Herniated disc during pregnancy
introduction
A herniated disc, i.e. the displacement of the gelatinous core (nucleus pulopsus) an intervertebral disc (discus intervertebralis) into the spinal canal, through which the spinal cord runs, is one of the most common diseases of the spine.
A herniated disc becomes problematic when it comes to nerve root compression. Then numbness due to the herniated disc and restricted mobility (motor failure symptoms) come. Theoretically, a herniated disc can affect anyone, which is why pregnant women are also affected by the disease.
In pregnancy, herniated discs often occur from the third month of pregnancy, they can theoretically affect any part of the spine, but most common are incidents in the lumbar spine, and more rarely there are also herniated discs in the cervical spine.
causes
For a herniated disc to occur, the outer ring of fibers that hold the disc in its proper position must be weakened or damaged. Such damage can occur, for example, when lifting extremely heavy loads. However, genetic weaknesses in the fiber ring can also lead to a herniated disc without an apparent cause.
During pregnancy, however, the hormonal changes in the woman's body are the main cause of an increased risk of herniated discs during pregnancy. Hormones such as progesterone or estrogen, which are produced in excess during pregnancy, not only have an impact on the uterus, ovaries and the formation and maintenance of the placenta, but also prepare the ligaments and bony structures of the female pelvis for the upcoming birth.
Progesterone has a relaxing effect on the pubic symphysis in the pelvis, for example (Symphysis plate). This connection between the two pubic bones is loosened by the action of the hormones in order to widen the pelvis even more during birth and to enable the child to pass through the birth canal. Unfortunately, the hormone affects not only the connective tissue of the pubic symphysis but also the fibrous rings of the intervertebral discs, which consist of connective tissue. Even with low stress, a herniated disc can occur during pregnancy.
In addition to the hormonal changes, the increasing weight of the growing child also puts an enormous strain on the spine.
Please also read: Lumboischialgia in pregnancy
Symptoms
The main symptom of a herniated disc during pregnancy is severe pain. If the spinal cord is impaired by the displaced core of the intervertebral disc, symptoms of paralysis and sensitivity disorders occur in addition to pain.
The pain often begins suddenly, usually when the patient is exerted, and those affected quickly adopt a so-called relieving position. A relieving posture describes the posture in which the pain is bearable. Movement worsens the pain symptoms, sometimes the patient is no longer able to walk independently.
In the worst case, urinary incontinence and fecal incontinence occur, which are associated with sensitivity disorders in the genital area. Such failures are an emergency and must be operated on.
The symptoms of a herniated disc differed according to the region where the herniated disc is present (cervical, thoracic or lumbar spine). The symptoms are the same in an existing pregnancy as if there were no pregnancy. However, the symptoms are aggravated by the increased weight of the pregnant woman, which weighs on the spine.
Read more on the topic:
- Symptoms of a herniated disc
- Symptoms in the legs of a herniated disc in the lumbar spine
treatment
If back pain suddenly sets in during pregnancy, the symptoms should be examined by a doctor.Back pain is normal to a certain extent during pregnancy, but it can also be an indicator of initial labor.
If a herniated disc is diagnosed during pregnancy, conservative therapy is the top priority for pregnant women. Painkillers that are administered must of course not harm the unborn child, which limits the choice of drugs available. In theory, active ingredients such as paracetamol or ibuprofen come into question.
The use of medication during pregnancy should be clarified with the attending physician.
In addition to taking pain relievers, heat or cold will relieve the pain of a herniated disc. Warm baths, heat lamps or cold compresses can be used at home. Physiotherapy and massages are also suitable for treating a herniated disc during pregnancy, but should be tailored to the needs of the pregnant woman.
Read more on the topic:
- Treatment of a herniated disc
- Exercises for a slipped disc during pregnancy
Herniated disc surgery during pregnancy
Herniated discs in which urinary incontinence or fecal incontinence occur must definitely be treated surgically. Then there is no other therapy option for a pregnant woman either. In principle, a herniated disc operation is possible during pregnancy.
