Causes and diagnosis of pain in the tailbone during pregnancy

Many women waiting for a baby face in the second or third trimester of pregnancy with back pain and the coccyx. Most often the pain syndrome of moderate intensity, i.e., to endure such pain possible. But there are exceptions when the quality of life of pregnant is significantly reduced.

Next, consider why a tailbone pain in pregnancy and what are the causes of this phenomenon.

back pain and the coccyx in pregnancy

Hormonal changes during pregnancy

Pregnancy is a special condition of the woman. In this period there are incredible processes in the body, ranging from full hormonal changes and to the restructuring of metabolism (metabolism). How does the content of hormones in a pregnant body and how this leads to changes that are explained in the table below.

Hormonewhich produces thepositive EffectsEffects negative
Progesterone: increases throughout pregnancy, decreases before birthluteum in the early stages, the placenta in the later stagesReduces the ability of the uterus to contractions and stops the cell cycle endometrium, i.e. It facilitates the attachment of the ovum and maintenance of pregnancy ensures the growth of the uterusStores water and sodium in tissues of the organism, i.e. Can cause the development of edema. Catabolic effect can increase sweating, feeling of heat, increased body temperature
Estrogens: content increases throughout the pregnancyPlacenta after 10 weeks of pregnancyEnsure the growth of the mammary gland during pregnancy, the growth of the muscular tissue of the uterus and bone, increase the sensitivity of the myometrium to oxytocinAffect lipid metabolism, reduce the content of bile acids and increases cholesterol in bile, contributing to the development of cholelithiasis
HCG the content increases until the second trimester, then decreasesPlacentaStimulates the production of progesterone in the yellow body of ovaries, secretion of estrogen, prolong pregnancy, has antiallergic effect.-
Chorionic somatomammotropin:
the amount of hormone in the blood plasma gradually increases
PlacentaProvides the growth of milk glands during pregnancy, the growing fetus, antiinsulinovykh effect to maintain the level of glucose, activates lipolysis from adipose tissue (acts as growth hormone and prolactin simultaneously)-
Relaxin: the amount of the hormone gradually increases by the third trimesterCells of the corpus luteum during early pregnancy, the placenta in the late stagesRelaxes ligaments of the pelvis, decreases the tonus of uterus and cervix, lysis of the cartilage of the pubic symphysis (pubic symphysis)Promotes relaxation of ligaments, can cause a decreased ability to resist injury, excess impact leads to the development of simpatica, pain in the lumbar region and pelvis

As you can see from the table, under the influence of hormones relaxes, tension, improve the elasticity of the ligamentous apparatus of the pelvis and spine, in addition to this increased direct load on the spine. The sum of these effects is sufficient for the formation of pain syndrome in the lumbar region, sacrum and coccyx.

Pain in the coccyx which is connected with hormonal shifts, characterized by the following features:

  • aching, medium intensity, it is possible to endure;
  • sometimes the pain can be described as "pressure in the lower back, pelvis and tailbone";
  • localized in the lower back (rarely) or sacrococcygeal (most);
  • occur in the supine position, hinder normal sleep, hurts to roll from side to side in bed;
  • arise when sitting, when rising from a sitting position;
  • very concerned when prolonged standing (e.g. In a queue or bus);
  • when walking and moderate physical activity decreases.

Why do pregnant coccyx, pelvis and lower back hurt more often in later periods (second-third trimester after 17 weeks)? This is due to the increased production of relaxin by this date, the birth canal as if preparing for the birth process.

the consequences of injuries

Pain in the tailbone during pregnancy in addition to excessive influence of hormones may be due to old injuries. Special influenced by old untreated fractures, dislocations and subluxations of the coccyx. What is the reason?

Pain in the coccyx area (kokcigodiniâ PTSD) occurs after some period of time after the injury (fall or difficult birth), sometimes in a few years.The pathogenesis of coccygodynia is associated with the involvement in inflammation of the coccygeal plexus and the sacrococcygeal ligaments.

Pain in the coccyx coccygodynia occur when, as a rule, when sitting, rising from sitting, squatting and bending, after walking a moderate pace pain decreases.

