Continuous Lower Right Back Towards Rear Hurts While Pregnant

Back pain is very common in pregnancy. Up to three quarters of pregnant women have it at some stage (Mota et al 2015).

However, there is plenty you can do to ease back pain and prevent it from getting worse. Some women who had back pain before they became pregnant also find it gets better during pregnancy (Mota et al 2015).

What causes back pain in pregnancy?

Your bones and joints are connected with tough tissues called ligaments. During pregnancy, a hormone called relaxin loosens your ligaments. Relaxin levels peak at 10 weeks to 14 weeks of pregnancy (Murray and Hassall 2014).

So, if you're getting back pain early on in pregnancy, relaxin is likely to be the cause. It's common to have lower back pain in the first trimester (Murray and Hassall 2014).

As you progress through your second and third trimester, the increasing weight of your baby and expanding womb put further strain on your ligaments and muscles (Murray and Hassall 2014).

Your abdominal muscles also become stretched. This means they won't be able to help you hold your posture as firmly as before (Murray and Hassall 2014). Your lower back will then take more of the strain.

You're also more likely to experience lower back pain during your pregnancy if you are overweight or if you don't take regular exercise (Gjestland et al 2013, Mota et al 2015).

If you've previously experienced lower back pain or pelvic pain, you're more likely to suffer from it in pregnancy. Strenuous physical work can also make it more severe (Murray and Hassall 2014).

What are the symptoms of back pain in pregnancy?

You're most likely to feel pain where your lower back joins your pelvis. It's easy to get it confused with pelvic pain, so it's helpful to divide this type of pain into two categories:

• Lower back pain. If you haven't had it before, this is a dull pain which you feel when you bend forwards. It restricts your ability to move the lower (lumbar) section of your spine. Certain muscles in your back will hurt when pressed (Murray and Hassall 2014).
• Pelvic girdle pain (PGP). This results from loose ligaments and joints in your pelvis. You may feel pain at the back of your pelvis, where there is a joint between your hip bone and the bottom bone in your spine. This joint is called the sacroiliac joint. The pain may be stabbing, shooting, dull or burning, and it may come and go. PGP can radiate into the back of your thighs too (NHS 2019). If you also feel pain on or around your pubic bone at the front, you may have a type of PGP called symphysis pubis dysfunction (SPD) (NHS 2019).

If you think that you have PGP, or your back pain is severe, ask your midwife or GP to refer you to a physiotherapist. Your physiotherapist will work out whether you have back pain alone or PGP alone, or a combination of the two. She'll tailor her therapies according to whether you have one or both, and will give you strengthening exercises to do at home (NHS 2019).

Back pain may make the following daily activities difficult:

• getting up from sitting
• turning over in bed
• dressing and undressing
• walking for a long time
• lifting and carrying small weights (Mota et al 2015)

You may notice that your back feels more sore towards the end of the day (Mota et al 2015) or if you have been on your feet for a long time. This is because your muscles get tired and your ligaments stretch slightly from the weight of your body and baby as the day goes on.

Can I prevent back pain during pregnancy?

Taking exercise before and throughout your pregnancy can help to ward off back pain or reduce its severity (Pennick and Liddle 2013, NHS 2018, Shiri 2018) (Sklempe Kokic 2017).

If you aren't used to doing exercise, start slowly. Aim for 10-minute sessions of moderate exercise to begin with, spread throughout the week. Moderate exercise means your heart beats faster but you can still talk. Slowly build up to the recommended 150 minutes (two and a half hours) a week (UK Chief Medical Officers 2019).

Strengthening exercises during pregnancy, such as Pilates, aquanatal swimming classes and yoga, build up and strengthen your core abdominal muscles, helping to prevent back pain (O'Connor 2011). They'll also improve your posture which will help to support your increasing weight (Holden et al 2019, Kinser et al 2017, NHS 2018). Find a class tailored to pregnant women if you can. If you already go to yoga or Pilates, be sure to tell your teacher that you're pregnant.

