Spinal pain in the first trimester of pregnancy

Starting from the second and throughout the third trimester of pregnancy, many women are often bothered by discomfort in the back and lower back. The pain is initially aching in nature and becomes more intense and more frequent closer to childbirth. Back discomfort can occur even in women who did not have any problems before pregnancy.

The appearance of painful sensations in different women appears at different points in pregnancy. But, as a rule, the back hurts from 20-21 weeks of pregnancy. However, pain can appear much earlier, in this case it all depends on the woman’s lifestyle.

Back pain is worse during the end of pregnancy, this is approximately 34, 35, 36 and 37 weeks of pregnancy. The reason in this case lies not only in excess weight, but also in the fact that the child begins to put pressure on the lower back. Around this time, the body begins a kind of “preparation”, as a result of which some women feel quite intense and severe pain, although others may not feel it at all. In this case, you can notice that the abdominal wall itself sometimes tenses, becoming noticeably hard. This is clearly noticeable when a woman has to exert herself physically, or when she is angry, but this happens without any reason.

To understand why your back hurts during pregnancy, you need to understand the causes of pain.

• Shifting center of gravity due to increased weight.
• Problems with the spine before pregnancy.
• Wearing high heels during pregnancy.
• Weakening of the ligamentous apparatus during pregnancy.
• Hormonal changes in the body of a pregnant woman.
• Infectious and colds.
• Increased uterine tone and threat of miscarriage.
• False Braxton-Hicks contractions in late pregnancy.
• Stress.
• Poor physical fitness, weak back muscles.
• Lack of calcium in the body.

Shifting the center of gravity in a pregnant woman is the main cause of back pain

All women experience weight gain during pregnancy. Throughout pregnancy, a woman gains up to 16-20 kg. Accordingly, the load on the legs and spine increases, and back pain appears during pregnancy.

The fetus grows and gains weight every week, and the uterus also begins to enlarge. At the same time, the abdominal muscles stretch and weaken, the load on the back muscles begins to increase and the center of gravity shifts. To maintain balance, a woman has to strain her back muscles. A pregnant woman's posture changes. The woman involuntarily tilts her shoulders back, bends her neck and sticks her stomach forward in order to maintain balance and not fall.

Throughout pregnancy, the uterus continues to increase in size and becomes a cause of discomfort for the pregnant woman. An enlarged uterus can put pressure on the diaphragm, blood vessels and nerve endings, causing back pain. This can especially manifest itself in the later stages and often in a lying position.

How to independently reduce the intensity of pain

Before the doctor arrives, you can independently reduce the intensity of the pain and slightly improve your general condition. There is no need to allow too sudden movements, bending with maximum amplitude, the weight lifted should not exceed five kilograms. But we should not forget about daily physical education, walks in the fresh air, and strengthening the muscle corset. If the pain is not associated with concomitant diseases, then medicine recommends massaging the lower back, exercising in the pool, and giving up high-heeled shoes. A special bandage effectively relieves pain. There is no need to allow excessive weight gain or stress. When sleeping, you should choose the most comfortable position. And one more important condition is a positive mood. The child should be desired, everyone around should provide the pregnant woman with maximum support. Due to such a comfortable psychological state, the body can independently cope with most unpleasant physiological sensations.

If you want to learn in more detail how to properly massage the lower back, and also consider an overview of the technique with instructions, you can read an article about it on our portal.

Bandage during pregnancy

Bandages for pregnant women

In the last weeks of pregnancy, the fetus rapidly gains weight, which causes increasing stress on the pregnant woman’s supporting apparatus and, as a result, the appearance of pain. If a woman in labor has had problems with the spine, then doctors advise wearing a bandage; it evenly distributes the load on the vertebrae and significantly reduces it, redistributing part of the load to the hips. Use ointments to relieve pain very carefully and only after consulting a doctor. Those medications that were previously considered completely safe can be harmful to pregnant women.