The Amplification of pain during pregnancy can be associated with the exacerbation of the disease and the influence of hormones of pregnancy, as well as a combination of both factors.

it is Important to remember previous injuries of the coccyx and to seek Advisory medical care during pregnancy planning.

Treatment of posttraumatic coccygodynia during pregnancy carries a tandem gynecologist, neurologist and trauma surgeon..

the consequences of an injury of the coccyx

Additional methods of examination

Additional screening during pregnancy in pain in the coccyx area includes:

  1. Digital rectal examination.
  2. ultrasound of the pelvic organs and the determination of the internal dimensions of the pelvis (pelvimetry).
  3. ultrasound of the uterus and fetus, assessment of the child.
  4. Radiography of the pelvis in the frontal and lateral projections, it is important to fully grasp sacrococcygeal region. On the radiograph assess the shape and position, the degree of curvature (the forward angle) of the coccyx, in the direction of its vertices.

Note that to x-rays during pregnancy have a high requirement. First, it should be numeric, i.e. with minimum radiation exposure. Secondly, a certain degree of rigidity of the snapshot to be limited to two shots without re. Third, the harm from CT and MRI during pregnancy are much higher than from x-rays.

According to the survey results the most important parameters – the internal dimensions of the pelvis, especially the pelvic outlet, which is measured from the symphysis pubis to tip of coccyx. Normal size is 9.5 cm. The Decrease of the size of a pregnant woman is fraught with the impossibility of entering the child from the pelvic cavity, the development of pathology in childbirth, called clinically narrow pelvis, with subsequent emergency caesarean section.

It Should be noted that in standard gynecological examination, measurement of internal sizes of pelvis not included. Measured external dimensions of the pelvis (indirect), which in the presence of pathology of the coccyx does not comply. Therefore, if a woman remembers the trauma to the sacrococcygeal region in its history, it is advisable to inform your doctor and insist on additional testing before birth for the purpose of establishing the need a planned caesarean section.

Treatment of pain

The First direction in the therapy of pain syndrome is the reduction of muscle tension in the back and hip orthopedic devices. So, for sitting (a long sitting it was better to delete at once), you can apply special orthopedic circles-pillows made of polyurethane foam. They look something like this:

orthopedic round cushion made of polyurethane foam

If the work in pregnant women is associated with prolonged sitting, in every half an hour need to arrange a five to ten minute fibrosing (see exercises below). For a restful sleep, relieve tension from back muscles and pelvis at night is recommended to use special pillows for feeding, they're pillows for sleeping (universal). They look as follows:cushion for feeding and sleeping

The Treatment of pain in the tailbone and back of pregnant women is complicated by the fact that many drugs used for relief of pain, can not be used in connection with adverse effects on the fetus.

  1. Drugs that may be used in pregnant women. Undesirable the use of the following NSAIDs: indomethacin (teratogenic effect on the fetus and impaired renal function in neonates), dipyrone (risk of tumors in the infant, impaired renal function in the newborn, closure of arterial duct), Ketorolac (effect not studied), as well as COX-2 inhibitors (e.g., meloxicam), since the action of COX-2 inhibitors on the fetus have not been studied.

Aspirin (acetylsalicylic acid) at doses required for analgesia, not recommended for use during gestation because of the risk of uterine hemorrhage, closure of the arterial duct, congenital malformations. Cardiac dose aspirin can be used.

From other groups of drugs, commonly prescribed in connection with pain in the coccyx area, you can call tolperison (mydocalm), sirdalud (tizanidine). This muscle relaxants Central action, the effects of which include relaxation of the musculature in the area of inflammation, analgesic effect easy. Due to the fact that the influence of these drugs on the fetus have not been studied, it is necessary to refrain from reception of tolperisone, sirdalud during gestation.

  1. Drugs permitted for use in pregnant women under certain conditions (1).

Therapy of pain in the back and in the coccyx in pregnancy may include the assignment of some NSAIDs: paracetamol at any stage of gestation, ibuprofen and diclofenac only in the first and second trimesters (in the form of gels or externallytablet forms). Ibuprofen and diclofenac when used in the third trimester cause premature closure of the arterial duct. Possible schemes the appointment of NSAIDs in pregnant women are presented in the table below.

