Gynecology And Obstetrics-

Hip pain in pregnancy

introduction

Hip pain during pregnancy is quite common.
The pain can vary in intensity and become so severe that it interferes with everyday activities and sleep, and can thus lead to a severe impairment of the quality of life of the pregnant woman.

causes

There are numerous possible causes of hip pain during pregnancy. The most important are listed below:

Hormonal changes
Weight gain
Muscle tension
Wrong sleeping position
Bursitis
Arthrosis of the hip joint, for example due to rheumatism

Hormonal changes

First of all, hormonal changes should be mentioned. During pregnancy, pregnancy hormones are released, which cause the ligaments and joints of the pelvis to become more elastic in order to facilitate the delivery of the child.
Most important for a successful delivery is the softening of the pubic symphysis, a cartilaginous connection between the two bony halves of the pelvis. The pubic symphysis is called the pubic symphysis in Latin. In one in 600 pregnant women, however, there is excessive softening of the pubic symphysis (symphysis pubica), which is known as symphysis loosening. The symphysis loosening causes severe hip pain, which can occur particularly in the pubic and groin area depending on the load. During the birth of the child, this can expand further and even tear, which is then referred to as a symphysis rupture or rupture. This in turn can trigger extremely severe hip pain.

Weight gain and muscle tension

Other reasons for hip pain during pregnancy can be the size of the child and the weight of the pregnant woman. This results in a strong additional load on the pelvis, which can cause hip pain. Furthermore, there is a change in the posture of the pregnant woman, which can promote tension in the hip muscles and hip pain.

Nocturnal hip pain during pregnancy

Hip pain during pregnancy is a common problem with different causes. The pain is often felt particularly strongly at night, as the body comes to rest and the pain is experienced more consciously. Another problem is the sleeping position with the associated pressure on the hips and pelvis. In some cases, a pillow between or under the legs provides relief. In addition, light movement before going to bed or a hot water bottle has a relief.

However, there are many cases in which, if at all, only taking a painkiller (e.g. paracetamol) helps. In this case, the attending physician should be consulted to ensure optimal treatment of mother and child. The midwife is also a suitable contact person to show exercises that relieve the hip region.

When changing position in bed, it helps to pull your knees towards your stomach.When getting up, it is also helpful to turn on your side with your knees drawn up and then to get out of bed from this position.

Bursitis in the hip

Hip pain during pregnancy does not always have to be caused by hormonal changes or changes in weight and posture, but can also occur in the context of various diseases that can also cause hip pain in non-pregnant women. An example of a disease that can also cause hip pain during pregnancy is an inflammation of the bursa on the hip joint, known as bursitis. A bursa is a fluid-filled sac that protects joints and other structures under pressure from damage. If the bursa becomes inflamed, usually due to mechanical overloading of the bursa, this is accompanied by severe pain. The pain initially occurs depending on the load, i.e. when walking or running and later also at rest. Inflammation of the bursae on the hip joint usually leads to severe pain in the groin area, which can radiate into the outer thigh. The hip joint can also be overheated and reddened.

Hip osteoarthritis

The hip joint itself can also become inflamed, which is known as coxitis. The inflammation of the hip joint causes significant hip pain that can severely affect the mobility of the hip joint. Inflammation of the hip joint is often associated with redness, swelling and overheating.
Other diseases that can also cause hip pain during pregnancy are coxarthrosis, in which there is wear and tear in the hip joint due to incorrect and overstressing and severe pain especially after periods of rest, and gout, in which there is a painful deposition of uric acid crystals in various joints, for example also in the hip joint, and rheumatism, which summarizes symptoms that are characterized by flowing pulling pain in the musculoskeletal system.

Can it also be irritation of the sciatic nerve?

In some cases, the sciatic nerve can also be the cause of pain problems during pregnancy. It rises from the small pelvis and then pulls towards the back of the thigh, where it runs, and then forks at the hollow of the knee.
He enters through an opening in the pelvis that is normally large enough for him. However, pregnancy can cause the pelvis to tilt more or less and the fruit in the womb also presses on the organs in the pelvis. This can lead to an obstruction of the nerve, which is then touched by bony structures with which it normally has no contact. This is perceived by those affected as a pain stimulus, which can either be near the buttock or the entire rear thigh.

Can this be a sign of pregnancy?

Yes, pelvic pain can be a potential sign of pregnancy. The question, of course, is what the person in question understands by hip pain.

Pain that often occurs during pregnancy and has its origin near the hips would be, for example, symphysis dilatations. So a loosening of the pubic symphysis, which is more flexible, but also more susceptible to painful irritation. As a rule, however, this relaxation phenomenon does not occur until a few weeks before the birth, so that at this point in time it is usually clear whether the person concerned is pregnant or not.
Another potential cause could be a so-called extrauterine pregnancy - i.e. an embryo that has implanted outside the uterus. In almost all cases, such a pregnancy is not compatible with the life of the unborn child, since it cannot be supplied with sufficient nutrients at this point, which is why the embryo dies. The body reacts to this with a strong inflammatory reaction at this point, which in rare cases can also feel like hip pain.

Concomitant symptoms

Back pain

Back pain is a typical symptom of pregnancy, and it is estimated that almost three quarters of women suffer from it.

In many cases, the back pain has existed since before pregnancy and has its origin in poor posture or insufficiently developed back muscles. This back pain can then be counteracted by posture training or by building back muscles. Especially in this case, pregnancy should not be seen as a reason not to worry about your back pain.
Furthermore, the origin of the back pain can also be localized in the pelvis. Especially in the later course of pregnancy, when the fetus is getting bigger and bigger, the angles between the bones in the pelvis change and pain radiating to the back can occur. These disappear again after pregnancy when the angles of the bones in the pelvis have "normalized" again.