Various ointments during pregnancy should be treated with caution

Hormonal changes in the body that cause back pain

Hormonal changes can contribute to pain. The body and all its systems are intensively preparing for the pregnancy and birth of a baby. A woman’s hormonal system plays one of the main roles in rebuilding the body of the expectant mother. Under the influence of the hormone relaxin, which is secreted by the placenta, the pelvic joints and intervertebral ligaments expand and become elastic. Mobility of the pelvic joints is necessary for the passage of the baby through the birth canal during childbirth. But at the same time, relaxed ligaments and joints cause pain in the lower back and back.

Closer to childbirth, the production of estrogen in a woman’s body increases, and the level of progesterone decreases. An increase in estrogen stimulates the production of hormones that will be responsible for contractions of the uterus during childbirth.

The uterus will “train” intensively before giving birth. Women will increasingly experience false contractions, which will not only cause pain in the abdominal area. Tone muscles can provoke attacks of back pain. Sometimes a woman’s hormonal system cannot cope with its functions. The result is an imbalance in hormone production. The tone of the uterus may increase, which leads to sharp pain in the lower abdomen and back. Along with bloody vaginal discharge, these symptoms may indicate a threat of miscarriage. In such cases, it is necessary to urgently call an ambulance, do not endure and do not self-medicate.

What not to do

It is strictly forbidden to eliminate pain in the lower back with pharmacological drugs not prescribed by a doctor. You should not use any folk remedies, especially for oral administration. Until the cause of the pain is identified, do not use cold compresses that can provoke muscle spasms. Any warming procedures are also prohibited - applying heating pads, baths, applying ointments with a local irritating effect to the skin.

You can't do that!

Pain in late pregnancy (38,39 and 40 weeks)

In principle, many women experience lower back pain during such periods. Most often, the appearance of pain is due to the high load on the spine and the fact that due to overstretching, the abdominal muscles weaken. In other words, in this case, the back hurts from the 27th week of pregnancy until childbirth. At the same time, it can radiate to the leg, intensify after prolonged walking, physical activity, or simply standing for a long time. Also, pain may appear in the pubic area and sacroiliac joint, which is due to the natural softening of the ligaments.

It is quite possible to cope with such pain if you follow some simple rules. First of all, foods rich in calcium (dairy products, fish, nuts, herbs, meat) will help with this. If pain bothers you regularly, then it makes sense to start taking calcium supplements. You should also limit movements that may increase stress on your back. For example, to pick something up from the floor, you do not need to bend down, but squat down. In this case, the muscles of the legs and shoulders will become tense, not the back.

It is much worse when the cause of pain is a variety of neurological diseases, such as radiculitis, intervertebral disc herniation, etc. In this case, problems can begin as early as 14-15 weeks of pregnancy, and the back hurts quite severely. However, such diseases can also affect the later stages of pregnancy. In this case, it is assumed that bed rest is established, the use of a soft corset or bandage is used, and sometimes painkillers are used, but this is rather an exception.

Treatment of lower back pain during pregnancy

The main difficulty in developing treatment tactics for various diseases manifested by back pain is that many drugs and physiotherapeutic procedures are contraindicated during pregnancy. Therefore, doctors often have to assess the risks and choose the lesser evil in order to preserve the health of mother and child.

As a result of very gentle treatment, at best it is possible to slow down the development of pathology, especially when it comes to diseases of the spine. But constantly increasing weight and changes in the load on the intervertebral discs lead to the rapid progression of degenerative processes and deformations. Therefore, patients with protrusions and hernias after childbirth often require surgery. In particularly difficult cases, very rarely, for example, when part of the nucleus pulposus is separated from the disc (sequestrated intervertebral hernia), surgery can be performed even during pregnancy with the utmost care. This is due to the fact that the risks of non-intervention in such situations are much higher than during surgery.

Conservative treatment

Initially, treatment is carried out conservatively. This may include:

• massage;
• manual therapy;
• Exercise therapy.

When diagnosing kidney pathologies, as well as the threat of miscarriage or premature birth, treatment is carried out mainly in an inpatient setting under constant medical supervision, since disturbances in their functioning are fraught with serious consequences for the mother and fetus.

