I’m Experiencing Sciatica During Pregnancy: What Are My Treatment Options
By Dr. Jenna Lane, M.D.
Back pain during pregnancy is common. In fact, nearly 80% of women experience back pain during pregnancy.
- You may experience back pain because the weight of your baby is adding more pressure to your pelvic region, and changing your posture.
- Progesterone is a hormone that maintains pregnancy. Progesterone in combination with the hormone relaxin, relaxes the ligaments around the pelvis, which makes pregnant women more susceptible to back pain.
- You may have just entered your third trimester, and the weight of the baby adds stress to your lower back.
- Due to your growing belly and breasts causing a shift in gravity in your body, the paraspinal muscles can spasm or strain.
- Back pain during pregnancy can be due to muscle strain, sacroiliac joint arthropathy, pelvic girdle dysfunction, or sciatica, a compression to the sciatic nerve that runs down your lower back, buttocks, legs, to your feet.
For most women, true compression of the nerve is a less common cause of back pain during pregnancy. Patients who are older or have a history of sciatica pain are more prone to developing sciatica.
If you are experiencing mild back pain, bring it up with your obstetrician at your next appointment. If your pain is moderate or severe, you experience weakness or numbness in your legs, or have difficulty controlling your bowel or bladder control, seek medical attention immediately. The vast majority of back pain can be controlled with conservative management without any diagnostic testing. If there are concerning symptoms, MRI or EMG testing may be necessary.
What are the symptoms of sciatica in pregnancy?
Typically, sciatica pain runs down one or both legs. You may feel sharp shooting pain, tingling, numbness, and weakness in your lower extremities. More severe symptoms of sciatica are leg weakness and loss of bowel or bladder control.
What are the treatments available for back pain during pregnancy?
You can take over-the-counter Acetaminophen to help relieve back pain. Unfortunately, after twenty weeks, it is important you avoid taking NSAIDs, because these can decrease blood flow to the baby’s kidneys and other organs.
Depending on the severity of the pain or if it is indeed sciatica, other medications such as gabapentin could be prescribed. Many of the pain medications used for the general population are not well studied in pregnancy. This makes treating more severe cases of back pain challenging. Although these common medications do not seem to cause any malformations in the fetus, they are less commonly prescribed as they are not well studied.
Chiropractic treatments / physical therapy
Your obstetrician may suggest a chiropractor or a physical therapist who can aid in noninvasive pain relief options. There are some chiropractors and physical therapists who specialize in pregnancy.
Steroids / Surgery
Your doctor may rarely consider a caudal epidural steroid injection that can be administered under an ultrasound by a pain physician. However, this treatment is controversial in patients who are pregnant and would not be done without approval from the obstetrician. There can be side effects from the steroid such as increased blood pressure and glucose. That is why typically it is administered only if you are a patient that has severe sciatica pain and communication between the pain physician and obstetrician is necessary.
Surgery is also a high-risk treatment and is typically only reserved for those who cannot control their bowel or bladder function or have severe, sudden-onset leg weakness. This scenario would be extremely uncommon.
At home remedies
In general, you want to avoid lifting, pushing, or pulling heavy objects, especially as your pregnancy advances to avoid muscle strain. You don’t want to do any activity that is causing you pain or discomfort; and when you are actively doing something that is painful, stop immediately.
It is also useful to change how you sleep. Try to sleep on your side with a pillow in between your legs. As your pregnancy advances, you may find extra support and pain relief with a pillow under your belly.