Back pain during pregnancy: causes, symptoms and treatment

Back pain during pregnancy can be experienced in different areas of the back and may have a different intensity depending on the stage of pregnancy. This causes varied symptoms.

Lower back pain is the most common type of pain and forms the most frequent complaint among pregnant women. It has been estimated that as many as 50% to 75% of women will experience this type of pain at some point during their pregnancy.

Depending upon the pain site, lower back pain during pregnancy can be classified as lumbar pain or pelvic girdle pain, which have their unique patterns of pain perception. Some women may also suffer from a combination of these two types. Generally, pelvic girdle pain is four times more common.

Let’s discuss more about these two types of back pain experienced by pregnant women:

• Pelvic girdle pain
  Pelvic girdle pain is as a deep, sharp and stabbing pain, which will be experienced on both or either of the sides of the pelvic girdle. This type of pain can be experienced continuously or may occur recurrently. It often has a tendency to radiate to the inner thigh, knee and even the calf. Sometimes, this pain is experienced so severely that it may affect the quality of life of those affected and minimise their movements. This may even limit their social interactions and prevent them from persuading activities of interest.
• Lumbar pain
  Lumbar pain is experienced over the area of the lumbar spine and is felt in the same manner by pregnant and non-pregnant women. In this type of pain, tenderness over the affected area is often experienced and it even has a tendency to radiate to the foot. Lumbar pain is less severe and disabling than pelvic girdle pain and usually does not limit their physical or social activities. This type of pain has a tendency to be exacerbated by intense physical activities and movements.

Differentiation of the two types of pain is important since their management and specific diagnosis differ. Back pain during pregnancy is quite severely experienced and even has a tendency to be prolonged until the postpartum period, it being the most common complaint of women post delivery.

Back pain in pregnancy may be due to several physical and hormonal changes occurring during this period. During different trimesters and at different stages of pregnancy, the reasons for back pain can be vary. Following are the most important physiological and pathological causes of back pain during pregnancy:

Changes in hormonal activity during early pregnancy

It is quite inevitable to go through a bundle of hormonal changes during pregnancy. More often, back pain experienced during early pregnancy is merely a manifestation of these hormonal changes since changes in the body size are not so pronounced at this stage. During this time, pain along with an inflammation of the lower back is experienced by women.

Apart from the hormonal changes, there are some additional causes that may be associated with back pain in the later stages of pregnancy. Let us have a look at them:

Weight gain

As you gain weight during pregnancy, there is an increase in the abdominal size, which tends to shift the centre of gravity of the body. This increases the magnitude of forces to the lumbar spine, which is present in the area of the lower back and causes you to experience pain in the area.

Change in posture

Due to an increase in the abdominal size and stretching of the abdominal muscles, there is a change in the body posture during pregnancy to support the growing abdomen and to manage movements. Gradually, this causes a change in the curvature of the spine causing it to curve inwards. As this happens, the magnitude of stress and forces experienced in this area further increases making you to feel more pain.

Excessive physical activity

While it is important to be physically active during pregnancy, it is essential that you minimise extreme activities if you experience lower back pain. Studies have found that women who suffer from lower back pain during pregnancy take a longer time to recover after physical activity than women without back pain. So, if you already experience back pain, continuing with excessive activity is likely to worsen your concern.

Multiple foetuses

Weight gain due to multiple foetuses is more and so is the abdominal girth. As more and more relaxin, a hormone released during pregnancy, is increased to facilitate abdominal growth, joint laxity is diminished and back pain is manifested.

Venous congestion

Extreme lower back pain during pregnancy cannot be entirely physiological as opposed to the above-listed factors. If back pain is so severe that it causes you to wake up from your sleep and is more so during the night, it can be a consequence of venous congestion in the pelvis and the lumbar spine. This occurs due to the growing size of the abdomen, exerting a pressure on the vena cava, which gets worse when you lie down.

Congestive heart failure

Sometimes, a very extreme back pain during pregnancy can be reflective of congestive heart failure, due to the aforementioned mechanism. So, it is important to differentiate between normal and severe back pain during pregnancy and not ignore your symptoms if pain is experienced intensely.

