Lower back pain is common during pregnancy; doctors say that the main cause of the pain is the weight of the growing baby and the uterus which puts pressure on the blood vessels and nerves in the pelvis and back. Eric Mutabazi, a senior physiotherapist at Oshen King Faisal Hospital, Kigali, says that the estimated incidences of backache during pregnancy range between 35 per cent and 61 per cent. Among these women, 47 to 60 per cent reported backache first developing during the 5th to 7th month of pregnancy. Symptoms are often reported by women to be worse in the evening and in the third trimester. Pain often increases with advancing pregnancy and interferes with work, daily activities and sleep. CAUSES Mutabazi explains that back pain during pregnancy is attributed to an altered posture; this is a result of the increasing size and weight of the growing foetus in the uterus as the pregnancy progresses; which causes the woman’s abdominal wall to stretch to accommodate the expanding uterus. The uterus is normally a pelvic organ; however, after the first trimester the uterus expands and becomes an abdominal organ, which presses forwards onto the abdominal muscles. This results in distorted posture with the increased lumbar lordosis (exaggerated curvature of the lower spine), which is necessary to balance the increasing anterior weight of the womb, he says. He further says that increased relaxin (a hormone secreted by the placenta that causes the cervix to dilate and prepares the uterus for the action of oxytocin during labour) is also a cause of lower back pain. During the first trimester of pregnancy, relaxin continues to rise and additional relaxin is produced by the decidua. Relaxin is present in 10 times its normal concentration during pregnancy. It reaches its peak at 12 weeks gestation and then drops to 50 per cent of its peak by 17 weeks gestation. Dr John Muganda, an obstetrician gynaecologist at Harmony Clinic Kigali says, “Lower abdominal cramping or lower back pain is associated with UTIs and any other general infection, causing, for example, fever, among other symptoms, since during pregnancy the immune system is also low.” WHAT TO DO? Mutabazi says that the best method of preventing back pain during pregnancy is to be physically fit, active and not overweight before conception occurs. Strong abdominal muscles and a supple frame will help prevent general aches and pains, which may occur during pregnancy. He advises women with lower back pains to participate in strengthening exercises, sitting pelvic tilt exercises, water gymnastics (exercise in water) or hydrotherapy. These reduce pain intensity. Muganda states that to treat back pain, doctors prescribe drugs like pain killers, however, it is mandatory to manage the underlying cause so that you are given the right advice or treatment. He adds that when sitting, make sure your back is supported by a small pillow in the curve of your spine to encourage you to sit up straight, don’t wear high heels, and turn at the left side while sleeping though it is more guided if it is an advanced pregnancy from around 27 weeks of gestation. Mutabazi advises pregnancy-specific exercises, physiotherapy, and usual prenatal care to relieve back pain, acupuncture treatment reduces the pain as well. Core stability reduces low back pain (this is the capacity of the muscles of the torso to assist in the maintenance of good posture, balance). He warns women to avoid excessive lifting, and having a comfortable and safe sleeping position is vital in preventing back strain; women should be advised not to sleep on their backs during the later stages of pregnancy. Instead, they should be advised to sleep on the side with pillows supporting both the abdomen and back with an extra pillow between the knees. This will help to stabilise the spinal column, you can also ask for an appointment with a physiotherapist. Practice good posture as your baby grows, your centre of gravity shifts forward. To avoid falling forward, you might compensate by leaning back which can strain the muscles in your lower back and contribute to back pain during pregnancy. Keep these principles of good posture in mind: Stand up straight and tall, hold your chest high, keep your shoulders back and relaxed. Don’t lock your knees, Mayo Clinic advises. editorial@newtimes.co.rw