The nature of the treatment for lower back pain during pregnancy depends entirely on what caused it, and is selected individually for each woman. But in all cases, it is very important to monitor your lifestyle and diet. For back pain it is recommended:

• avoid prolonged standing and sitting;
• wear comfortable low-heeled shoes or sneakers;
• sleep on an orthopedic mattress; for comfort, you can use a special pillow for pregnant women;
• completely eliminate carrying heavy objects;
• use a prenatal bandage that will help reduce the load on the spine and back muscles;
• enrich your daily diet with fresh vegetables, fruits, and calcium-rich foods;
• visit the pool if there are no contraindications.

If the cause of lower back pain is spinal disease, the woman is advised to rest more. Depending on the severity of the existing disorders and their nature, treatment is selected. The most commonly used medications are local remedies in the form of ointments, gels and creams. Their main components are non-steroidal anti-inflammatory drugs (NSAIDs), which also have analgesic properties. Their application helps to improve well-being and relieve pain without harming the child.

If a woman’s condition allows, she is recommended to engage in physical therapy. For each pregnant woman, the complex is developed individually, taking into account the diagnosis, the presence of a threat of miscarriage and the level of physical development. It is recommended to conduct classes under the supervision of a specialist in order to perfectly master the technique of performing each proposed exercise. During gymnastics, any sudden movements are completely excluded, and the exercises are more aimed at stretching and relaxing the back muscles.

Manual therapy can help reduce the severity of lower back pain during pregnancy and even slow down the progression of spinal diseases. But the choice of a specialist must be treated with the greatest possible care, otherwise special massage sessions can cause irreparable harm to the health of the mother and child. When using a number of manual therapy techniques, it is possible to reduce the load on the intervertebral discs and improve the position of the vertebrae relative to the central axis. This will not only reduce pain and sometimes release pinched nerves, but will also help avoid serious changes in the spine before childbirth.

Surgery

Indications for operations are the development of radicular syndrome (lower back pain radiating to the legs) with protrusions and herniated intervertebral discs, as well as other severe pathologies of the spine.

But during pregnancy, surgical interventions are performed only in very complex, life- and health-threatening conditions. Often, when large protrusions and intervertebral hernias occur, surgery is scheduled for the immediate postpartum period.

It may involve:

• Nucleoplasty is a method of percutaneous surgery that involves the destruction of part of the nucleus pulposus with a laser, radio waves or cold plasma under local anesthesia, as a result of which the hernia decreases in size. Surgical instruments are inserted under the control of an image intensifier through a thin puncture of the skin in the projection of the affected disc, which ensures minimal intraoperative risks and the absence of a postoperative scar.
• Hydroplasty is a method similar to nucleoplasty, differing only in the use of liquid pressure to destroy the required volume of the nucleus pulposus and aspiration of waste material through a special outlet. Like nucleoplasty, hydroplasty allows you to solve the problem of lower back pain in one day and does not require a complex and lengthy recovery. The woman can leave the clinic on the day of the operation.
• Microdiscectomy is an operation indicated for large-sized intervertebral hernia, implying its resection through an incision of up to 3 cm. It allows for revision of the affected spinal motion segment, freeing pinched nerves and blood vessels, and also radically solving the problem of the hernia. The method allows, if necessary, to completely remove the disk if it is too damaged and can no longer perform the functions assigned to it.
• Endoscopic surgery - in some cases is considered as an alternative to microdiscectomy. It involves removing a hernia using special endoscopic equipment with a camera, which is inserted into the patient’s body through several punctures up to 1 cm in diameter.

If the disc is so damaged that it needs to be completely removed, patients are offered the installation of interbody endoprostheses or special implants. The former are preferable, since in terms of their functionality they are practically no different from natural intervertebral discs. By design, they are their exact copies and in the same way have an analogue of the nucleus pulposus and the fibrous ring. With their help, it is possible not only to maintain the flexibility of the spine in the operated spinal motion segment, but also to provide it with normal biomechanics. As a result, patients do not even notice the difference after the end of the rehabilitation period.

