Understanding Sciatica and Pregnancy

Approximately 50% of pregnant women experience lower back pain, but true sciatica – pain radiating along the sciatic nerve – is less common, affecting roughly 1% of pregnancies. The discomfort can range from a mild ache to a debilitating, sharp pain that travels from the lower back, through the buttocks, and down one or both legs. This pain is often caused by compression or irritation of the sciatic nerve, a large nerve that extends from the lower spine down the back of each leg.

The Physiological Changes of Pregnancy and Sciatica

Pregnancy triggers a cascade of physiological changes that can contribute to sciatica. Hormonal shifts, particularly the release of relaxin, loosen ligaments and joints in the pelvic area to prepare the body for childbirth. While essential for delivery, this increased flexibility can also lead to instability and nerve irritation. Furthermore, the growing uterus places increasing pressure on the sciatic nerve as it travels under the uterus and through the pelvic region. Weight gain and a shifting center of gravity exacerbate this pressure, particularly during the third trimester when the baby’s weight is greatest.

“Pregnancy hormones loosen the joints in preparation of birth, and this can cause a lot of shifting and stretching of the ligaments and joints of the pelvis, leading to sciatica,” explains Ai Mukai, MD, a physical medicine and rehabilitation physician in Austin, Texas. “The symptoms are usually worse after the greatest weight gain,” adds Atul Patel, MD, an orthopedic surgeon at the Kansas City Bone & Joint Clinic in Kansas, “which typically occurs in the third trimester.”

Risk Factors: Who is More Susceptible?

Certain factors can increase a woman’s risk of developing sciatica during pregnancy. These include:

• A history of pelvic trauma
• Chronic lower back pain
• Experiencing lower back pain during a previous pregnancy

Is It Sciatica or Sacroiliac (SI) Joint Pain?

Differentiating between sciatica and sacroiliac (SI) joint pain can be challenging, as the symptoms can overlap. The SI joint connects the sacrum (the triangular bone at the base of the spine) to the iliac bones (the large bones of the pelvis). SI joint pain is actually more common during pregnancy than true sciatica. The same hormonal changes that loosen ligaments can also cause excessive motion in the SI joint, leading to pain that radiates to the buttocks, hip, groin, and the back of the thigh.

G. Shaun Reynolds, a chiropractor based in Draper, Utah, notes that relaxin, the hormone responsible for loosening ligaments, contributes to this instability. A key distinction is that SI joint pain typically doesn’t extend past the knees, while sciatica can radiate all the way down to the feet. Have you ever wondered if your back pain is simply a part of pregnancy, or something more?

Finding Relief: Conservative Treatments for Sciatica

Fortunately, most cases of sciatica during pregnancy can be managed with conservative treatments. Doctors generally prioritize non-invasive approaches to avoid potential risks to the developing baby. The American Pregnancy Association (APA) emphasizes the importance of informing your healthcare provider about any pain you’re experiencing.

Effective strategies include:

• Rest and Stretching: Gentle stretching and adequate rest can help alleviate nerve pressure.
• Proper Positioning: Lying on the side opposite the pain can reduce pressure on the sciatic nerve, according to the APA.
• Avoiding Strain: Limit heavy lifting and prolonged standing.
• Low-Impact Exercise: Swimming is an excellent option for maintaining fitness and relieving pain.
• Hot and Cold Compresses: Applying heat or cold to the affected area can provide temporary relief.
• Acupuncture: Some women find acupuncture helpful for managing low back pain and potentially sciatica.
• Maternity Support Belts: These belts can provide support to the pelvis and lower back.
• Physical Therapy: A physical therapist can teach proper positioning techniques and exercises to strengthen core muscles and improve posture. Dr. Patel suggests learning how to safely transfer in and out of bed, chairs, and automobiles.

In more severe cases, or when neurological symptoms (sensory changes or weakness) are present, a spinal injection guided by ultrasound (to avoid X-ray exposure) may be considered. MRI scans are generally reserved for the second trimester and beyond, if deemed necessary by a physician. Pelvic floor therapy, focusing on alignment and function, is also a valuable approach, as recommended by Dr. Mukai.

“I usually get patients into pelvic therapy with a certified pelvic therapist to work on looking at the pelvic floor function and teach techniques to try to self-correct alignment issues,” she says. “I also recommend a pregnancy support belt or an SI joint belt to help support the pelvis.”

It’s vital to contact your healthcare provider if the pain becomes constant, more frequent, or more severe. Early intervention can help manage symptoms and ensure a healthy pregnancy.

Frequently Asked Questions About Sciatica in Pregnancy