Lumbago in pregnant women: how to treat an acute condition?

In the process of bearing a child, as the uterus grows, the load on a woman’s internal organs increases. In this case, the lumbar region often suffers. What warming ointments can expectant mothers use to relieve back pain? What drugs to relieve lower back pain are prohibited during pregnancy? What other forms of pain medications are there?

Why does back pain occur during pregnancy?

Every woman has a certain pain threshold, so while carrying a child, some expectant mothers experience severe pain in the back, while others may feel almost nothing. The occurrence of lumbar pain during pregnancy is provoked by physiological, harmless, and pathological factors that require immediate action.

Back pain during pregnancy

General information

During pregnancy, all functions of a woman’s body are forced to work with increased load, ensuring the proper development of the baby.
It is not surprising that in such harsh conditions, weaknesses in the health of the expectant mother herself are revealed. In particular, as the fetus grows, the center of gravity of the body of the pregnant woman herself changes, and back pain appears in the lumbar region. According to statistics, the incidence of pain in the back, lower back and pelvic area during pregnancy is 30–50%, and in the postpartum period reaches 65–70%.

Causes of back pain in the lumbar region during pregnancy

During pregnancy, the femoral-sacral joints, which are usually immobile, begin to relax under the influence of the hormone relaxin so that the baby can pass more easily during labor. This, as well as an enlarged belly, disrupts balance.

To compensate for this, you have to pull your shoulders back and bend your neck. Protruding the abdomen so that everyone notices the mother's condition only complicates the problem. The result is a strongly arched spine, tense lower back muscles, and severe pain. If before pregnancy you had problems with the musculoskeletal system , you are at risk for back pain. These may be the following diseases:

• rachiocampsis;
• osteochondrosis;
• poor development of the muscles involved in pelvic tilts,

Back pain in the lumbar region during pregnancy

Painful sensations may occur in different women during each period (trimester) of pregnancy. As a rule, this occurs no earlier than the second trimester, from approximately the fifth month (20 weeks). However, back pain in the lumbar region may occur earlier. For example, it depends on the lifestyle that the expectant mother leads. By the eighth month, when the end of pregnancy is just around the corner, the pain may intensify, and not only because of the growing weight. But also because the child’s head can put pressure on the lower back. In late pregnancy, a woman's body prepares for childbirth. A pregnant woman may experience very intense pain. Some women. however, they are barely felt or not felt at all. You will recognize pain caused by the approach of labor as follows: the abdominal wall suddenly, against your will, tenses and becomes noticeably harder to the touch than usual.

This phenomenon appears especially often when you exert physical effort, experience an orgasm, or are sad and angry, but sometimes for no apparent reason. If your stomach later becomes soft again, then you have no reason to worry. Back pain in late pregnancy indicates a critical condition when the cervix shortens and the uterine os begins to open.

Late back pain in the lumbar region

Back pain in the lumbar region in late pregnancy is observed in approximately half of women. Most often, this pain is associated with increased load on the spine and weakening of the abdominal muscles due to their overstretching. Typically, pain begins to appear after the 5th month of pregnancy, and decreases and goes away only after childbirth.

The pain sometimes radiates to the leg, and intensifies after physical activity, prolonged walking, prolonged standing, or sitting in an uncomfortable position. Pain in the area of ​​the pubic symphysis (pubis) and sacroiliac joint (felt in the area of ​​the hip joints and along the front surface of the thigh) is caused by a slight softening of the ligaments caused by hormonal changes in pregnant women and the production of the hormone relaxin.

Prevention of back pain

You can cope with back pain during pregnancy with a special diet rich in calcium, which includes:

• dairy products;
• nuts;
• fish, meat;
• greens and vegetables.

If you regularly experience back pain in the lumbar region and pelvic bones, you should take calcium lactate. Pregnant women should avoid movements that increase stress on the back. When picking something up from the floor, you need to squat down and tense the muscles of your shoulders and legs, but not your back.

You should sit leaning on the back of the chair, and under no circumstances should you sit down abruptly, as this may damage the intervertebral discs . For sleeping, you should choose an orthopedic mattress, semi-rigid and elastic. The pillow should be of medium size, preferably an anatomical shape that takes into account the natural curves of the spine. Shoes should be worn comfortable with low and stable heels. And of course, physical exercises that strengthen the muscles of the abdomen, back, thighs and buttocks are indispensable: aerobics or swimming.

