Lower back pain during pregnancy

What could be causing my lower back pain during pregnancy?

The two most likely culprits for back pain during pregnancy are:

• Your growing uterus. As your uterus expands, it shifts your center of gravity and also stretches out (and weakens) your abdominal muscles, affecting your posture and putting strain on your back. It may also cause back pain if it's pressing on a nerve. Plus, the extra weight you're carrying means more work for your muscles and increased stress on your joints, which is why your back may feel worse at the end of the day.
• Hormonal changes. Hormonal changes in pregnancy loosen your joints and relax the ligaments that attach your pelvic bones to your spine. This can make you feel less stable and cause pain when you walk, stand, sit for long periods, roll over in bed, get out of a low chair or the tub, bend, or lift things.

How common is back pain during pregnancy?

More than 60 percent of pregnant women experience lower back pain, particularly posterior pelvic pain and lumbar pain (see below).

You might have back pain in early pregnancy, but it usually starts during the second half of pregnancy and can get worse as your pregnancy progresses. It may persist after your baby arrives, but postpartum back pain usually goes away within a few months.

What is posterior pelvic pain during pregnancy?

Posterior pelvic pain is felt in the back of your pelvis. It's the most common type of lower back pain during pregnancy, though some women have lumbar pain as well.

You may feel posterior pelvic pain as deep pain on one or both sides of your buttocks or at the back of your thighs. It may be triggered by walking, climbing stairs, getting in and out of the tub or a low chair, rolling over in bed, or twisting and lifting.

Certain positions may make posterior pelvic pain worse - for example, when you're sitting in a chair and leaning forward at a desk or otherwise bent at the waist. Women with posterior pelvic pain are also more likely to have pain over their pubic bone.

What is lumbar back pain during pregnancy?

Lumbar pain occurs in the area of the lumbar vertebrae in your lower back, higher on your body than posterior pelvic pain. It probably feels similar to the lower back pain you may have experienced before you were pregnant. You feel it over and around your spine approximately at waist level.

You also might have pain that radiates to your legs. Sitting or standing for long periods of time and lifting usually make it worse, and it tends to be more intense at the end of the day.

What is sciatica in pregnancy?

When lower back pain radiates into the buttocks and thighs, it's often confused with sciatica, a relatively uncommon condition. True sciatica during pregnancy, which can happen when a herniated or bulging disk in the lower part of the spine presses on the nerve roots in the spine, affects only about 1 percent of pregnant women.

If you have sciatica, your leg pain will usually be more severe than your back pain. You're likely to feel it below the knee as well, and it may even radiate to your foot and toes. And you'll probably feel a tingling, pins-and-needles sensation in your legs or possibly some numbness.

With severe sciatic nerve pain, you may have numbness in your groin or genital area as well. You may even find that it's hard to urinate or have a bowel movement.

If you think you have sciatica, see your healthcare provider. Call her immediately if you feel weakness in one or both legs, or lose sensation in your legs, groin, bladder, or anus. (This may make it hard to pee or have a bowel movement, or, alternatively, cause incontinence).

Who is most likely to have lower back pain during pregnancy?

You're at higher risk for lower back pain if:

• You've had this kind of pain before, either before you got pregnant or during a previous pregnancy
• You have a sedentary lifestyle
• You are not very flexible
• You have weak back and weak abdominal muscles
• You are carrying twins (or more)
• You have a high BMI (body mass index)
• You've had spinal fusion in the past for adolescent scoliosis

What can I do to relieve lower back pain?

Exercise

When your back hurts, you may feel more like curling up in bed than exercising, but don't take to your bed for long periods. Bedrest is generally not helpful for lower back pain in the long run and may even make you feel worse. Exercise may actually be just what you need.

Check with your provider before beginning an exercise program because in some situations, you may have to limit your activity or skip exercise altogether. If you get the go-ahead to work out, consider:

• Weight training to strengthen the muscles that support your back and legs, including your abdominal muscles.
• Stretching exercises to increase the flexibility in the muscles that support your back and legs. Be careful to stretch gently because stretching too quickly or too much can put further strain on your joints, which become looser in pregnancy. Prenatal yoga is one good way to stay limber, and it can improve your balance, too.
• Swimming is another great exercise for pregnant women because it strengthens your abdominal and lower back muscles, and the buoyancy of the water takes the strain off your joints and ligaments. Consider signing up for a prenatal water exercise class if one is available in your community. These can be very relaxing, and research suggests that water exercise may reduce the intensity of back pain during pregnancy.
• Walking is another low-impact option to consider. It's also easy to make it a part of your daily routine.
• Pelvic tilts can ease lumbar pain by stretching and strengthening your muscles. Here's how to do them: Get on your hands and knees, with your arms shoulder-width apart and knees hip-width apart. Keep your arms straight, but don't lock your elbows. Slowly arch your back and tuck your buttocks under as you breathe in. Relax your back into a neutral position as you breathe out. Repeat three to five times at your own pace.

Whether you're a seasoned athlete or just starting out, you'll most likely have to modify your workout to accommodate your pregnancy. If you're new to exercise, check out our exercise suggestions for beginners. And be sure to follow guidelines for exercising safely during pregnancy, such as avoiding lying flat on your back and being careful when you change positions or get up from the floor.