You can protect your back by being careful how you bend, stretch and lift in everyday life. If you have to lift something, hold it close to your body, bend your knees rather than your back and try not to twist. Read more on how to protect your back and pelvis during pregnancy.

What can I do to ease my back pain?

Exercise

Stretches, pelvic floor exercises and stabilisation exercises can help to ease back pain (Pennick and Liddle 2013).

Try getting down onto your hands and knees and level your back so that it is roughly flat. Breathe in and then, as you breathe out, squeeze your back passage and try to draw up your muscles like a zipper towards your front passage.

Imagine you're trying to stop yourself from passing wind or weeing. Keep squeezing for between five seconds and 10 seconds without holding your breath and without moving your back. Relax the muscles slowly at the end of the exercise.

Diane Rai for BabyCenter

If you feel steady on your hands and knees, you could try the Superman pose (see image). To do this pose, raise your right arm and left leg at the same time. Use your abdominal muscles to hold yourself steady during the movements. Hold for five seconds, then lower your arm and leg. Switch to the other arm and leg. Aim for up to 10 repeats on each side. See more pregnancy exercises.

Exercising in water may help to ease back pain (Pennick and Liddle 2013). Find out if your local pool holds aquanatal classes.

Massage

Massage soothes tired, aching muscles, and may help to ease the pain (NICE 2017, Pennick and Liddle 2013).

Lean forwards over the back of a chair or lie on your side. Ask your partner or a friend to gently massage your lower back and the muscles in the rest of your back. A trained massage therapist, your midwife or a physiotherapist may be able to help you too.

Lower back massage

Your lower back can suffer during pregnancy. Our video shows your partner how to give you a lower back massage.More preparing for birth videos

Good posture

Try not to slump when sitting, or twist when lifting. Try to avoid staying in the same position for long periods (Pennick and Liddle 2013).

Stand or sit up straight and arch your back periodically, as much as is comfortable. Take regular rest breaks so that you don't get too tired.

Use a cushion or lumbar roll to support your lower back and encourage good posture when you're sitting (Murray and Hassall 2014).

Osteopathy

Osteopathy and chiropractic are hands-on therapies that aim to realign your bones, muscles and joints to reduce pain.

Both therapies can help to relieve back pain, sciatica, pubic pain and groin pain (Draper et al 2019) and both are safe to have in pregnancy (Hensel & Roane 2019).

If you do decide to try one of these therapies, look for an osteopath or chiropractor with experience of treating pregnant women. Registered practitioners are fully trained and regulated by law in the UK.

Acupuncture

Acupuncture uses fine needles to stimulate parts of the body. Research shows it may help to relieve back pain (Bishop et al 2016, Bishop et al 2019, Martins et al 2018, Vas et al 2019). However, it's essential to find a practitioner who's trained and experienced in treating pregnant women (Pennick and Liddle 2013, NHS 2016). You can find a qualified practitioner on The British Acupuncture Council website.

Maternity pillows

Sleeping on your side with a wedge-shaped pillow under your tummy may help (Pennick and Liddle 2013). Going to sleep on your side in the second and third trimester also helps to reduce the risk of stillbirth (Gordon et al 2015, Heazell et al 2017, McCowan et al 2017). Don't worry if you wake up during the night on your back. Just roll over to your side before falling asleep again.

If you can't get comfortable, experiment with various pillows and cushions until you find what works for you (NICE 2017).

Alternate with heat and ice

A bath, a warm (not hot) water bottle or a warm jet of water from a shower head can help to ease discomfort (NICE 2017). If the weather's hot, you may prefer to use ice, such as a bag of frozen peas wrapped in a tea towel (NICE 2017). Alternate to see which one suits you best and brings you more relief from your symptoms.

Will back pain affect how I give birth?

With the right treatment, it's rare for back pain to cause difficulties in labour.

