Sciatica in Pregnancy

Generality

Sciatica is a sensation of intense pain localized in the lower back and leg, caused by an irritation of the sciatic nerve. This disorder is quite common in women during pregnancy.

Typically, sciatica occurs from the fifth to sixth month of gestation and intensifies as the pregnancy progresses, as the changes undergone by the expectant mother's body become more relevant.
Sciatica is manifested by pain that is concentrated along the back of the thigh, but can also extend upwards, starting from the hip and buttock, and downwards, to the back of the calf and to the foot.
Sciatica occurs mainly as a result of the compression exerted by the uterus on the sciatic nerve. Secondly, this disorder is the result of muscle tension and / or vertebral compression resulting from having to support the weight of the fetus, in addition to one's posture. of late pregnancy.
The women most at risk of suffering from sciatica are mothers-to-be who have problems with overweight or back problems prior to conception.
To counteract the painful symptoms, during pregnancy it is advisable to contact your doctor, who can prescribe the most suitable drug therapy. In addition, it is possible to intervene with other remedies such as: physiotherapy sessions, massages, assuming a correct posture, applying hot-cold compresses on the painful area and yoga.

What's this

Sciatica (also known as sciatica or ischialgia) is a neuralgia of the sciatic nerve.
This disorder typically manifests itself with severe lumbar pain that radiates along the course of the sciatic nerve, ie from the buttock and posterior aspect of the thigh to below the knee.
Often, sciatica occurs during pregnancy, particularly towards the last months of gestation.

Usually, this disorder derives from a compression exerted by the uterus on the sciatic nerve or from the muscular tension caused by the weight of the fetus or by the assumption of incorrect postures.

Causes

Sciatica can occur during the last months of gestation for several causes:

• Effect of uterine dilation on the sciatic nerve: the enlarged uterus presses on the sciatic nerve, causing very intense pangs, which go from the lower back to the leg, sometimes reaching the foot. The progressive expansion of the organ can accentuate sciatica also for the diastasis of the rectus abdominals (ie the dilation of the space between the muscle bundles that run on the two front sides of the abdomen).
• Muscle tension caused by the weight of the fetus: the continuous contraction of the abdomen and back predisposes to assume incorrect postures and causes pain at the height of the kidneys and in the area where the spine joins the pelvis. This occurs mainly when standing up, but sometimes also when sitting or lying down. Furthermore, it should be remembered that during pregnancy the production of relaxin increases, a hormone that loosens the lumbar muscles to prepare them for the elasticity necessary for the expulsion of the baby during delivery. As a result, these muscles become more sensitive.
• Vertebral compression caused by the weight of the fetus: the "enlarged" pelvis (to make room for the growing child) rests on the pubic bone, causing very intense pain in the back as well (by irradiation). During pregnancy, then, the spine spinal cord undergoes a natural imbalance, since the back is subjected to a greater work load. Starting from the sixth month, the expectant mother tends to accentuate the natural curvature of the lumbar area of ​​the back, to reduce the tension of the pelvic floor, on which bears the weight of the fetus. The woman gradually shifts her center of gravity, in order to maintain balance and is led to assume a posture different from the normal one, with the pelvis pushed forward and the bust pulled back. This attitude causes constant contraction of the abdominal and back muscles, and, consequently, soreness and pain in the area.
• Posture defects: with the progressive increase in the weight of the belly, to maintain a better balance, the woman tends to push the pelvis forward, accentuating the natural curvature of the lower part of the spine. In addition to postural defects, some behaviors can trigger or increase the pain associated with sciatica in pregnancy, such as, for example, standing for a long time or performing movements incorrectly while performing mundane everyday activities.

Depending on the triggering cause, sciatica presents with more or less intense pain. There are also some factors that can contribute to the occurrence of the problem during pregnancy, including:

• Hormonal balance: During pregnancy, the body produces relaxin, which allows the muscles in the pelvic area and the pubic symphysis to relax. The purpose of this hormone is to prepare the woman's body to host the fetus and to face childbirth. In addition, the hormones released during pregnancy (estrogen and relaxin) help loosen the joints and ligaments of the pelvis, as well as the muscles that support the spine. The process makes the pelvis more flexible, adapting it to the baby's progressive growth in the womb. The adaptation of these structures can affect the support the back normally experiences.
• Weight gain: the back must support the downward pressure exerted by the progressive expansion of the uterus that houses the fetus, and better maintain balance by shifting the center of gravity. The weight gain by the expectant mother also favors the onset of sciatica.
• Stress: emotional tensions can affect the muscles in the back of the body. This state can feel like back pain and can occur during some particularly stressful times of pregnancy.

