Experts describe two common patterns of low back pain in pregnancy: Lumbar pain occurs in the area of the lumbar vertebrae in your lower back and posterior pelvic pain is felt in the back of your pelvis. Some women have symptoms of both types of low back pain.

Lumbar pain is like the low back pain you may have experienced before you were pregnant. You feel it over and around your spine approximately at the level of, or a little above, your waist. You might also have pain that radiates to your legs. Sitting or standing for long periods of time and lifting usually make it worse, and it tends to be more intense at the end of the day.

Even more pregnant women have posterior pelvic pain, which is felt lower on your body than lumbar pain. You may feel it deep inside the buttocks, on one or both sides or in the back of your thighs. It may be triggered by activities such as walking, climbing stairs, getting in and out of a tub or a low chair, rolling over in bed, or twisting and lifting.

Positions in which your hips are bent — such as sitting in a chair and leaning forward while working at a desk — may make posterior pelvic pain worse. Women with posterior pelvic pain are also more likely to have pain over their pubic bone.

Could it be sciatica?

With severe sciatica, you may have numbness in your groin or genital area as well. You may even find that it’s hard to urinate or that you have the opposite problem of incontinence (difficulty holding your urine or bowel movements).

If you think you have sciatica, be sure to see your practitioner. Call her immediately if you feel a loss of sensation or weakness in one or both legs or a loss of sensation in your groin, bladder, or anus (which may make it hard to pee or have a bowel movement, or — alternatively — cause incontinence).

Who’s most likely to have low back pain during pregnancy?

Not surprisingly, you’re most likely to have low back pain if you’ve had this kind of pain before, either before you got pregnant or during a previous pregnancy. You’re also at higher risk if you’ve lead a very sedentary lifestyle and have poor flexibility and weak back and abdominal muscles.

Carrying twins (or more) increases your odds of having an aching back. Obesity may be a risk factor for developing low back pain during pregnancy, but study results are conflicting.

What can I do to avoid back pain?

•  Start an exercise program to stretch and strengthen muscles that support the back and legs, including your abdominal muscles. Be careful to stretch gently because stretching too quickly or too much can put further strain on your joints, which have been made looser by pregnancy. Swimming is a great exercise option for pregnant women because it strengthens your abdominal and lower back muscles, and the buoyancy of the water takes the strain off your joints and ligaments. Pelvic tilts can also help (see below).

•  Stand up straight. This gets harder to do as your body changes, but try to keep your bottom tucked in and your shoulders parallel with your ears. Pregnant women tend to slump their shoulders and arch their backs as their bellies grow, which puts more strain on the spine.

•  If you sit all day, be sure to sit up straight. Supporting your feet with a footstool can help prevent lumbar pain, as can using a small pillow called a lumbar roll behind your lower back. Take frequent breaks from sitting. Get up and walk around at least every hour or so.

•  It’s equally important to avoid standing for too long. If you need to stand all day, try to take a midday break and rest lying on your side while supporting your upper leg and abdomen with pillows.

•  Wear comfortable shoes and avoid high heels. As your belly grows and your balance shifts, high heels will throw your posture even more out of whack and increase your chances of stumbling and falling.

•  Always bend from your knees and lift things from a crouching position to minimize the stress on your back. This isn’t the time to risk throwing your back out, so let someone else lift heavy objects. Don’t reach for high objects, either, and try not to twist your back.

•  Divide up the weight of items you have to carry. A shopping bag in each hand with half the weight is much better than the uneven stress on your back of carrying one heavier bag.

•  Take care when getting out of bed: Bend your legs at your knees and hips when you roll to the side, and use your arms to push yourself up as you dangle your lower legs over the side of the bed.

•  To get a good night’s rest, try sleeping on your side with one or both knees bent and a pillow between your legs. As your pregnancy advances, use another pillow or wedge to support your abdomen.

•  Listen to your body. If you find that a particular activity or exercise makes your back hurt, then avoid doing it!In addition to following the suggestions above, women suffering from low back pain should:

•  Take it easy. Don’t let yourself get too fatigued. (But don’t take to your bed for long periods, either, since bed rest is generally not helpful in the long run for low back pain and may even make you feel worse.) Avoid activities like vacuuming and mopping that require you to bend and twist at the same time. If there’s no one else to do these chores, move your whole body rather than twisting or reaching to get to out-of-the-way spots.

•  Learn relaxation techniques. They may help you cope with the discomfort and may be especially useful at bedtime if your back pain is just one more thing that makes it hard to get to sleep.