Of course, minimally invasive procedures are preferred to surgery under general anesthesia, because during general anesthesia it is particularly important to maintain an optimal oxygen supply for the child in the womb. In addition, drugs that are used for general anesthesia cross the placenta, which means that the substances also get into the child's blood.
Minimally invasive procedures are suitable for pregnant women, as the skin incision is only very small and the surgeon uses a tube (endoscope) reaches the damaged intervertebral disc. The back muscles and the surrounding tissue are not stressed as much as during an operation under general anesthesia. Furthermore, early mobilization (Move) of the patient, which means that the subsequent physiotherapy can be started very quickly.
Which surgical procedure should be used, however, must be decided individually in each case.
Read more on the topic: Operation of a herniated disc
Should a caesarean section be preferred for a herniated disc during pregnancy?
If a pregnant woman has a herniated disc, the type of birth should be discussed carefully with the gynecologist.
In principle, a normal birth is possible despite the herniated disc and in most cases it can take place without complications related to the herniated disc. Before giving birth, however, it should be discussed with an anesthetist whether epidural anesthesia is possible. The nerves in the spinal cord are numbed, blocking the transmission of pain from the abdomen. In most cases this is possible despite a herniated disc. In this way, the woman can decide individually how she wants to bring her child into the world.
prophylaxis
During pregnancy, joint-friendly sports such as swimming or water aerobics are ideal for preventing a slipped disc during pregnancy. In general, regular exercise protects against damage to the spine and contributes to the general well-being of the pregnant woman. Exercise in the fresh air also helps relieve other pregnancy symptoms such as tiredness or nausea. Walks or Nordic walking are not too demanding, but they promote circulation and blood circulation.
Read more on the topic: Prevent a herniated disc
Herniated disc and childbirth
During childbirth, a woman's body is put under extreme stress. The spine is also exposed to immense strain, especially during pressure contractions (Labor that pushes the child out through the birth canal). Due to the pressure exerted on the spinal column by the child and the additional stress caused by the pressing of the expectant mother, there is a possibility that nerves in the area of the herniated disc, which were not previously affected, are suddenly constricted, causing symptoms. that did not exist before birth.
Pregnant women who suffer from a herniated disc are therefore often required to have a caesarean section (Cesarean section) devices. Nevertheless, some women with a herniated disc during pregnancy opt for a natural birth, as giving birth in the hospital always gives birth to children by caesarean section should the health of the mother or child deteriorate during the birth process. In contrast to a caesarean section, a spontaneous birth leads to a better mother-child bond, as the child can be placed directly on the mother's breast after birth (Bonding).
diagnosis
When diagnosing a herniated disc during pregnancy, the medical history (anamnesis) and a neurological examination are in the foreground. A neurologist can estimate which nerve root is narrowed by the herniated disc on the basis of the areas that have sensitivity disorders.
In addition, checking the reflexes on the extremities provides information about the functionality of the nerves that supply the muscles.
Afterwards, an MRI is performed despite the existing pregnancy in order to complete the diagnosis with an imaging procedure.
If the situation is judged to be uncritical for permanent neurological damage, the MRI can also be performed after completion. In many cases, however, the MRI must be performed during an existing pregnancy.
Imaging examinations such as x-rays or computed tomography are largely avoided due to the radiation exposure for the unborn child.
You can also read other topics:
- MRI in pregnancy
- MRI for a herniated disc
Employment ban
For a prohibition of employment during pregnancy, according to the law, the health of the mother or child must be endangered by the type of employment. The pregnant woman then needs a medical certificate to present to the employer.
Herniated discs during pregnancy make it necessary to be banned from employment if the herniated disc is associated with urinary incontinence or fecal incontinence, i.e. requires immediate surgery.
In contrast, herniated discs that cause severe pain but do not pose an acute threat to the health of mother and child, but make it impossible to carry out the work properly, require a sick note from the attending physician.
Read more on the subject at: Employment prohibition during pregnancy