Neurological diseases (herniated disc, lumbar radiculitis) can also cause back pain in the lumbar region in late pregnancy. Treatment in this case involves bed rest, a soft corset or bandage, physical therapy, and occasionally the use of painkillers. Prolonged pain in the symphysis pubis and gait disturbance are signs of symphysiopathy, a hereditary disease associated with significant stretching and softening of the symphysis pubis and hemorrhages into it. In this case, treatment is carried out inpatiently, and the entire pregnancy takes place under the constant supervision of a doctor. Periodic back pain in the lumbar region, in which tension of the uterus is felt, occurs with the so-called false Braxton-Hicks contractions. These “training contractions” in late pregnancy prepare the body for childbirth. However, if the pregnancy is less than 37 weeks, there is discharge from the genital tract, pain is felt in the lower abdomen, and the intervals between contractions are reduced, this may indicate a threat of miscarriage. In such a situation, it is necessary to urgently seek medical help.

Other causes of back pain during pregnancy

Back pain in the lumbar region may be associated with the following diseases:

• pancreatitis;
• pyelonephritis;
• Urolithiasis.

Pancreatitis (inflammation of the pancreas), the development of which is facilitated by impaired outflow of bile , poor diet, in particular rich meat and fatty foods, alcohol consumption, hereditary predisposition, and stress. But it must be said right away that during pregnancy this disease occurs, fortunately, quite rarely.

Acute pancreatitis is manifested by intense pain in the upper abdomen (episgastric region, right or left hypochondrium), lower back, often of a girdling nature. The following general symptoms often occur :

• vomit;
• bowel dysfunction;
• decrease in blood pressure.

The right decision would be to call a doctor at home. To diagnose the disease, laboratory tests of blood and urine, ultrasound, FGDS (fibrogastroduodenoscopy), and MRI are used. Most often, treatment is carried out in a hospital. A strict diet, medications to normalize pancreatic function, as well as anti-inflammatory and painkillers are prescribed. In severe cases of the disease, surgery is not excluded. In case of kidney diseases, back pain in the lumbar region can be pulling, aching (with pyelonephritis) or sharp, cramping (with renal colic), usually associated with the movement of a stone from the renal pelvis to the ureter.

Renal colic can cause quite severe, intense pain. Sometimes the pain spreads along the ureter, towards the groin and urethra. It is often possible to relieve it with the help of heat by applying a heating pad to the lumbar area. Another symptom of this disease is a change in urine: it becomes cloudy, and in some cases there is an admixture of blood. In addition, with pyelonephritis, an increase in temperature is possible.

Treatment

To establish an accurate diagnosis for back pain during pregnancy, ultrasound, laboratory blood and urine tests are required. The obstetrician-gynecologist conducts a thorough examination of the patient, compares the test data with the patient’s previous complaints. For the treatment of pyelonephritis antibacterial drugs ; they are selected individually, taking into account the sensitivity of the microorganisms that caused the inflammatory process.

Treatment can take place on an outpatient basis, but most often the pregnant woman is in a hospital. For renal colic, antispasmodics are used to reduce pain, painkillers are used, and the inflammatory process is prevented. If the stone is small, it is possible that it will pass on its own, but if the stone is large and blocks the lumen of the ureter, then surgical removal may be required.

Review of effective ointments for back pain, approved during pregnancy

While carrying a child, you should not self-medicate. Ignoring this rule can lead to serious consequences, including the loss of the baby or the development of intrauterine anomalies. Ointments and gels that can be used during pregnancy to relieve pain in the lumbar region are determined by the doctor. General information about medications allowed during gestation is indicated in the table.

Drugs prohibited for pregnant women

During pregnancy, many medications are prohibited due to the lack of data on the effect of their composition on the fetus. However, some of them can be used after a thorough analysis of the expected benefits for the expectant mother and the likely harm to the child.

Pregnant women are strictly prohibited from using ointments and gels such as:

• Fastum;
• Nicoflex;
• Finalgon;
• Viprosal;
• Apisatron;
• Nurofen.

Lumbago in pregnant women: how to treat an acute condition?

There is also a type of lumbago called lumbodynia. Its difference is that the pain is chronic and can last for months. It occurs due to injury or prolonged exposure to low temperatures.

Symptoms of lumbago

The first and most obvious symptom of lumbago is sharp pain in the lumbar region. The pain may radiate to other parts of the body, such as the kidneys or heart. Usually the acute pain goes away after three days, but there are cases where the pain did not go away for two weeks or longer. Pain with lumbago is assessed by patients as severe, unbearable, and intensifies with any movement. The patient's mobility is limited.