Always listen to your body, and don't do anything that hurts. Finally, watch for warning signs that you may be overdoing things or developing a problem that needs medical attention.

Pay attention to your posture

• Stand up straight. This gets harder to do as your body changes, but try to keep your bottom tucked in and your shoulders back. Pregnant women tend to slump their shoulders and arch their back as their belly grows, which puts more strain on the spine.
• If you sit most of the day, be sure to sit up straight. Supporting your feet with a footstool can prevent lumbar pain, as can using a small pillow (called a lumbar roll) behind your lower back. Take frequent breaks from sitting. Get up and walk around at least every hour or so.
• It's equally important to avoid standing for too long. If you need to stand all day, rest one foot on a low step stool. Take breaks, and try to find time to rest lying on your side while supporting your upper leg and abdomen with pillows.
• Be aware of movements that make the pain worse. If you have posterior pelvic pain, try to limit activities like climbing stairs, for example. And avoid any exercise that requires extreme movements of your hips or spine.
• Wear comfortable shoes and make sure your shoes have good arch support. Put away your high heels for a while because as your belly grows and your balance shifts, high heels will throw your posture even more out of whack and increase your chances of stumbling and falling.
• Always bend from your knees and lift things from a crouching position to minimize the stress on your back. This isn't the time to risk throwing your back out, so let someone else lift heavy things and reach for high objects. Avoid twisting movements too, and activities that require you to bend and twist, like vacuuming and mopping. If there's no one else to do these chores, move your whole body rather than twisting or reaching to get to out-of-the-way spots.
• Divide up the weight of items you have to carry. Carrying a shopping bag in each hand with half the weight in each is much better than the uneven stress of carrying one heavier bag.
• Take care when getting out of bed, which becomes more difficult once your belly starts to bulge in your second or third trimester. You can handle it by doing what’s most comfortable and leaves you steady on your feet. One technique is to bend your legs at your knees and hips when you roll to the side, and use your arms to push yourself up as you dangle your lower legs over the side of the bed. Take your time getting up, and don't forget that your center of gravity has changed. Don't hesitate to ask your partner for help getting into and out of bed.
• To get a good night's rest, try sleeping on your side with one or both knees bent and a pillow between your legs. As your pregnancy advances, use another pillow or wedge to support your abdomen. Add a mattress topper or consider switching to a firmer mattress to support your back.

Take care of yourself

Taking steps to ease soreness and tension and generally taking care of yourself is always a good idea. At the very least, you'll feel better temporarily. Here are some measures to try:

• Learn relaxation techniques. They can help you cope with discomfort and may be especially useful at bedtime if your back pain makes it hard to get to sleep.
• Try heat or cold. There's some evidence that heat may provide short-term relief. Soaking in a warm (not hot) tub can also be soothing. You can also place a heating pad or hot water bottle on your lower back. Although there's no hard evidence that cold helps, applying a cold pack is easy to do and worth a try if heat doesn't work for you. Whether you use heat or cold, cover the pack or bottle with a thin cloth to protect your skin.
• Get a massage. Prenatal massage by a trained therapist may provide some relief and relaxation. Alternatively, ask your partner or a friend to gently rub or knead your back. (Most insurance companies don't cover therapeutic massage unless you have a referral from your healthcare provider.)

What if I continue to have lower back pain during pregnancy?

Let your provider know if your back pain doesn't respond to the measures above. She can evaluate your situation, discuss treatment options, and refer you to a specialist if necessary.

Some options to consider and discuss with your provider:

• Acupuncture may reduce the intensity of back pain during pregnancy. Some studies have demonstrated acupuncture to be superior to physical therapy alone and more effective than standard treatment in many cases. Make sure, however, that the practitioner you choose knows how to do prenatal acupuncture and the areas to avoid.
• Physical therapy can relieve pain and prevent recurring episodes of lower back pain.
• Chiropractic care may be helpful, although there isn't much evidence that it helps with pregnancy-related back pain.
• A "sacral belt" lessens pain when walking for some women, although the device doesn't help others at all. It may even increase pain for some women. Various maternity support garments have also been shown to improve low back pain in some cases.
• Prescription medication may be necessary for severe pain.

When is lower back pain during pregnancy serious?

If your back pain lasts more than two weeks, it's time to contact your healthcare provider. Call your provider immediately if:

• Your back pain is severe, gets progressively worse, or is caused by trauma.
• Your back pain is accompanied by a fever, vaginal bleeding, or a burning sensation when you pee.
• You've lost feeling in one or both legs, or you suddenly feel uncoordinated or weak.
• You lose sensation in your buttocks, groin, genital area, or your bladder or anus. This could make it hard to pee or have a bowel movement, or, alternatively, cause incontinence.
• You have suddenly worsened lower back pain in the late second or early third trimester. This can be a sign of preterm labor, especially if you didn't have intense back pain previously.
• You have pain in your lower back or in your side just under your ribs, on one or both sides. This can be a sign of a kidney infection, especially if you have a fever, nausea, or blood in your urine.

Lower back pain is just one of pregnancy's possible discomforts. Read our article on 7 common pregnancy aches and pains to find out what the others are.

Learn more:

• Leg cramps during pregnancy
• Pregnancy symptoms you should never ignore
• Tips for staying comfortable in the third trimester