Hernias and protrusions during pregnancy: assessing the risks

The effect of pregnancy on the spine

During pregnancy, a woman’s body changes greatly: physiological changes, hormonal changes occur, and, starting from the second trimester, the fetus also actively grows and gains weight. Towards the end of pregnancy, a woman's skeletal system and ligamentous apparatus, under the influence of hormones, begin to prepare for childbirth: the ligaments become softer and more elastic, the bones slightly change their position - all this should help the baby to be born without problems. But all these wonderful changes expose the pregnant woman’s spine and musculoskeletal system to additional stress. And if there were problems on this side before pregnancy (for example, a woman complained of back pain, she was diagnosed with osteochondrosis, intervertebral hernia) - it is during pregnancy, during a period of increased stress on the spine, that these diseases can make themselves felt again and cause various complications during gestation, childbirth or the postpartum period.

Osteochondrosis is one of the most common diseases of the spine; according to statistics, it affects about 80 percent of the world's population, and half do not even suspect that they are sick. Protrusions can be found in approximately 50 percent of people over 30, and this is due not only to the fact that diagnostics have become more advanced, but also to a sedentary lifestyle.

Preventive actions

In most cases, disc displacement is a complication of osteochondrosis. Timely treatment of all joint pathologies, absence of increased physical activity, and maintaining an active lifestyle help prevent its development. It is necessary to exclude from the diet foods high in fat (smoked meats, semi-finished products), salt and spices. Preference should be given to fresh vegetables and fruits, soups, and lean meats. And to remove harmful mineral salts, waste and toxins from the body, doctors recommend drinking at least 2 liters of clean still water daily.

Intervertebral hernia

How does such a problem as intervertebral hernia occur? The reason lies in the intervertebral discs. They have no blood vessels, and nutrition comes to them directly from the tissues surrounding the spine. If for some reason the flow of nutrients is disrupted, osteochondrosis first develops: due to metabolic disorders, the disc “dries out”, its fibrous capsule delaminates and loses its strength. The neighboring vertebrae begin to put intense pressure on such a weak intervertebral disc - and the higher the load a person experiences, the stronger the pressure. As a result, the contents of the disc may be “squeezed out” beyond the spinal column. If the contents of the disc are still retained by the fibrous ring, this is called protrusion of the intervertebral disc. If the fibrous ring, which has lost its strength, is damaged, part of the contents of the disc forms an intervertebral hernia. Most often, this problem occurs in those discs on which the load is especially high - cervical and lumbar (the thoracic region suffers less often).

All these problems with the spine are usually accompanied by pain of varying degrees of intensity. After all, both protrusion and hernia cause muscle spasm, which leads to compression of blood and lymphatic vessels. The outflow of fluid from the damaged area is disrupted, and local edema forms, which compresses the nerve endings. Pain occurs.

Particularly severe pain in the back, lower back, and neck with any movement is caused by intervertebral hernias. In addition to pain, the main symptoms of a hernia include numbness of the skin of the neck, limbs, chest, pain in the joints of the arms and legs, and for lumbar hernias - pain in the lower abdomen, swelling of the lower extremities, problems with urination and defecation.

Prevention and prognosis

Prevention of a sequestered hernia can be called anything that eliminates the factors predisposing to it. It is important to maintain correct posture and avoid excessive stress and lifting heavy objects. To prevent osteochondrosis, preference should be given to moderate but regular physical activity, swimming, and avoid obesity. In old age, it is recommended to take chondroprotectors.

The prognosis depends on the timeliness of its diagnosis. The smaller the hernia, the better the prognosis. If the sequestration affects the roots and leads to complications, the prognosis is less favorable. The longer the complications exist, the longer it will take to recover.

Protrusion of intervertebral discs

Very often, a woman only finds out during pregnancy that she has one or another disease of the intervertebral discs. After all, protrusions, unlike hernias, can be practically asymptomatic, especially in the early stages of formation. Pain occurs only after excessive physical activity, and even then not always. However, pregnancy is precisely the condition in which a woman’s body constantly experiences increased stress. And it is at this time that an exacerbation of any diseases of the intervertebral discs can occur, and existing protrusions (which, with proper treatment and lifestyle changes, are completely reversible) can develop into intervertebral hernias. This is especially dangerous if the problem is in the lumbar region. In case of lumbar intervertebral hernia in a pregnant woman, special attention is required from doctors during pregnancy and childbirth, and here’s why.