Causes of the disease

Previously, doctors were of the opinion that the disease had a bacteriological cause. At the moment, as a result of many years of research, it has become clear that the cause is spinal diseases

, and in most cases the cause is osteochondrosis of the lumbar spine. The discs that make up the spine contain a special substance, and when this disease occurs, it loses its protective functions. As a result, intervertebral discs cease to perform their function, become deformed and change location.

The mechanism for the occurrence of an attack of lumbago is as follows: when a spinal disc is displaced, the cerebral cortex reacts to this with an order for the muscles to sharply contract. The purpose of this order is to stop movement in the area of ​​the displaced disc. The most favorable position for the patient is to lie on a hard bed with bent legs.

Lumbago during pregnancy

It happens that the first attack of lumbago in a woman’s life occurs during pregnancy. Typically, pregnant women believe that they should not consult a doctor in this situation. Most medications and manipulations are still prohibited. However, the lack of treatment can significantly harm your well-being and worsen the course of pregnancy as a whole.

Without treatment of the disease, pain may occur periodically, worsening an already difficult situation. In addition, the disease can become chronic and practically deprive a woman of the ability to move, or lead to oxygen starvation. If lumbago is not treated during pregnancy, another attack may occur during labor or labor, which will greatly complicate the situation.

A competent doctor will always help in this condition and select the most effective and safe treatment that cannot harm the baby in any way.

How to treat lumbago

Even just one attack is a reason to contact a neurologist and undergo the tests he has prescribed and take tests. It is imperative to take an x-ray and, if necessary, an MRI of the spine if the doctor suspects severe inflammation or tumors. But during pregnancy, X-rays and MRIs are contraindicated.

What medications are indicated for treatment

The main focus of treatment is to relieve pain and reduce inflammation. In this case, only a doctor will prescribe medications; self-medication in this case only worsens the condition. A set of medications is prescribed individually and only after research.

Steroidal anti-inflammatory drugs are contraindicated during pregnancy. An experienced doctor will definitely select the optimal medications for a pregnant woman. If other measures are ineffective, blockade with novocaine is used.

treating lumbago with exercises

The treatment complex is prescribed only after the acute stage of the disease has passed. The purpose of the set of exercises is to train the muscles that support the nerve endings in the correct position. More blood, oxygen and nutrients are supplied to the affected area. Additionally, the patient is prescribed:

• physiotherapy complex;
• acupuncture;
• massage;
• visiting a chiropractor.

During pregnancy, you must first exclude the presence of obstetric pathology, for example, increased uterine tone, and consult a doctor before performing exercises. There are sets of exercises designed specifically for pregnant women, and they can be performed safely at any stage.

Preventive measures

Doctors advise starting the prevention of spinal diseases the sooner the better. The best prevention is movement in any form.

1. Classes at the fitness club, exercise and physical education, walking whenever possible.
2. It is important not to stay in non-physiological positions that are harmful to the spine for a long time.
3. The optimal sleeping position is on the left or right side. In this case, the pillow should not be too low or high. It is advisable to use an orthopedic mattress and pillow.
4. A chair for working in an office should also be orthopedic, if possible, and have supports for the elbows and head.
5. Equip the car seat with a special cover with massage protrusions.
6. Learn the rules of safe lifting. Weights should only be lifted with a straight back. You cannot lift a heavy thing with only one hand, in this case a distortion of the spine occurs. If there is a need to carry a heavy bag for a long time, you need to change hands, alternately carrying it in your left and then in your right. If you often have to carry heavy things, it is better to use an anatomically shaped backpack. In this case, the weight will be distributed evenly along the entire length of the spine. Pregnant women are not recommended to lift more than 2 kilograms.
7. In the cold season, you need to dress according to the weather, and if necessary, additionally insulate the lumbar region. Use thermal underwear and therapeutic wool belts.

If pain or discomfort occurs, consult a doctor immediately.
Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr

Other forms of medication

In addition to pain-relieving ointments, to relieve pain in the lumbar region, expectant mothers can use:

1. Analgesics and antispasmodics for oral use. The safest drugs in this group of drugs during pregnancy include Paracetamol, No-Shpa, Papaverine.
2. Local anesthetic solutions. Such medications that are approved for use by expectant mothers are Menovazin and Diclofenac. The latter drug is prohibited for use in the third trimester of gestation.