Common Issues During Pregnancy

Written By Sarah Cline

Hello, Bestie! Let’s talk pregnancy. If you are or have ever been pregnant, you know it can be a pretty overwhelming experience (overstatement of the century?). So if you’re pregnant, hoping to get pregnant, or recently postpartum, what are some of the common aches and pains you could face and how are they treated? Let’s discuss!

Common Issues During Pregnancy:

  • Low back Pain/Sacroiliac Joint (SIJ) Pain: Lumbosacral (where the lumbar and sacral spines meet) and SIJ pain during pregnancy are common and thought to affect nearly half of all pregnant people at some point during pregnancy (1). This happens for a few reasons. First, the body is growing rapidly and there is more weight for the muscles and joints to support. Second, the distribution of weight changes the body’s natural center of mass, making it even more challenging to maintain a comfortable spinal alignment. Third, the rectus abdominis (RA) muscles start to move apart during pregnancy in order to make room for the growing fetus. The migration of these muscles makes your abdominal core less effective at core muscle utilization. As the core is part of the back’s support system, decreased core activity means decreased support to the low back. Check out our chat on Diastasis Rectus Abdominis (DRA) to learn a bit more about this topic. Finally, during pregnancy, hormone levels fluctuate. Importantly, your body has a higher amount of the hormone relaxin during pregnancy. Relaxin is important to pregnancy because it helps ligaments and other structures stretch to accommodate the growing fetus. However, its effect on ligament laxity means joints have a little bit more room to move than normal, which can be painful. 

    • Low back pain during pregnancy can be treated in physical therapy with a variety of techniques. When the SIJ is the main source of pain, a sacroiliac support belt can be beneficial (2). The SI belt provides compression to the joint and allows for an increased feeling of stability. Specific exercises or exercises that are catered to the precise needs of your body, may also help in pain relief (2). It is important that you talk with your medical provider before starting a new exercise program. Other treatment options for low back pain during pregnancy include manual therapy, transcutaneous electrical nerve stimulation (TENS), ice or heat, or education (2, 3). 

  • Meralgia Paresthetica: Meralgia Paresthetica occurs when there is compression to the Lateral Femoral Cutaneous Nerve (LCFN). The LCFN provides sensation to the front-outer thigh and when the nerve is compressed, symptoms such as numbness, tingling, or even pain can result in the affected distribution (4). As the fetus and uterus grow during pregnancy, excess pressure is placed on the LCFN. Compression of this nerve is common during pregnancy, but can also occur in non-pregnant folks who wear tight pants or belts (5). 

    • Meralgia Paresthetica typically goes away on its own once the nerve is no longer being compressed (i.e. after giving birth). However, there are some physical therapy treatments that may help patients manage pain and/or discomfort during pregnancy. Treatment should focus on reducing pressure to the affected nerve. This includes education regarding the nature of the condition, recommendations on what types of clothing will be the least irritating, icing, and potentially nerve exercises and manual therapy (6, 7). 

  • Stress Urinary Incontinence (SUI): SUI is the most common type of urinary incontinence in pregnant women (8). SUI is bothersome and contributes to poorer quality of life scores and higher embarrassment scores in pregnant women with the condition (8). As the fetus grows and the uterus expands during pregnancy, increased pressure is placed on the pelvic floor muscles (PFMs) and the bladder. This can cause urinary leakage during activity (SUI). 

    • Working with a physical therapist can reduce instances of SUI during pregnancy. Pelvic floor muscle training (PFMT) has been shown to significantly improve PFM strength during both the antepartum and postpartum periods and prevent SUI (9). However, the PFMT used in the cited study was much more intense and specific than just kegels. For PFMT to have a truly preventative effect, the research shows that one needs to work with a trained professional, rather than just incorporate kegels into their daily routine (9). 

  • Pregnancy-Related Carpal Tunnel Syndrome (PRCTS): PRCTS results from the compression of the Median nerve as it travels through the wrist. This can cause numbness, tingling, or other altered sensation mainly along the palmar side of the hand. During pregnancy, the body has an increased volume of fluid (10). This increased fluid means more substance in a similar amount of space and when the fluid has nowhere to go, its presence can mean added pressure to certain nerves. 

