back ache in pregnancy

            Oops my back hurts…..how many of us have used these words in our life ? Probably many times….well it hurts and worries you most , specially when you are pregnant. Coz many a times you can not pop those pain killers like you used to do before.


Regardless of whether you are pregnant or not the lifetime incidence of low backache ranges from 50 to 70%.All the structures of the lower spine and pelvis i.e. the muscles ,ligaments, joints,intervertebral discs and nerve root can cause back ache.

As if that was not enough, back ache is very common during pregnancy. You will be surprised to know that 50 to 80% of pregnant ladies will admit to the fact that they have some degrees of back pain while they are pregnant. Of which a very few reported it to their doc. The pain may be associated with certain activities only, or it may be so severe that you would have restricted mobility.( I hope I have not scared you ).

Back pain usually starts to bother you between 5th to 7th month(i.e.20 to 28 weeks of pregnancy). But if you have had back pain before , it might come even earlier.

There are two commonest types of back pain

• Lumbar                                                                  

• Sacral/pelvic


Lumbar

This pain usually occurs over your lower lumbar vertebra but may be associated with radiation pain into your legs too.It is usually aggrevated by maintenance of the same position for a prolonged period of time, be it sitting or standing for a long time.

Sacral/pelvic pain 

This pain is about four times common than the lumbar pain.Usually you will have this pain way lower down over your sacrum. It could be on one side or could be symmetrical.It may also radiate down to your pubis infront and down to your buttocks into the back of the thighs. I am sorry to say , but the pain is not relieved by short period of rest. The pain get worst if you roll over in bed or raise up from seat or climb stairs.

Cause of Backache: The causes of back pain are myriad and fortunately rare in pregnancy. Infact many of these causes are likely to affect fertility and result in difficulties in conceiving. But never the less I have prepared an exhaustive list of causes of backpain. It will be difficult to explain each and every disease separately but I will try to explain in my subsequent blogs.

Mechanical

• Muscle pain

• Prolapse of itravertebral disc

• Spondylolisthesis

• Lumbar spondylosis

• Fibromyalgia

• Osteoarthritis

• Spinal Stenosis

Traumatic

• Fracture of vertebra

• Soft tissue injury

• Foreign body migration including shot pellets and sharpnels

Inflammatory

• Rheumatoid arthritis

• Ankylosing Spondylitis

• Reiter’s Syndrome

• Psoraitic Arthritis

Infective

• Osteomyelitis

• Tuberculosis

Metabolic

• Osteomalacia

• Paget’s disease of bone

• Osteoporosis and vertebral collapse

Tumours

• Primary of bone : Benign or malignant

• Secondary of bone

• Multiple Myeloma

Haematological

• Sickle cell disease

Referred from other organs

• Gastric Ulcer

• Duodenal ulcer

• Gallbladder disease

• Pancreatitis

• Renal :Infections,stones,or tumours

Vascular

• Aneurysm


                   Majority of pregnancy related back pain is caused by a combination of hormonal effects on joint laxity,postural changes and a change in the centre of gravity.

                  There is also evidence to suggest that ladies who are overweight or who smokes cigarettes have a higher chance of developing back pain in pregnancy. So girls beware of those puffs you take when you are pregnant. and undertaking physical activity and maintaining fitness before pregnancy reduces the risk of backache during pregnancy. so girls its another reason why you should hit the gym. most pregnancy related back pain tends to resolve quickly in the postpartum(this is the period after you deliver the baby till 6 weeks). But 1/3rd of sufferers will continue to have back pain for 4 weeks after delivery and 1/6th will continue to have till 9weeks after delivery.

                   Thankfully in the majority of cases the cause of pregnancy with back pain is mechanical. However few ladies may trace the pain to her pre pregnancy days also. Most mechanical back pain are sudden in onset after lifting or straining, but in contrast to that pregnancy related back pain tends to be more of a gradual onset.

Management

          What and how you should get yourself relieved of backache when you are pregnant mostly depends on the below mentioned points provided you don’t have any evidence of prolapsed itervertebral disc.



• Avoidance of aggrevating factors

• Wearing shoes with low heel or no heel( I personally advise this)

• Bed rest in a firm bed

• Analgesia but not NSAID( non steroidal anti inflammatory drugs)

• Exercise to strengthen the back….such as swimming



            I hope I have not bored you enough… but coming to think of it don’t go for the long list of causes I have illustrated. Being a doc I cant help but provide you with the entire scenario.but probably and mostly you will never have a severe backache in your pregnancy. So just maintain a healthy life style,avoid.smoking keep your back straight ,remain active and enjoy life……..