Piriformis Syndrome in Pregnancy

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Piriformis syndrome and is very common during pregnancy. The growing child in the uterus presses on the piriformis muscle in the deep hip muscles, which become inflamed by the pressure load.
The sciatic nerve runs under the muscle in the infrapiriforme foramen, which is compressed by the strained muscle. As a result, pain occurs in the buttocks area, which can radiate over the thigh down to the knee.

Causes of Piriformis Syndrome in Pregnancy

The cause of the appearance of piriformis syndrome in pregnancy is the increase in size of the uterus caused by the growing fetus. During pregnancy, the uterus presses more and more on the deep hip muscles and compresses the sciatic nerve (sciatica). The sciatica emerges from the spinal cord between the lumbar vertebrae and reaches the buttocks and thigh muscles under the piriformis muscle, which it supplies with motor and sensitivity. Compression typically causes pain in the buttocks that extend down the leg to the knee. Sometimes the pain is difficult to localize and radiates from the buttocks to the lower back and groin.

Due to the changed center of gravity due to the growing belly, pregnant women shift their weight backwards, which increases the pressure on the sciatic nerve and causes symptoms. Another reason why piriformis syndrome tends to occur during pregnancy is that the weight of women increases as the pregnancy progresses. This often compresses the sciatica and causes pain.

Find out all about the topic here: The causes of piriformis syndrome.

The accompanying symptoms

In addition to pain in the buttocks and legs, other symptoms of piriformis syndrome during pregnancy that are similar to the symptoms of sciatica irritation occur. However, in contrast to sciatica, there is no back pain because the nerve is not compressed when it exits the spinal cord, but only when it passes through the hip muscles. The pain increases after standing or walking for a long time. Sitting for long periods of time, such as driving a car, also increases the symptoms.

Other symptoms are abnormal sensations, such as tingling, and sensory disturbances along the buttocks and lateral thighs. The irritation of the nerve can also cause numbness in the affected leg. When sitting, the sciatic nerve becomes more pinched and symptoms worsen. The pain in the buttock also worsens when climbing stairs or after strenuous activities such as long walking or standing.

Read more about the topic here: Symptoms of Piriformis Syndrome.

Diagnosing piriformis syndrome in pregnancy

In pregnant women with severe pain in the hip or buttock region, the doctor makes the diagnosis based on the medical history.

During the physical examination, the doctor can perform various functional tests of the hip joint and muscles. The piriformis syndrome is characterized by pain when bending the leg and during internal rotation. In addition, the leg on the affected side is weak and weak.
Imaging procedures such as an MRI or CT serve to rule out other causes and to confirm the diagnosis.

What tests are there?

However, there is no precise test for the specific detection of nerve compression. Various functional tests of the gluteal and thigh muscles can, however, provide indications of the presence of piriformis syndrome in pregnant women.
The examining doctor checks whether the woman can move the stretched thigh outwards or inwards and feels pain in the process. Piriformis syndrome can also cause pain when lifting the straight leg and during internal rotation.

Find out more about the topic here: Tests for Piriformis Syndrome.

Treatment of piriformis syndrome during pregnancy

Treatment of piriformis syndrome during pregnancy involves rest and rest. Long periods of sitting and strenuous activities such as long walks and long periods of standing should be avoided. In addition, the pregnant woman must not lift heavily, as this increases the pressure on the piriformis muscle and makes the pain worse. Cooling the painful area with a cooling pad or treating it with a hot water bottle can also alleviate the symptoms.

After the diagnosis, the doctor can refer the pregnant woman to a physiotherapist. Regular stretching and exercises to strengthen the hip and gluteal muscles lead to an improvement in the symptoms. The exercises should be done 2 to 3 times a week.

If the symptoms are severe, the doctor can prescribe pain relievers. However, not all medications are allowed during pregnancy and those affected should definitely check with their doctor about the exact choice and dosage of the preparations. Ibuprofen (administration only permitted in the 1st and 2nd trimester) and paracetamol are considered to be well tolerated by pregnant women and pose no known risk of embryo malformations.

Read more on the topic: Therapy of piriformis syndrome.

Which exercises can help?

Certain exercises can reduce the pain associated with piriformis syndrome during pregnancy. Which exercises are best for the pregnant woman to perform depends on the week of pregnancy and should best be clarified with the attending physician.

One possibility is to stretch the thigh muscles: while sitting, bring one leg forward and bend the knee joint at a right angle. The other leg is stretched straight back until the stretch is felt in the bent leg. Another possibility is for the pregnant woman to lie on her back, bend her legs and place the left leg on the knee of the right one. Then the right leg is pulled below the knee towards the stomach until a noticeable stretch in the buttocks is noticeable.

The tension in the gluteal muscles can also be loosened with a fascia roller. The massage stimulates the blood circulation in the connective tissue and the muscles become supple again.

Stretching exercises for piriformis syndrome? Read more here.

Cold or warm - which is better?

Treatment with either heat or cold can improve the symptoms and relieve pain. Every pregnant woman has to try for herself whether heat or cold helps better.
However, the hot water bottle or cooling pad should not be placed directly on the pregnant belly, but on the painful point on the buttocks. However, it is not a problem if the cooling pad lies on the stomach for a short time, as the stomach is very well supplied with blood and the child is thus protected from the cold. The amniotic fluid also compensates for short-term temperature fluctuations. However, caution is advised with a hot water bottle, as excessive heat can cause the baby to overheat. The further the pregnancy has progressed, the more the baby lies directly behind the abdominal wall and quickly absorbs the heat.

Duration of Piriformis Syndrome During Pregnancy

Piriformis syndrome during pregnancy persists until the trigger for the pressure load has disappeared, that is, until the woman has given birth. Only then is the piriformis muscle relieved and the symptoms disappear.
However, medical and physiotherapeutic treatment during pregnancy can improve symptoms and alleviate pain.

You can find more information on this topic here: Healing a Piriformis Syndrome.

Which Doctor Treats Piriformis Syndrome During Pregnancy?

If there is pain in the buttocks that radiates into the thigh, piriformis syndrome is suspected and the pregnant woman should consult a doctor. A family doctor writes the referral to an orthopedic surgeon, who can make the diagnosis. A physiotherapist or sports doctor can also treat piriformis syndrome during pregnancy.