Even if you have a serious back problem, you should still be able to labour as you wish. Your doctor is unlikely to recommend a caesarean because of back pain. And recovery from the surgery can be harder on your back than after a straightforward labour.

If your back pain is related to a long-term problem, such as curvature of the spine (scoliosis), or to a previous injury or surgery, it makes sense to plan ahead.

Ask your midwife to arrange a meeting with a maternity anaesthetist. Some back problems make it impossible or unsafe to have an epidural during labour. It's much better to know beforehand so you can plan natural pain relief or other types of medical pain relief instead.

When should I get help for back pain straight away?

Contact your GP or midwife as soon as possible if you have back pain, and:

• you're in your second or third trimester, as it could be a sign of premature labour
• you have a fever (more than 38 degrees C), pain when you wee or you're bleeding from your vagina
• you lose feeling in one or both of your legs, your bottom or your vagina
• you have pain under your ribs on either side
  (NHS 2018)

More common pregnancy side effects

• Carpal tunnel syndrome
• Round ligament pain
• Skin changes

References

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Bishop KC, Ford AC, Kuller JA, Dotters-Katz S, 2019. Acupuncture in Obstetrics and Gynecology. Obstet Gynecol Surv. 74(4):241-251

Draper C, Azad A, Littlewood D, Morgan C, Barker L, Weis CA 2019. Taping protocol for two presentations of pregnancy-related back pain: a case series. J Can Chiropr Assoc.  63(2):111-118.

Gjestland K, Bo K, Owe KM, et al. 2013. Do pregnant women follow exercise guidelines? Prevalence data among 3482 women, and prediction of low-back pain, pelvic girdle pain and depression. Br J Sports Med. 47(8):515-20

Gordon A, Raynes-Greenow C, Bond D, et al. 2015. Sleep position, fetal growth restriction, and late-pregnancy stillbirth. Obstet Gynecol. 125(2):347-55

Heazell A, Li M, Budd J et al. 2017. Going-to-sleep supine is a modifiable risk factor for late stillbirth – findings from the Midlands and North of England Stillbirth Case-Control Study. BJOG. Online first: 20 Nov. onlinelibrary.wiley.com [Accessed December 2019]

Hensel KL, Roane BM 2019. Does Compression of the Fourth Ventricle Cause Preterm Labor? Analysis of Data From the PROMOTE Study. J Am Osteopath Assoc.  119(10):668-672

Holden SC, Manor B, Zhou J, Zera C, Davis RB, Yeh GY, 2019. Prenatal Yoga for Back Pain, Balance, and Maternal Wellness: A Randomized, Controlled Pilot Study. Glob Adv Health Med.

Kinser PA, Pauli J, Jallo N, Shall M, Karst K, Hoekstra M, Starkweather A, 2017. Physical Activity and Yoga-Based Approaches for Pregnancy-Related Low Back and Pelvic Pain. J Obstet Gynecol Neonatal Nurs. 46(3):334-346.

Martins ES, Tavares TMCL, Lessa PRA, Aquino PS, Castro RCMB, Pinheiro AKB, 2018.Acupuncture treatment: multidimensional assessment of low back pain in pregnant women. Rev Esc Enferm USP. 52:e03323

McCowan LME, Thompson JMD, Cronin RS, et al. 2017. Going to sleep in the supine position is a modifiable risk factor for late pregnancy stillbirth; Findings from the New Zealand multicentre stillbirth case-control study. PloS ONE. 12(6):e0179396. [Accessed December 2019]

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Vas J, Cintado MC, Aranda-Regules JM, Aguilar I, Rivas Ruiz F 2019. Effect of ear acupuncture on pregnancy-related pain in the lower back and posterior pelvic girdle: A multicenter randomized clinical trial. Acta Obstet Gynecol Scand.  98(10):1307-1317

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Source: https://www.babycentre.co.uk/a536387/back-pain-in-pregnancy

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