Sciatica in Pregnancy

Generality

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

In general, sciatica occurs from the fifth to sixth month of gestation and intensifies as pregnancy progresses, when the changes suffered by the body of the future mother become more relevant.

Sciatica manifests itself with a 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 the foot.

Sciatica occurs mainly as a result of compression exerted by the uterus on the sciatic nerve. Secondly, this disorder is the result of muscular tension and / or vertebral compression resulting from having to support the weight of the fetus, in addition to the posture proper to advanced pregnancy.

The women most at risk of suffering from sciatica are future mothers who have problems with overweight or previous back problems at conception.

To counteract the painful symptoms, during pregnancy it is advisable to consult your doctor, who can prescribe the most suitable drug therapy. Moreover, it is possible to intervene with other remedies such as: physiotherapy sessions, massages, taking a correct posture, applying hot-cold packs 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 with a strong lumbar pain that radiates along the course of the sciatic nerve, ie from the buttock and from the posterior side of the thigh up to below the knee.

Often, sciatica occurs during pregnancy, particularly towards the last months of gestation.

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

Causes

Sciatica can manifest itself during the last months of gestation for different 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 due to the diastasis of the abdominal rectus muscles (ie the dilation of the space between the muscular bundles that run on the two front sides of the abdomen).
Muscular tension caused by the weight of the fetus : the continuous contraction of the abdomen and back predisposes to take incorrect postures and causes pain at the level of the kidneys and in the area where the column joins the pelvis. This occurs especially when one is standing upright, but sometimes even when one sits down or lies down. Furthermore, it must 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 child during birth. As a result, these muscles become more sensitive.
Spinal 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 also in the back (by irradiation). During the pregnancy, then, the vertebral column undergoes a natural unbalance, since the back is subjected to a greater work load. Starting from the sixth month, the future mother tends to accentuate the natural curvature of the lumbar area of the back, to reduce the tension of the pelvic floor, on which the weight of the fetus rests. The woman gradually shifts her center of gravity, in order to maintain balance and is inclined to assume a posture different from the normal one, with the pelvis pushed forward and the torso pulled back. This attitude causes the constant contraction of the abdominal and back muscles, and, consequently, soreness and pain in the area.
Postural defects : with the progressive increase in the weight of the bump, in order 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 prolonged time or performing movements incorrectly while performing everyday mundane 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 cope with delivery. Furthermore, the hormones released during pregnancy (estrogen and relaxin) allow the joints and ligaments of the pelvis to be loosened, as well as the muscles that support the spine. The process makes the pelvis more flexible, adapting it to the progressive growth of the child in the uterus. The adaptation of these structures can affect the support that 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 moving the center of gravity. Even the weight gain by the future mother favors the appearance of sciatica.
Stress : emotional tensions can affect muscles in the back of the body. This condition can be felt as a back pain and can occur during some particularly stressful periods of pregnancy.

Symptoms, signs and complications

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

In some cases, the pain in the lower back may begin 8 to 12 weeks after the start of pregnancy.

Generally, sciatica occurs with pain in the lower back (lumbar area) and involves only one of the two legs (both at the back of the thigh and towards the shin; it can extend to the pelvic bones or radiate to the foot).

In some cases, the disorder can be located in other neighboring regions (for example, the buttock area) or it can only affect the sole of the foot, the calf or the heel. Back pain can be pungent and accompanied by burning.

Other symptoms related to pain are:

Tingling;
Muscle weakness;
Numbness;
Incontinence problems.

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

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 simply to be reassured. .

Warning! If you experience severe back pain during pregnancy, associated with vaginal bleeding, fever or burning during urination it is essential to seek medical attention immediately.

Therapy

In the presence of sciatica, some painkillers 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 eventuality, they should only be taken under strict medical supervision. For example, intake of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, is contraindicated during pregnancy.

Some advice

Sciatica in pregnancy can have a negative impact on the regular daily routine or interfere with the quality of the night's rest.

To prevent or reduce the severity and frequency with which the disorder occurs, it is possible to adopt certain behaviors:

Perform correct movements and do not stress the back too much
While walking, try to distribute the weight evenly over the entire spine and pelvis. When you turn around you, don't just rotate your back, but move your feet and your whole body to avoid painful movements.
Avoid lifting objects that are too heavy and when you collect something from the ground, bend your knees and do not lean forward.
During household chores (ironing, cooking or cleaning), try to maintain a well-built position, with both feet resting 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 excess pounds, in order not to aggravate the pressure on the abdominal area and not to further overload the column, forcing her to take unnatural curvatures.
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. The shoes must allow the weight of the body to be distributed evenly. During pregnancy, shoes with high heels should be avoided: they do not provide adequate support and bodily weight is thrown forward, accentuating the curvature of the column and exposing to the risk of falls. Even the dancers should not be worn: they force the foot to an incorrect posture and do not distribute the weight of the body well.
Avoid sleeping on your back: during rest, try to sleep on your side, keeping one or both legs bent. Consider using a cushion between bent knees or providing support under the abdomen and behind the back. The supine position can cause excessive pressure on the spine and on the nerves that run through it, aggravating sciatica.
Maintain a good posture: with the development of the fetus, the center of gravity moves forward; during everyday life, it is important to get into the habit of maintaining a correct posture, without bringing your baby too far forward. You can try to get the right posture by trying to make the spine assume the most correct curvature, for example by contracting the buttocks to make the bust assume the right attitude. In this way, the back muscles and the spine itself may also be less tired. When you sit down, instead, choose a chair that supports your back well, place a cushion behind the lumbar area and place your feet on a low stool.

Other devices that may prove useful include:

Physical activity : regular movement can help strengthen the back and abdomen, increase flexibility and relieve stress on the spine. Safe exercises for most pregnant women include gentle exercise, walking, swimming, stretching and yoga. You can ask your gynecologist for advice on the activity best suited to your situation.
Sheath for pregnant women : wearing this elastic band, available in pharmacies or in shops selling sanitary ware, 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.
Massages, cold or hot packs : the application of heat and ice packs to the back can help relieve pain. If the doctor agrees, it is possible to try placing cold compresses on the painful area, up to 20 minutes several times a day. After two or three days, apply a warm compress on the back. Even a massage can help alleviate muscle pain, as it produces a relaxing effect.