Sciatic Nerve Pain During Pregnancy

Sciatic nerve pain can happen to anyone, but pregnant people are especially susceptible. Sciatic pain may catch you off guard, and is often described as low back pain that radiates down the back of the legs. 

Whilst it can be especially troublesome for pregnant people to experience sciatic nerve pain in their third trimester of pregnancy, it is most often nothing to worry about and there are treatment options such as physical therapy that can help to reduce painful symptoms.

What is Sciatic?

Sciatica is a condition that refers to pain that radiates along the path of the sciatic nerve. This nerve branches from your lower back through your hips and butt and down each leg. While this nerve travels down both legs, sciatica usually only affects one side of your body.

Sciatica very commonly occurs when a herniated disk, bone spur on the spine, or narrowing of the spine (spinal stenosis) compresses part of the nerve. This can cause inflammation, pain, and often slight numbness in the affected leg. 

Even without any of these medical problems, sciatica can occur in otherwise healthy pregnant people who are experiencing weight gain and loosening of ligaments and joints due to normal changes in pregnancy hormone levels.

While the pain associated with sciatica can be intense, most cases will resolve with non-surgical treatment in a few weeks. People who have severe sciatica associated with significant leg weakness and bowel or bladder changes may need surgical intervention or emergency treatment from a healthcare provider.

The Prevalence of Sciatica During Pregnancy

Often, people experience an increase in sciatic sensations during pregnancy. Lower back pain and sciatic problems most commonly develop in the third trimester when the center of gravity shifts, but this pain can happen at any stage of pregnancy.

This is due to the fact that the growing baby and expanding uterus put pressure on the sciatic nerve, causing inflammation, irritation, and pain.

While sciatica in the general population is commonly caused by a herniated or bulging disc, in pregnancy, that's a rare cause. Only about 1% of pregnant people experience this type of complication in pregnancy. 

During pregnancy, people have high levels of the hormone relaxin. This hormone is produced to help loosen the pelvic ligaments for the baby to fit through the pelvis during birth. If the joints and ligaments in the back and pelvis loosen too much, sciatic nerve pain can occur.

Other Symptoms of Sciatica

Sciatic nerve pain radiates from the lower spine to the bottom, and down the back of the leg. The discomfort can be felt anywhere along the nerve pathway, but it's especially likely to follow the path from the lower back to the butt and down the back of your thigh and calf.

The pain can vary from a mild ache to a sharp, burning sensation or excruciating pain. Sometimes it can even feel like an electric shock. Coughing, sneezing, and sitting for extended periods of time can intensify the pain and aggravate symptoms. 

Numbness, tingling, or muscle weakness in the foot or back of the leg can also occur, and sometimes in combination with one another.  

When to See a Healthcare Provider

Mild sciatica and pregnancy-related sciatica often goes away over time. If the pain is unbearable, lasts longer than a week, or gets progressively worse, a healthcare provider should be consulted.

Get immediate medical attention if:

• Sudden, severe pain in the lower back or leg and numbness or muscle weakness in the leg occurs
• The pain follows a traumatic injury
• There is trouble controlling your bowels or bladder

Causes of Sciatica

Sciatica occurs when the sciatic nerve gets pinched, often the result of a herniated disk in the spine or by an overgrowth of bone in the vertebrae. On rare occasions, the nerve can be compressed by a tumor or damaged by diabetes.

Risk Factors for Sciatica

Age

Age-related changes in the spine such as herniated disks and bone spurs are the most common causes of sciatica.

Obesity 

Excess body weight can contribute to spinal changes that trigger sciatica by increasing stress on the spine.

Occupation

Any job that requires a lot of twisting of the back, heavy lifting, or driving a car or truck for extended periods of time can contribute to sciatica.

Diabetes

Diabetes affects the way the body uses blood sugar which can increase the risk of nerve damage.

Pregnancy 

Pregnant people experience weight gain, increased pressure in the pelvis, and loosening of joints and ligaments that make sciatica common in pregnancy.

Complications

Most often, those who suffer from sciatica fully recover even without treatment. However, it is possible for sciatica to cause permanent nerve damage. Pregnancy-related sciatica is unlikely to cause this permanent damage, as the problem is corrected after the birth of the baby.

Prevention

Sciatica is not always preventable, and it frequently recurs, but there are some things that can be done to protect your back:

1. Exercise regularly. 

To keep the back strong, it’s imperative that the core muscles are strong. Practice good posture while sitting. There are a few other things to consider when sitting: 

• Choose a place to sit with good lower back support, armrests, and a swivel base
• Place a pillow in the small of your back to maintain its normal curve
• Keep your knees and hips level

2. Use good body mechanics. 

• While standing for long periods of time, rest one foot on a stool from time to time.
• When lifting something heavy, lift with your legs. Keep your back straight and bend only at the knees. Hold the object close to your body. Avoid lifting and twisting at the same time. Find someone to help you if the object is heavy or awkward.

Treatment

There are many home remedies that may improve pregnancy-related sciatica and provide pain relief. These include:

• Stretching to relieve tight muscles
• Prenatal yoga
• Prenatal massage

If your sciatica doesn't get better with the use of these and other self-care measures like the use of a heating pad and pregnancy pillow, some of the following treatments may be recommended or prescribed by your healthcare provider:

Medications

• Over-the-counter pain medication, such as Tylenol
• Muscle relaxants
• Stronger pain medications such as narcotics

Physical Therapy

Once concerning causes of sciatica have been ruled out, a physical therapist can create a rehabilitation program to help treat current symptoms and prevent future episodes of sciatica. This usually includes exercises to fix your posture, strengthen the muscles supporting the back, and improve flexibility.

Most people who experience sciatic pain during pregnancy note improvement in their pain after giving birth. If more treatment is needed in the postpartum period, there are additional options that may be safe once the baby is born, including: 

Steroid Injections 

In some cases, your doctor might recommend an injection of a corticosteroid medication into the area around the involved nerve root to help reduce pain by suppressing inflammation around the irritated nerve. The effects can last up to a few months.

Surgery

Surgery is usually the last resort when the compressed nerve causes significant weakness, loss of bowel or bladder control, or when the pain gets progressively worse or doesn't improve with other less invasive treatments.