Pregnancy can be such an exciting time! But during this relatively short time, the body goes through many amazing changes. These are all in an effort to support a growing baby. However, all of these changes can lead to discomfort and sometimes, downright pain. Unfortunately, low back and any sort of pelvic pain can sometimes all get lumped together. Being able to differentiate the different types of pain can be helpful when communicating with your healthcare provider. Here is a list and short description of some of the most pains in pregnancy. It’s best to know your pregnancy pain!
Low Back Pain
As the uterus expands upwards and outwards, the lower back muscles often struggle to keep up with the challenge of holding the spine upright. The muscle fatigue and strain can be very uncomfortable. Also, in an effort to counterbalance the growing abdomen, most pregnant women lean back even farther increasing their lumbar lordosis (lower back curvature). This does help to keep your centre of gravity over your feet but it also compresses the lower vertebrae of the spine in extension. This too can contribute to the pain. On top of all this, most women just want to stretch their lower back muscles forward (into flexion), but because of the large, firm uterus, even that can be difficult! This type of pain seems to be worsened with long periods of standing or walking.
Pelvic Girdle Pain (& Pubic Symphysis Dysfunction)
Pain in the pelvis (or pelvic girdle) can be felt across the back of the pelvis, one side of the back portion of the pelvis (sacroiliac joint) around the hips and into the groin. This can even include pubic bone pain also called pubic symphysis dysfunction (PSD). It is thought that this is caused by strain through any of the pelvic joints, possibly due to asymmetrical movements in the pelvis, or overuse of certain surrounding muscles, or simply by muscles being used differently around a changing body shape. Whatever the reason, the pain can be sharp, burning, achy or sore. It may come and go or be there almost all the time. It can make everyday activities like walking, standing, sitting, rolling over in bed, climbing stairs, bending and lifting very difficult.
Sciatica is an irritation to the sciatic nerve. Pain can be felt along the nerve as it travels from the buttock area down the back of the thigh, outer portion of the leg and sometimes into the heel. Some women feel the pain only in the top portion of the nerve, while others can feel the pain all the way down the leg. Sciatica during pregnancy is often attributed to the expanding pelvis, changes in buttock muscles and swelling. As the pelvis opens to accommodate the growing baby, it can put increasing strain and pressure on the muscles and connective tissue near the nerve, or the nerve itself. The pain is often sharp, shooting or electric in nature.
Round Ligament Pain
The round ligament attaches to the uterus (where the uterus meets the fallopian tubes) and descends through the pelvis towards to the pubic and labial area. This ligament helps to hold the uterus in its correct position. During pregnancy as the uterus grows, the round ligaments (there is one on either side) get stretched. This can lead to sharp and intense pain felt in the lower abdomen or groin area. It’s often associated with quick movements – like standing up quickly, and is usually short lasting. On rare occasions the pain can last for several hours at a time.
Tailbone (Coccyx Pain)
Fluctuating hormones during pregnancy cause increased flexibility of connective tissue and ligaments including those in the pelvis and pelvic floor. Combine this with increasing weight, and strain to the pelvic floor muscles and possibly increased sitting (because who doesn’t need a good sit when they are pregnant!?) and tailbone pain can appear. Tailbone pain is usually right at the end of the tailbone, and worse with sitting especially for long periods or on hard surfaces. It can also feel like sharp pain as you stand up. With increased constipation during pregnancy, pressure with straining on the toilet can exacerbate coccyx pain. In late pregnancy, the baby’s head can start to press into the tailbone area. It tends to feel like an ache or bruise often at the tip of the tailbone but sometimes slightly higher up, or to the left or right of the tailbone where the ligaments attach.
As the uterus grows the overlying muscles have to adapt. The connective tissue that runs between the abdominals must stretch to make way for a growing babe. This often leads to a diastasis recti, or a separation of the abdominals muscles. But don’t worry too much – this is a normal effect of pregnancy and for the large majority of women, recovers well after delivery. However, while pregnant, it can appear as a bump…over your bump. Perhaps more like a dome or tent that can be especially noticeable when straining in a sit-up movement. Occasionally this muscle straining can be uncomfortable, or sometimes the abdomen feels itchy as the abdominal skin thins.
Rib pain can be felt anywhere along the ribs. The position of the ribs can change quite dramatically during pregnancy. The chest circumference increases 5 to 7 cm, the diaphragm elevates 4 cm and the angle where the ribs attach to the breastbone changes from 45 degrees to almost 90 degrees. This can put strain on the joints where the ribs attach to the spine leading to spine or upper back pain. It can also cause strain to the intercostal muscles, the muscles that lie between the ribs. Add any sort of spine curvature (scoliosis) and you could see an exacerbation of these issues. Since lung expansion becomes more difficult you can easily get a spasm or “stitch” in the breathing muscles, felt in the side of the ribs. Add to this, tiny baby feet and elbows that like to tuck up and under the ribcage.
Upper Back Pain
Excluding the above-mentioned rib involvement; other factors can contribute to upper back pain. Once again, postural changes due to pregnancy can lead to discomfort. A growing uterus makes it difficult to move the thorax and the upper back. Additionally, the breasts increase by 500-800 grams. Both of these changes can lead to upper back slouching, or thoracic kyphosis. The limited ability to move the torso can lead to muscle strain and fatigue. Add to that, pregnant women will often wait until too late in their pregnancy to change bra sizes. But making sure that you have a properly fitting bra can be very important for upper back and rib pain.
Pelvic Floor Pain and Heaviness (Yes – even vaginal pain)
Combine increased muscle and connective tissue flexibility with strain from a growing baby, increased body fluid, standing for long periods, and maybe some chronic vomiting or constipation, and you can end up with an achy, heavy, pressure feeling around the genitals. This can lead to hemorrhoids or vaginal varicose veins (yes, that’s a thing). While reasonably harmless, they can certainly be uncomfortable.
Foot and Lower leg pain
Swelling, weight gain, flexible connective tissue and posture changes can all lead to achy feet and legs. Swelling can get quite dramatic leading to changes in shoe size. It can also cause pitting edema – when fluid pools and becomes a little bit thick. Want to test for it? Press your thumb into the swollen body part, with firm pressure, and hold for 6 seconds. If you see an indent from your thumb, you might have pitting edema. Always tell your obstetric care provider if you notice increased swelling – this is something they keep an eye on. Achy legs and feet usually worsen if you are standing for long periods, or in the heat. We also see an increased risk of plantar fasciitis; pain in the sole of the foot, usually felt when standing up or during walking.
Balance can also worsen in the second and third trimesters leading to sprained ankles.
Know Your Pregnancy Pain
All of these aches and pains should be discussed with your family physician or obstetrician. This list is not exhaustive and some types of pain during pregnancy can be of a serious nature. There are a variety of ways to manage each of these conditions. This is why it’s so important to know your pregnancy pain! Practitioners with advanced knowledge in women’s health or pelvic health can offer exercises, equipment, tips and tricks in managing each of these issues, leading to a more comfortable and active pregnancy.
Looking for ways to help pregnancy pelvic pain? Click HERE for our 3 top tips to help pregnancy pelvic pain.
Looking for more information about vaginal heaviness/pain? Check out this article.
Katie & Eryn
Looking to prepare your core and pelvic floor muscles for birth? Check out our online course HERE.