Name of productDosageusage Duration
Paracetamol (any gestational age)500 mg up to 4 times a day, it should be noted that paracetamol has very weak analgesic and anti-inflammatory effect, therefore, it should not be regarded as the drug of choice for painweek
Ibuprofen, tab. (first and second trimesters)200 mg 3 times dailyweek
Ibuprofen gel4-6 cm, (a strip from the tube) up to 4 times daily2 weeks
Diclofenac, tab. (first and second trimesters)50 mg 2 times a day3-5 days
Diclofenac injection1 ampoule in day in/m3-5 days
Diclofenac gel 5%2-4 g on the skin in the area of inflammation (pain) 2-3 times a day2 weeks
Diclofenac candle50 mg 2 times a day (2 candles per day)5-7 days

In Addition to the above groups NPVS, for the treatment of back pain and tailbone in pregnant women may be administered candles with anestezin (benzocaine), with papaverine – a candle 2-3 times a day. Is also possible to use papaverine injection (20 mg/m 4 times a day).

Significant analgesic effect of procaine blockade (procaine + lidocaine). In pregnant women they can only be used when very expressed pain syndrome, wherein the alcohol component is not used.

In Addition to drug therapy good effect give water aerobics, swimming, gentle massage. You can also do gymnastics for pregnant women. To prevent lower back pain and the coccyx second and third trimester the exercises should start during the planning of pregnancy and then continued throughout the course of gestation with correction of physical exertion.

Acupuncture, manual therapy, treatment at the osteopaths require a very careful approach.

Exercises to alleviate back pain

so, if a sore tailbone during pregnancy or pain occurs in the sacrum or lower back, the process is not associated with a fresh injury, the best method of correcting the condition of the woman is therapeutic exercise with metered load.

Below are some sets of exercises for each trimester of pregnancy. It should be remembered that any sport must be approved by your physician-gynecologist. Contraindications to therapeutic exercises are of threatened abortion, acute febrile condition, decompensation of chronic diseases, severe gestosis and toxicosis, as well as some other conditions.

a set of exercises in the first trimester (before 16 weeks)

figure 1 – the Complex of exercises in the first trimester (before 16 weeks).

complex for the second trimester, 17-1 32-th week of pregnancy

figure 2 – Complex for the second trimester, with 17-1 for 32-th week of pregnancy.

a set of exercises for the third trimester (after 32 weeks)

figure 3 – a Complex of exercises for the third trimester (after 32 weeks).

Fresh tailbone injury

An Awkward fall are more common in pregnant women than other adults, due to shifting of the center of gravity in the late stages. Among the injuries that occur, if a pregnant woman fell on the gluteal region, it is possible to allocate contusions (most often), dislocations and subluxations, fractures and dislocation of coccyx (rare injury). Damage to the coccyx develops severe pain with the following characteristics:

  1. Intense pain without regard to the position of the body. Sometimes the victim is torn in pain and cannot find any poses that ease pain.
  2. With sitting, standing, bending pain even greater.
  3. Can be painful defecation (sprains, fractures), due to the inability to go to the toilet develop constipation.
  4. to Bed and lie on your back hurt.
  5. Pain relievers do not help much.
  6. Maximum pain intensity in the first two or three days (to a week), it then gradually reduced and stopped within 2-3 months.

In Addition to pain in the tailbone injuries can be observed edema, swelling, hematoma location of the damage.

Bruised tailbone before birth is less dangerous for its complications than other types of injuries, although their symptoms may be the same (except for the pain during defecation).

What to do when the fresh injury, or when the alleged injury to the coccyx area? it is Important to seek medical help immediately after the fall, in the first place – to the gynecologist (preferably in the emergency Department).

Ifthe results of the examination, ultrasound and CTG abnormalities in the General condition of the mother and fetus have been identified, we will lead the victim traumatologist. If there are deviations in the results of the study therapy provides tandem gynecologist and surgeon in the gynecological ward or in the Department of pathology of pregnant women.

Additional sources:

  1. non-Steroidal anti-inflammatory drugs among pregnant women: the risks of adverse events. Ivanova A. A., Kolbin A. S. – Pediatric pharmacology, No. 3, vol. 8. – 2011.
  2. back Pain and their treatment with Mydocalm. Parfenov V. A. – RMJ.
  3. physical therapy exercises for pregnant women.