Pelvic pain

Pelvic pain during pregnancy is usually attributed to the softening of the pubic symphysis.

In the late stages of pregnancy, this is a natural reaction of the body to give the birth canal more space as the child is directed outwards through the opening in the small pelvis. This softening ensures that both halves of the pelvis can be twisted more strongly against each other and that they can be twisted when running. The resulting overstimulation of the pubic symphysis can then become painful and cause pelvic pain.

Knee pain

Knee pain is also not uncommon during pregnancy and usually only occurs towards the end.

As a rule, it is women who have previously tended to exercise less and who therefore do not have adequate knee support. Due to the sometimes considerable weight gain in a relatively short time, the knee is not adequately adapted to this additional load. This can lead to pain in the ligament structures but also in the menisci, for example.

therapy

Hip pain that occurs during pregnancy is usually difficult to treat. Physiotherapy, pelvic floor exercises, and orthopedic support belts are often prescribed to strengthen the pelvic muscles and relieve the pelvis.

The use of heat, such as a hot bath or hot water bottle, can also help relieve hip pain.
Many pregnant women continue to benefit from light physical activity such as walking, as this strengthens the muscles of the pelvis and lower back and can thus prevent hip pain. In addition to these conservative procedures, surgical treatment can also be considered for symphysis loosening. During the operation, the pubic symphysis can be stiffened with screws and plates and thus hip pain can be prevented.

In the case of bursitis (trochanteric bursitis) of the hip joint, additional relief is achieved through cooling. Pain-relieving and anti-inflammatory drugs can also be used to treat bursitis. Furthermore, the hip joint should be spared for some time. If none of these measures lead to success, the bursa can be surgically removed.

Treatment for inflammation of the hip joint (coxitis) is similar and also includes cooling and immobilization of the hip joint, as well as pain reliever and anti-inflammatory drugs. If the inflammation of the joint is caused by bacteria, antibiotics can also be used. For coxarthrosis and rheumatism, physiotherapy, occupational therapy and various medications can be considered. Treatment for gout is to prevent uric acid crystals from forming and building up. This is done first through a change in diet, later through drug therapy.

Which exercises can help?

Exercises for hip pain during pregnancy are taught by doctors, midwives, physiotherapists or in birth preparation courses. You should definitely learn the exercises under supervision to be sure that you can use them correctly and effectively.

Good experiences have been made with the aid of an exercise ball. Swap your chair for a ball and slowly let the pelvis rotate. The constant slight movement prevents the body from staying too long in a sitting position.

Targeted training of the pelvic floor muscles helps the stressed muscles to improve stability. A simple exercise is to stop the urine stream. The muscles that are needed for this are the pelvic floor. Depending on the cause of the hip pain, physical therapists can perform exercises for the hip muscles, lower back, or abdominal muscles.

Acupuncture used to treat pain

Since hip pain is often difficult to treat during pregnancy, alternative approaches to alleviating the symptoms are increasingly being considered. One of these approaches is acupuncture. The idea of acupuncture is to use the stimulus of the needle to create an undisturbed flow of energy through the body. To do this, the acupuncture needles are not only inserted into the painful region but also on the hands, feet or head.

It should be noted that not all health insurances reimburse acupuncture for hip pain during pregnancy. You should therefore find out more from your health insurance company. Individual experience reports show that acupuncture is effective during pregnancy, but no study has yet been carried out that would scientifically prove positive effects.

Kinesio tape

Kinesio taping is an originally Japanese "trend" that is also becoming increasingly popular in this country.

The tapes not only create something visually, but also represent a conservative treatment measure for joint complaints or lymphatic congestion. So far, however, there is no medical study that has been able to confirm the effectiveness of the tapes.
In many cases, the tape is already being used to improve back problems in pregnant women. The supporting muscles of the spine are often tense here. The tape is supposed to help stimulate the blood flow in order to allow the muscles to regenerate more quickly and to relieve tension. To what extent the taping is suitable for each individual pregnant woman and how effective such an application is, everyone has to find out for themselves. You do not harm the fetus or yourself.

homeopathy

Pain in pregnancy can also be remedied in a homeopathic way.

There are different globules for different locations and qualities of pain. However, since some globules derive their effect from partly poisonous plants, it is essential to speak to an expert before use in order to rule out any risk to the unborn child. Which substance crosses the placenta and how far it can get to the fetus via the mother's blood is an important point that should be taken into account.

diagnosis

The cause of hip pain during pregnancy is determined with the help of a detailed questioning of the pregnant woman and various examination methods. If the hip pain in pregnancy is based on the loosening of the symphysis, the diagnosis can often already be made on the basis of the symptoms described, such as severe movement-dependent pain in the pubic and groin area.

The expansion of the pubic symphysis (symphysis pubica) can also be seen as an enlarged gap between the two halves of the pelvis in the X-ray image. However, since x-rays are contraindicated during pregnancy, this form of examination for diagnosis is not possible.
The inflammation of the bursa on the hip joint bone (trochanteric bursitis) and inflammation of the hip joint itself (coxitis) can rarely be visible from the outside through swelling and reddening.

The physical examination reveals severe tenderness in the hip joint. The inflammation of the bursa or the inflammation of the hip joint can also be seen in the ultrasound image. Furthermore, certain parameters in the blood of those affected can indicate inflammation. In the case of coxarthrosis, gout and rheumatism, in addition to a detailed questioning and physical examination of those affected, blood tests or an MRI of the hip are used to make the respective diagnosis.
However, an MRI during pregnancy is a rare indication. Even if there is no radiation exposure during an MRI, the data on MRI during pregnancy are thin.