The essence of the problem

Many women take planning a pregnancy seriously. In the presence of chronic pathologies, they try to achieve stable remission. This allows you to avoid taking pharmacological drugs with pronounced side effects during pregnancy. In most cases, this approach contributes to the proper course of pregnancy and trouble-free childbirth. But there are chronic, sluggish pathologies of the spine that cannot yet be completely cured. The only way to prevent their exacerbation is prevention and compliance with all medical recommendations.

During pregnancy, nagging, aching pain in the lower back can occur for natural, physiological reasons. They significantly complicate the life of the expectant mother, who is forced to spend time in bed instead of a useful walk in the fresh air. And an increase in the size of the hernial protrusion leads to a manifold increase in the intensity of pain, up to the occurrence of a “lumbago”.

Symptoms of the disease

• Hernias compress nerve endings, and they do not transmit impulses well - this can affect, in particular, the course of labor.
• In the second and third trimester of pregnancy, the uterus is located close to the spine, and if there are herniated intervertebral discs in this place, they negatively affect the posterior wall of the uterus, causing its hypertonicity.
• Hernias can disrupt the supply of nutrients and oxygen to the fetus: the child suffers from malnutrition and hypoxia.
• Due to pain, a pregnant woman who has intervertebral hernia is forced to move less. And this is extremely unhelpful: muscle tone decreases, the functioning of all internal organs is disrupted, in particular the pelvic organs.
• The woman constantly suffers from pain, she is tormented by mood swings, depression, and apathy. Such a reduced emotional and psychological background is very harmful for both the expectant mother and her baby.
• In the acute period, an intervertebral hernia can become one of the indications for a cesarean section: pushing in such a condition may be an impossible task.

Ideally, already at the stage of pregnancy planning, the expectant mother should undergo a spinal examination. And in any case - and if there are problems, and if there are no problems yet - she is strongly recommended to be monitored by an osteopath throughout pregnancy, as well as in the postpartum period. The fact is that a number of factors that many of us encounter every day can lead to the appearance of intervertebral protrusions and hernias. This:

• Sedentary work and sedentary lifestyle
• Trauma – birth injury or injury to the head and coccyx acquired during life (head bruises, whiplash injury from an unsuccessful fall are among them)
• Excess weight
• Scoliosis
• Intense sports, irrational loads and incorrect technique when performing sports exercises
• Poor nutrition
• Bad habits

Treatment of spinal diseases

An experienced osteopath can already assess the condition of the spine during diagnosis and, if necessary, either provide prevention of future problems with intervertebral discs or alleviate existing problems. For example, there is an opinion that intervertebral hernia can only be dealt with through surgery. However, this is not entirely true: surgery on one injured disc will not eliminate the cause of the herniation, and sooner or later herniated disc protrusions will begin to appear in other areas of the spine. The task of the osteopath is to find and neutralize the very reason that brought the spine into such a state, the deviation that made it possible for hernias to develop. With the elimination of the cause, the body will have the opportunity to self-heal and maintain an optimal natural and healthy state on its own.

During osteopathic treatment, the osteopathic doctor:

• Eliminates the consequences of whiplash and other spinal injuries, relieves tension from the dura mater, improves its trophism
• Improves nutrition of all tissues in this area, normalizes muscle tone
• Relaxes existing tension in nerve roots, ligaments, muscles
• Normalizes the flow of lymph and blood, thereby reducing swelling
• Helps improve nutrition of intervertebral discs (with protrusion, this can lead to its complete regression)
• Reduces pain and prevents new attacks of pain.

In combination with osteopathic treatment during pregnancy, the expectant mother will be prescribed a set of exercises to relax the back and maintain its tone, as well as wearing a bandage - from what week of pregnancy this should be done, the type of belt and the time of wearing it will be determined by the doctor.

The article is located in the sections: OSTEOPATHY FOR ALL OSTEOPATHY IN GYNECOLOGY

Diagnostic methods

The most informative method for diagnosing lumbar disc displacement is MRI. The resulting images clearly visualize all damaged structures: intervertebral discs, vertebrae, soft tissues, spinal roots, blood vessels. Using MRI, you can localize the protrusion and evaluate its shape and size. The study also allows us to identify typical signs of lumbar osteochondrosis, which provoked the formation of a hernia in this department.

MRI of the lumbosacral spine.

Pregnancy is not a contraindication for MRI. There have been no cases of negative effects of the magnetic field on the intrauterine development of the fetus. But during the diagnostic procedure, the temperature of the amniotic fluid may increase. Therefore, MRI is not performed in the 1st trimester, when the formation of organs of all vital systems of the embryo occurs.

In the early stages of pregnancy, this diagnostic method is used only for health reasons. Usually, disc displacement is detected during a safe ultrasound examination, taking into account the results of general clinical tests.