radiates into your leg or foot. This is similar to low back pain experienced by non-pregnant women. It usually increases with sitting for long periods of time, standing, or repetitive lifting. Tenderness may also be present in the muscles along your upper back.

Posterior pelvic pain during pregnancy

Pain in the back of the pelvis is more common than lumbar pain in pregnancy. It is a deep pain felt in your side at the waistline, or across the tailbone (sacrum), or in both places. You may have pain on one or both sides. This pain can also go into the buttocks and backs of the upper thighs. Pubic and groin pain may also be present. The pain does not quickly resolve with rest, and morning stiffness may also be present.

Pelvic pain during pregnancy can be brought on by most activities. A high level of fitness before and during pregnancy may or may not prevent this problem. Labor pain is usually 1 to 2 minutes apart, lasts for about 1 minute, and involves a bearing down feeling or pressure in your pelvis. However, if you are at term with the pregnancy, constant low back pain can be the beginning of early labor, and you should be aware of this.

DIAGNOSIS

X-rays of the back should not be done during the first 12 to 14 weeks of the pregnancy and only when absolutely necessary during the rest of the pregnancy. MRIs do not give off radiation and are safe during pregnancy. MRIs also should only be done when absolutely necessary.

HOME CARE INSTRUCTIONS

  • Exercise as directed by your caregiver. Exercise is the most effective way to prevent or manage back pain. If you have a back problem, it is especially important to avoid sports that require sudden body movements. Swimming and walking are great activities.

  • Do not stand in one place for long periods of time.

  • Do not wear high heels.

  • Sit in chairs with good posture. Use a pillow on your lower back if necessary. Make sure your head rests over your shoulders and is not hanging forward.

  • Try sleeping on your side, preferably the left side, with a pillow or two between your legs. If you are sore after a night's rest, your bed may be too soft. Try placing a board between your mattress and box spring.

  • Listen to your body when lifting. If you are experiencing pain, ask for help or try bending your knees more so you can use your leg muscles rather than your back muscles. Squat down when picking up something from the floor. Do not bend over.

  • Eat a healthy diet. Try to gain weight within your caregiver's recommendations.

  • Use heat or cold packs 3 to 4 times a day for 15 minutes to help with the pain.

  • Only take over-the-counter or prescription medicines for pain, discomfort, or fever as directed by your caregiver.

Sudden (acute) back pain

  • Use bed rest for only the most extreme, acute episodes of back pain. Prolonged bed rest over 48 hours will aggravate your condition.

  • Ice is very effective for acute conditions.

  • Put ice in a plastic bag.

  • Place a towel between your skin and the bag.

  • Leave the ice on for 10 to 20 minutes every 2 hours, or as needed.

  • Using heat packs for 30 minutes prior to activities is also helpful.

Continued back pain

See your caregiver if you have continued problems. Your caregiver can help or refer you for appropriate physical therapy. With conditioning, most back problems can be avoided. Sometimes, a more serious issue may be the cause of back pain. You should be seen right away if new problems seem to be developing. Your caregiver may recommend:

  • A maternity girdle.

  • An elastic sling.

  • A back brace.

  • A massage therapist or acupuncture.

SEEK MEDICAL CARE IF:

  • You are not able to do most of your daily activities, even when taking the pain medicine you were given.

  • You need a referral to a physical therapist or chiropractor.

  • You want to try acupuncture.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You develop numbness, tingling, weakness, or problems with the use of your arms or legs.

  • You develop severe back pain that is no longer relieved with medicines.

  • You have a sudden change in bowel or bladder control.

  • You have increasing pain in other areas of the body.

  • You develop shortness of breath, dizziness, or fainting.

  • You develop nausea, vomiting, or sweating.

  • You have back pain which is similar to labor pains.

  • You have back pain along with your water breaking or vaginal bleeding.

  • You have back pain or numbness that travels down your leg.

  • Your back pain developed after you fell.

  • You develop pain on one side of your back. You may have a kidney stone.

  • You see blood in your urine. You may have a bladder infection or kidney stone.

  • You have back pain with blisters. You may have shingles.

Back pain is fairly common during pregnancy but should not be accepted as just part of the process. Back pain should always be treated as soon as possible. This will make your pregnancy as pleasant as possible.