    • A physical therapist can be paramount in helping you manage your PRCTS. Common modalities include low-level laser therapy (LLLT) and polarized polychromatic noncoherent light (PPNL) (11). Another common technique for managing symptoms is splinting or the use of orthotics, especially at night when symptoms are typically worse (12). Pressure garments or fluid movement techniques such as manual lymph drainage (MLD) may also help, though they have not been studied in depth (11). Symptoms may also improve on their own after delivery, though this is not guaranteed. 

Remember, aches and pains are common during pregnancy, but that doesn’t mean you just have to suck it up and live with them. At the very least, your physical therapist can help you manage your symptoms and prevent them from worsening using conservative treatment approaches. What other uncomfortable changes have you experienced during pregnancy? Next time, we’ll talk about some of the common issues that occur in the postpartum period and how to manage them! 



XOXO,

Your Pelvic Bestie 

References:

  1. Fiani B, Sekhon M, Doan T, Bowers B, Covarrubias C, Barthelmass M, De Stefano F, Kondilis A. Sacroiliac Joint and Pelvic Dysfunction Due to Symphysiolysis in Postpartum Women. Cureus. 2021 Oct 9;13(10):e18619. doi: 10.7759/cureus.18619. PMID: 34786225; PMCID: PMC8580107.

  2. Clinton SC, Newell A, Downey PA, Ferreira K. Pelvic Girdle Pain in the Antepartum Population: Physical Therapy Clinical Practice Guidelines Linked to the International Classifi cation of Functioning, Disability, and Health From the Section on Women’s Health and the Orthopaedic Section of the American Physical Therapy Association.  DOI: 10.1097/JWH.0000000000000081

  3. Keskin EA1, Onur O, Keskin HL, Gumus II, Kafali H, Turhan N. Transcutaneous electrical nerve stimulation improves low back pain during pregnancy. Gynecol Obstet Invest. 2012;74(1):76-83. doi: 10.1159/000337720. Epub 2012 Jun 21.

  4. https://www.healthline.com/health/meralgia-paresthetica

  5. Van Diver T, Camann W. Meralgia paresthetica in the parturient. Int J Obstet Anesth. 1995 Apr;4(2):109-12. doi: 10.1016/0959-289x(95)83002-y. PMID: 15636988.

  6. Coffey R, Gupta V. Meralgia Paresthetica. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557735/

  7. Cheatham SW, Kolber MJ, Salamh PA. Meralgia paresthetica: a review of the literature. Int J Sports Phys Ther. 2013 Dec;8(6):883-93. PMID: 24377074; PMCID: PMC3867081.

  8. Sangsawang B, Sangsawang N. Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment. Int Urogynecol J. 2013 Jun;24(6):901-12. doi: 10.1007/s00192-013-2061-7. Epub 2013 Feb 23. PMID: 23436035; PMCID: PMC3671107.

  9. Mørkved S, Bø K, Schei B, Salvesen KA. Pelvic floor muscle training during pregnancy to prevent urinary incontinence: a single-blind randomized controlled trial. Obstet Gynecol. 2003 Feb;101(2):313-9. doi: 10.1016/s0029-7844(02)02711-4. PMID: 12576255.

  10. Irion JM Irion G. Women’s Health in Physical Therapy. Wolters Kluwer Health/Lippincott Williams & Wilkins; 2010.

  11. Dimitrios S, Stasinopoulos L. Treatment of Carpal Tunnel Syndrome in pregnancy with Polarized Polychromatic Non-coherent Light (Bioptron Light): A Preliminary, Prospective, Open Clinical Trial. Laser Ther. 2017 Dec 31;26(4):289-295. doi: 10.5978/islsm.17-OR-18. PMID: 29434429; PMCID: PMC5801454.

  12. Cîmpeanu M-C, Roman N, Grigorescu S, Grigorescu O-D, Miclăuș RS. Management of “De Novo” Carpal Tunnel Syndrome in Pregnancy: A Narrative Review. Journal of Personalized Medicine. 2024; 14(3):240. https://doi.org/10.3390/jpm14030240

*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives

Sarah Cline
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