Thus, back and lower back pain during pregnancy can be both natural and evidence of the development of the disease. But expectant mothers do not have the right to risk their own health and the child growing in their womb and hope that discomfort in the lower back is harmless. Therefore, if pain occurs, especially if it occurs frequently, in the early stages of pregnancy, or intensifies, it is better to play it safe and consult a doctor. This will prevent the development of complications, take measures to stop it at the earliest stages of the pathological process, give birth to a healthy baby, and ultimately undergo full treatment of existing diseases. Have an easy birth!

Other causes of pain

The reasons given above are the most common, so when it is said that the back hurts a lot during pregnancy, then they are almost always talking about them. But there are a number of other problems that can lead to such pain.

Pancreatitis

This disease is an inflammation in the pancreas. Fortunately, this disease is quite rare, but it is precisely when the back hurts at the beginning of pregnancy. The development of this disease is facilitated by disturbances in the outflow of bile, alcohol consumption, poor diet (rich fatty and meat foods), stress and hereditary predisposition. Pancreatitis in the acute phase makes itself felt by acute pain in the lower back and abdomen (upper part), while the pain is girdling in nature. Abnormal bowel movements, vomiting, and low blood pressure are common. In such a situation, you need to urgently go to the hospital.

Diagnosis of this disease requires a number of laboratory tests of urine and blood, it is necessary to undergo ultrasound, magnetic resonance imaging, etc. Most often, treatment has to be done in a hospital. In this case, a strict diet is prescribed, a number of drugs that should normalize the functioning of the pancreas, painkillers and anti-inflammatory drugs. If the situation does not improve, then sometimes it is necessary to resort to surgery.

Pyelonephritis

This is a kidney disease that causes nagging and aching pain. In this case, during pregnancy, your back hurts in the lumbar region on the left or right. It’s even worse when you have to deal with renal colic, which is associated with the movement of a stone into the ureter from the renal pelvis. With colic during pregnancy, the lower back hurts very much, and it is not possible to find a position in which the pain will ease. The pain may also spread towards the urethra or groin. Another noticeable symptom is that the urine becomes quite cloudy, and sometimes blood can be seen. An increase in temperature may also occur.

To determine the diagnosis, the doctor sends the patient for an ultrasound; it is also necessary to conduct laboratory tests of urine and blood tests. When treating pyelonephritis, antibacterial drugs are first prescribed, which are selected individually, taking into account the sensitivity of microorganisms that caused the inflammatory process. Treatment in some cases is carried out on an outpatient basis, but it is preferable to be treated in a hospital. In case of renal colic, antispasmodics and painkillers are used to reduce pain, and certain inflammation prevention is also carried out.

Diagnostics

To find out the true cause, a woman should undergo an examination by a gynecologist. After a conversation with the patient, the doctor will be able to suspect the presence of a particular pathology. A bimanual examination will help him identify various neoplasms, hypertonicity of the uterus or enlargement of its appendages during tubal pregnancy.

To distinguish physiological pain from pathological pain, the doctor pays attention to:

• the presence of pathological vaginal discharge;
• type, strength and nature of pain;
• condition of the uterus and appendages during bimanual examination;
• the appearance of other pathological symptoms (high temperature, difficulty urinating and defecating, restriction of movements in the spine, etc.).

Ultrasound examination (ultrasound) of the pelvic organs is of great importance in the diagnosis of complicated pregnancy , allowing one to assess the condition of the embryo, uterus and its appendages. To identify infectious diseases of the genitourinary system, a woman needs to undergo a urine test and a smear for microflora from the vagina. If necessary, the pregnant woman is prescribed additional studies or consultations with other specialists.

Prevention and prognosis of specialists

If the examination did not reveal any pathologies of the spine or internal organs, then lower back pain will disappear soon after the birth of the child. When any disease is diagnosed, treatment is required. It can be started immediately or delayed during pregnancy.

Prevention of lower back pain involves wearing supportive corsets, daily physical therapy exercises, and eating enough fresh vegetables, fruits, and dairy products.