Symptoms, signs and complications

Sciatica can occur at any time during gestation, but it most commonly occurs during late pregnancy, around the fifth to sixth month. The disorder then tends to gradually intensify as gestation progresses.

In some cases, pain in the lower back can begin 8 to 12 weeks after the start of pregnancy.
Sciatica usually manifests as pain in the lower back (lumbar region) and involves only one of the two legs (either in the back of the thigh or towards the shin; it can extend to the pelvic bones or radiate to the foot).
In some cases, the disorder can be localized in other neighboring regions (for example, the buttock area) or it can affect only the sole of the foot, the calf or the heel. Back pain can be stinging and accompanied by burning.
Other symptoms related to pain are:

• Tingling;
• Muscle weakness
• Numbness;
• Problems with incontinence.

In pregnant women, sciatica can be of different intensity: in some cases, the pain is mild, but continuous; at other times, moments in which the back pain is very acute alternate with those in which the pain tends to disappear.

Diagnosis

Sciatica during pregnancy does not usually represent a reason to consult a specialist, but if the pain is excessive or has persisted for more than two weeks, it is advisable to consult your doctor, to evaluate specific treatment options or to simply be reassured. .

Attention! If severe back pain associated with vaginal bleeding, fever or burning when urinating occurs during pregnancy, it is essential to seek immediate medical attention.

Therapy

In the presence of sciatica, some pain relievers or muscle relaxants may be indicated, to be taken safely during pregnancy. It must be remembered, however, that the use of drugs should be avoided during the period of gestation (and breastfeeding) and, in the event, should be taken only under strict medical supervision. For example, taking aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, is contraindicated during pregnancy.

Some advice

Sciatica in pregnancy can negatively impact your regular daily routine or interfere with the quality of your night's rest.
To prevent or reduce the severity and frequency with which the disorder occurs, some behaviors can be adopted:

• Make correct movements and do not strain your back too much
• As you walk, try to distribute your weight evenly across your spine and pelvis. When turning around, don't just rotate your back, but move your feet and your whole body to avoid painful movements.
• Avoid lifting too heavy objects and when picking something off the ground bend your knees and do not lean forward.
• During household chores (ironing, cooking or cleaning), you should try to maintain a very upright position, with both feet on the ground, trying to work from a sufficiently high surface to avoid bending over.
• Do not make sudden movements to get up from a lying position: turn on your side and only then put your legs on the ground.
• Do not gain too much weight: the pregnant woman should try to pay attention to the excess kilos, so as not to aggravate the pressure on the abdominal area and not to further overload the spine forcing it to assume unnatural curves.
• Attention to the choice of shoes: to avoid sciatica in pregnancy it is advisable to wear comfortable shoes, wide at the base and not exceeding 4 cm in height. Shoes must allow the weight of the body to be equally distributed. During pregnancy, shoes with high heels should be avoided: they do not provide adequate support and unbalance the body weight forward, accentuating the curvature of the spine and exposing you to the risk of falls. Ballet flats should also not be worn: they force the foot into an incorrect posture and do not distribute the weight of the body well.
• Avoid sleeping on your back: While resting, try to sleep on your side, keeping one or both legs bent. Consider using a pillow between bent knees or that provides support under the abdomen and behind the back. The supine position can cause excessive pressure on the spine and the nerves that run through it, aggravating sciatica.
• Maintain good posture: as the fetus develops, the center of gravity shifts forward; during everyday life, it is important to get into the habit of maintaining a correct posture, without bringing the belly too far forward. You can try to assume the right posture by trying to make the spine assume the most correct curvature, for example by contracting the buttocks to make the torso assume the right position. In this way, even the back muscles and the spine itself will be less tired. feet on a low stool.

Other measures that may prove useful include:

• Physical activity: Regular movement can help strengthen the back and abdomen, increase flexibility and relieve stress on the spine. Exercises that are safe for most pregnant women include gentle exercise, walking, swimming, stretching and yoga. You can ask your gynecologist for advice on the most suitable activity for your situation.
• Girdle for pregnant women: wearing this elastic band, available in pharmacies or in shops that sell health items, helps to support the weight of the abdomen, when it becomes very bulky.
• Complementary Therapies: Some research suggests that acupuncture and chiropractic treatment can help relieve back pain during pregnancy.
• Massage, cold or hot packs: applying heat and ice packs to the back can help relieve pain. If your doctor agrees, you can try placing cold packs on the painful area, up to 20 minutes longer. times a day. After two to three days, apply a warm compress to your back. Even a massage can help relieve muscle pain, as it produces a relaxing effect.