Sciatic Nerve Problems and Pregnancy: What to Do?

Introduction

Back pain is a prevalent issue during pregnancy, primarily characterized by discomfort in lower back pain. It can be due to various factors with limited treatment options involving lifestyle adjustments. The cause of this pain during pregnancy is not well-defined. It is related to changes in the posterior pelvic region, especially the sacroiliac joints, which undergo alterations during pregnancy and may expend pressure on intrapelvic arrangement. This results in pain in the lower back, buttocks, and posterior thighs, but typically does not extend beyond the knees. This discomfort significantly impacts a woman’s quality of life during pregnancy with varying levels of intensity and duration.

What Is a Sciatic Nerve Problem?

Sciatica is an enervating condition characterized by pain and abnormal sensations in the area covered by the sciatic nerve or related lumbosacral nerve roots. It is crucial to distinguish that not all low back or leg pain is classified as sciatica; genuine sciatica arises from problems with the sciatic nerve or its roots. This significant nerve, formed by nerve roots L4 through S2 at the pelvis, is the largest in the body.

Sciatica pain typically intensifies with bending, twisting, or coughing. The sciatic nerve plays an important role in managing leg muscles and provides a sensory response to the lower leg and the sole through its terminal branches. Most cases of sciatica are the result of inflammatory conditions that irritate the nerve. At the same time, direct compression can lead to more severe motor dysfunction, which may not always be immediately apparent but requires thorough evaluation.

What Causes Sciatica During Pregnancy?

Low back pain during pregnancy is often attributed to the significant changes in the body’s load and mechanisms that occur when carrying a child. Pregnancy typically involves a weight gain of 20 to 40 pounds, which shifts the body’s center of gravity forward and increases the forces applied to the lumbar spine. This anterior shift can lead to pubic symphysis issues, and the body may adapt to postural changes, resulting in lordosis, and an increased inward curvature of the spine, adding more stress to the lower back.

The stretching of abdominal muscles to accommodate the growing uterus reduces their ability to support body posture, causing the lower back to bear the increased weight of the torso. Exercise programs that target core strength and abdominal muscle strength have been shown to reduce postural changes and the severity of pain in pregnant women.

While mechanical changes play a role, some women experience low back pain in the first trimester when these changes are not significant. hormonal changes during pregnancy, particularly the hormone relaxin, which softens pelvic and lower spine structures, causing inflammation and pain in the back. Venous engorgement in the pelvis, caused by pressure on the vena cava due to the expanding uterus, is another theory for night-time low back pain during pregnancy, especially when lying down.

Sciatica, resulting from intervertebral disc herniation or bulging and nerve compression, can also cause low back pain during pregnancy, though it is relatively rare. Other common factors resulting in back pain including degenerative disc disease, malignancy, and infection, are possible during pregnancy. Additionally, specific pregnancy-related issues like preterm labor and pregnancy-induced osteoporosis can pose serious health risks to both the mother and fetus and require prompt attention.

What Are the Risk Factors?

Women with a history of lumbar problems or chronic back pain conditions are prone to experience back pain during pregnancy, with the pain occurring at twice the rate compared to those without such prior complaints. These individuals are also at a higher risk of suffering from severe and long-lasting pain. Furthermore, if a woman experiences back pain during one pregnancy there is an 85 percent chance that she will experience it in a subsequent pregnancy.

The level of physical activity is related to the onset of back pain during pregnancy. A sedentary lifestyle increases the risk of back pain compared to more active individuals. However, those with active or physically demanding occupations also have a higher risk of developing pain during pregnancy, suggesting that extreme activities are unsuitable.

Being overweight or increasing BMI (body mass index) may be a risk factor for back pain during pregnancy. It is often followed by symptoms like limited motion and stiffness in the back or legs. The pain and associated symptoms may be constant or occur in specific positions or after extended activity.

What to Do for Sciatic Nerve Problems During Pregnancy?

Some conservative approaches for managing sciatic nerve problems during pregnancy include:

1. Physiotherapy: Physical therapy can help improve posture, strengthen muscles, and alleviate pain. Exercises such as pelvic tilts, knee pulls, straight leg raises, curl-ups, lateral straight leg raises, and Kegel exercises are effective.

2. Transcutaneous Nerve Stimulation (TENS): TENS therapy, which uses electrical stimulation to relieve pain, can be considered.

3. Pharmacological Treatment: Medications like Acetaminophen are generally considered safe for pain relief during pregnancy, while Aspirin and Ibuprofen should be avoided. Muscle relaxants may also be prescribed.

4. Acupuncture or Chiropractic Treatment: Alternative therapies like acupuncture and chiropractic care can provide relief for some pregnant women.

5. Stabilization Belts: Supportive belts and corsets, such as pelvic girdle belts, may help stabilize the pelvis and reduce pain.

6. Exercise: Strengthening abdominal, back, and pelvic muscles through exercise, particularly in the early stages of pregnancy, can improve posture and reduce pain. Low-intensity exercise and water aerobics can also be beneficial.

7. Education: Pain-reducing programs involving exercise and education early in pregnancy can help prevent or reduce pain intensity.

8. Complementary and Alternative Medicine: Therapies like massage, relaxation, yoga, and chiropractic procedures are popular options for pain relief during pregnancy. Midwives are more likely to recommend alternative treatments than physicians.

9. Support Belts and Corsets: Pelvic belts can provide stability and reduce pelvic laxity, which may alleviate pain in some cases.

10. Prescription Medications: In severe cases, opioid medications may be prescribed, but caution is necessary to limit dosage to prevent opioid withdrawal in newborns. Epidural administration can be an alternative for pain relief.

11. Home Remedies: Simple remedies such as heating pads and over-the-counter pain medications can be used for pain relief.

What Is the Differential Diagnosis of Sciatic Nerve Problems and Pregnancy?

Diagnosing low back pain (LBP) during pregnancy and distinguishing it from pelvic girdle pain (PGP) often relies on symptoms due to the limited availability of diagnostic tests. The subjective nature of pain and its impact on daily life can complicate the evaluation.

Differential diagnosis may include:

• Muscle spasm.

• Epidural hematoma (accumulation of blood within the space between the dura mater and the skull’s inner table).

• Nerve root impingement (inflammation of damaged nerve root causing severe pain, numbness, and weakness).

• Herniated lumbosacral disc (a condition in which the disc of the lower back of the spine bulges within the spinal bone area)

• Epidural abscess (infection in the space between the brain lining and skull bones).

• Tumor (an abnormal body tissue growth).

• Pott’s disease or spinal tuberculosis (a condition that presents with the symptoms of osteomyelitis and arthritis).

• Piriformis syndrome (it occurs due to sciatic nerve entrapment at the ischial tuberosity level).

Conclusion

Sciatic nerve problems in pregnancy are a challenging and painful condition that significantly impacts a woman’s quality of life. This condition arises from the compression or irritation of the sciatic nerve or its roots, causing pain and discomfort in the lower back and legs. While there are various factors contributing to sciatic pain during pregnancy, including mechanical, hormonal, and musculoskeletal factors, treatment options are somewhat limited, with a focus on conservative measures and lifestyle adjustments.