Why does my back hurt?
The uterus grows, the stomach pulls the body forward, and to maintain balance, the woman leans back. The lumbar curve increases, the back muscles are constantly overstrained. At the same time, the hormone relaxin makes the ligaments more extensible, preparing the pelvis for childbirth, so the sacroiliac joints and pubic joint become more mobile and more painful. The rectus abdominis muscles diverge and provide less support to the spine. In later stages, the baby’s head can put pressure on the nerve plexuses of the pelvis. All these mechanisms explain the different nature of pain: in the lower back, in the sacrum or in the pubic area.
- Shifting the center of gravity and increasing lumbar deflection
- Softening of ligaments under the influence of relaxin
- Separation of the rectus abdominis muscles
- Increased load on the sacroiliac joints
- Dysfunction of the symphysis pubis
- Pressure of the baby's head on the nerves of the pelvis
- Exacerbation of an existing disc herniation
What are the types of pain?
Lumbar pain is felt above, in the midline or on the sides, intensifies with prolonged standing, bending and lifting heavy objects, and is relieved by lying on the side. Pelvic pain is located lower, in the area of the sacrum and buttocks, often on one side, and is provoked by walking, climbing stairs, turning over in bed. Pain in the pubic area with a clicking sensation and difficulty in spreading the legs indicates dysfunction of the symphysis pubis. Separately, there is pain radiating to the leg with numbness, which requires examination by a neurologist.
- Lumbar pain with strain and bending
- Pelvic pain in the sacrum and buttocks
- Pain in the symphysis pubis when walking
- Referring pain to the leg and numbness
- Night pain that interferes with sleep
- Pain that gets worse in the evening
When you need to see a doctor urgently
The main thing is not to miss conditions that disguise themselves as ordinary back pain. Regular cramping pain with a feeling of tension in the uterus up to 37 weeks may indicate a threat of premature birth. Lower back pain in combination with fever, chills, painful or frequent urination indicates kidney inflammation, which is more severe during pregnancy. Placental abruption causes constant pain and bleeding. Numbness of the perineum, weakness in the legs and difficulty urinating are rare but urgent neurological signs that require immediate attention.
- Threat of premature birth
- Pyelonephritis and urolithiasis
- Placental abruption
- Nerve root compression
- Severe dysfunction of the symphysis pubis
- Consequences of injury or fall
Survey
The doctor clarifies the nature of the pain, its connection with movement, the presence of discharge and urinary complaints, assesses the tone of the uterus and the condition of the child. A general urine test helps to quickly rule out a urinary tract infection; if suspected, urine culture and kidney ultrasound are performed. If cramping pain occurs, the cervix is assessed and CTG is performed. If there is numbness, weakness in the leg or loss of reflexes, call a neurologist. X-rays are not used during pregnancy, but magnetic resonance imaging is possible for strict indications when a decision cannot be made without it.
- Examination by an obstetrician-gynecologist and assessment of uterine tone
- General urine test and culture if necessary
- Kidney ultrasound
- Ultrasound of the uterus and cervical assessment
- CTG in later stages
- Neurological examination
- MRI without contrast according to strict indications
What helps and what doesn't
Simple measures work best. Regular gentle exercises for the muscles of the back and pelvic floor, swimming, walking in comfortable shoes without heels, sleeping on your side with a pillow between your knees, and the correct technique for lifting objects by squatting rather than bending over help. The support bandage reduces the load on the lower back in the later stages. A warm shower and a gentle massage from a specialist working with pregnant women provide noticeable relief. Any painkillers during pregnancy are taken only as prescribed by a doctor: many common medications are prohibited during pregnancy.
- Exercises for the muscles of the back, abdomen and pelvic floor
- Swimming and walking at a moderate pace
- Comfortable flat shoes
- Sleeping on your side with a pillow between your knees
- Support bandage as recommended by a doctor
- Lifting weights correctly and changing positions frequently
- Warm shower and gentle massage from a trained specialist
- Painkillers only as prescribed by a doctor
- Refusal of sharp manual manipulations and warming up the abdomen