Sciatica

Less commonly, back pain during pregnancy can be due to bulging out of the intervertebral disc causing nerve compression in the area, which results in sciatica. In these cases, lower back pain may radiate to the back of the leg and is typically manifested on one side of the body. This is quite an uncommon cause, occurring in about 1% of the pregnant women.

Other causes

Back pain during pregnancy can also be associated with other conditions, which would cause back pain in the remaining population. These include disc problems, degenerative disc disease, infection, pregnancy-induced osteoporosis and even malignancy.

In such cases, back pain can not only cause foetal defects and preterm labour but also lead to serious issues with the health of the mother and in serious cases, death.

So, it is important that an abnormal back pain during pregnancy is managed at the earliest.

Back pain during pregnancy can be diagnosed on the basis of patient history and physical examination. No other tests are usually performed in order to avoid any harm to the foetus. So, it is important that you clearly discuss your symptoms and specify the duration, type and intensity of pain along with its other characteristics, for your doctor to form a final diagnosis and begin early treatment.

Back pain during pregnancy can be easily managed, provided there is no severe underlying cause. Prevention forms an important part of the treatment strategy since treatment is not feasible during the later stages. It is important to manage back pain at the earliest to enhance the quality of life of women and to prevent it after delivery. After delivery, back pain is reported by several women even after 1 year postpartum owing to improper management during pregnancy. Here is how this can be avoided:

Exercise

Exercising before and during the early stages of pregnancy can help prevent back pain and is even effective in its management once it develops. Low-intensity exercises help to strengthen back, core and abdominal muscles thereby alleviating pain. The best exercises for the management of back pain include pelvic tilts, knee pulls and leg raises, which can be started during the second trimester. Performing these exercises thrice a week in a 12-week program significantly helps to minimise pain.

Kegel exercises are another form of work out, which have been found to be of immense help. You may talk with your fitness expert and consult with your doctor before beginning.

Aerobics

If you are not a fan of the gym and refreshing moves are your way of exercise, it is even better. Researchers have recognised water aerobics as an excellent way to alleviate back pain during pregnancy. It has been demonstrated as a helpful technique which remarkably assists in reducing the number of sick leaves among pregnant women owing to back pain. It is, however, important to seek your gynaecologist's approval and perform under the supervision of a trained expert.

Limiting intense exercise

While exercise plays an integral role in the management of back pain, it is important to not perform highly vigorous movements and stick to low-intensity workouts in order to manage back pain. Intensive workouts, especially in women prone to back pain, can have detrimental results.

Heating pads

Local application of heat to the painful area with the help of heat pads can help in alleviating pain. Keeping a soft pillow along your side as you sleep and preventing to sleep on the back can also help with your concern.

Sitting and standing

Sitting on soft, cushioned seats and those with proper support helps to manage back pain in pregnant women. You must be cautious while rising up from a prolonged sitting or resting position.

It is also important that you avoid standing for long hours and stay away from wearing heels in order to prevent back pain.

Yoga, acupressure, physiotherapy and massage

Yoga techniques have been recognised to reduce back pain during pregnancy but it is important that you perform them under the guidance of a trained expert. Similarly, getting a professional massage, physiotherapy and acupressure can be helpful for your pain.

In some women, even relaxation techniques have found to be helpful as they help in shifting away the focus from pain.

Posture

It is very important to stand and sit in a proper posture in order to reduce the incidence of back pain during pregnancy. Following your doctor’s instructions on this and keeping your back straight while lifting heavy objects and even while standing can be helpful. If you are unable to manage your posture with the help of these instructions, you can make the use of braces for support.

Use of support belts

Support belts help to press the area, which improves stability and reduces the laxity of the joint. Application of belt in a higher position significantly helps in reducing lower back pain in pregnant women. The use of support belts in the form of pelvic belts is the most prevalent and it also describes one of the most effective therapies for relieving back pain during pregnancy.

Pain-relievers

Over-the-counter medications like analgesics are commonly used to alleviate back pain. Your doctor may also prescribe specific pain-reducing drugs or muscle relaxants for the management of severe pain. In extreme cases, treatment of underlying cause is important to manage back pain in pregnant women. So, it is imperative that you seek medical and professional help for its management.