•  Try heat or cold. Although there’s no hard evidence that it helps, some women find that soaking in a warm tub or putting a hot water bottle on the affected area provides at least temporary relief. There’s even less evidence regarding the use of cold packs, but it’s easy to do and worth a try if heat doesn’t work for you.

•  Try massage. If do-it-yourself tactics don’t work, prenatal massage by a trained therapist may provide some relief, especially when combined with an exercise program focused on stretching.

There’s some research suggesting that acupressure (massage of specific acupuncture sites) may be more helpful than other types of massage and that acupuncture may provide some relief as well, but these studies weren’t done on pregnant women.

In addition, if you have posterior pelvic pain, try to limit activities like stair climbing that may make the pain worse. And avoid any exercise that requires extreme movements of your hips or spine.

If you need to sit for long periods, try to use an adjustable chair and tip the front slightly downward. Ask your caregiver about using a “sacral belt.” For some women, this device seems to help lessen the pain when walking, although for others it doesn’t help at all and for a few it may even increase pain.

What kind of exercise can help?

One study showed that prenatal aquatics classes (water aerobics) helped alleviate back pain. Avoid high-impact activities, overstretching, and, of course, anything that hurts.

For lumbar pain, try doing pelvic tilts, which can ease back pain by stretching your muscles and, over time, strengthening them as well. Here’s how:

•  Get down on your hands and knees, arms shoulder-width apart and knees hip-width apart, keeping your arms straight.

•  Tighten your abdominal muscles, tuck your buttocks under, and round your back, breathing in.

•  Relax your back into a neutral position and breathe out.

•  Repeat at your own pace.

When should I call my midwife or doctor?

Let your caregiver know if you’re suffering from back pain. Call her immediately if:

•  Your back pain is severe; you notice that you’ve lost feeling in your legs, buttocks, groin, genital area, bladder, or anus; or you suddenly feel uncoordinated or weak. She’ll refer you to a specialist if there’s any sign of a neurological problem or any underlying condition. She may also prescribe painkillers.

•  You have low back pain in the late second or third trimester. This can be a sign of preterm labor, particularly if you haven’t had back pain before that.

•  You have pain in your lower back or in your side just under your ribs, on one or both sides. This can be a sign of a kidney infection, especially if you have a fever, nausea, or blood in your urine.

The key to preventing kidney stones is first finding out what type of kidney stones you have and then taking the appropriate treatment. Laboratory tests help determine the levels of various substances in the stones. From there, your doctor may recommend that you increase your fluid intake, avoid certain foods, or take medication as part of preventing kidney stones.

• Urine volume
• Levels of acidity
• Levels of calcium
• Levels of sodium
• Levels of uric acid
• Levels of oxalate
• Levels of citrate
• Levels of creatinine (a product of muscle metabolism).

Your doctor will use this information to determine the cause of kidney stones. A second 24-hour urine collection test may be needed to determine whether the prescribed treatment is working.

Preventing Kidney Stones by Drinking More Liquids

The most important lifestyle change you can make in preventing kidney stones is to drink more liquids, especially water. If you tend to form kidney stones, you should try to drink enough liquids throughout the day to produce at least 2 quarts of urine in every 24-hour period. To prevent cystine kidney stones, you should drink more than a gallon of water every day to dilute the concentration of cystine that escapes into the urine. This can be difficult, however, because a third of that water must be drunk during the night.

Preventing Kidney Stones Through Diet

Recent studies have shown that foods high in calcium, including dairy products, may help prevent calcium stones. However, taking calcium supplements may increase the risk of developing stones. Therefore, doctors often advise patients to avoid food with added vitamin D and certain types of antacids that have a calcium base.

People prone to forming calcium oxalate stones may also be told to cut back on certain foods, such as:

• Beets
• Chocolate
• Coffee
• Cola
• Nuts
• Rhubarb
• Spinach
• Strawberries
• Tea

Wheat bran. People should not give up or avoid eating these foods without talking to their doctor first. In most cases, these foods can be eaten in limited amounts. In order to prevent uric acid stones, your doctor may recommend that you eat less meat, fish, and poultry, which increase the amount of acid in the urine

Suggestions for Preventing Kidney Stones

Additional tips for preventing kidney stones include:

• Drink 12 full glasses of water every day, which will help to flush away the substances that form stones in the kidneys.
• Limit your coffee, tea, and cola intake to one or two cups a day. Caffeine may cause you to lose fluid too quickly.
• Changes in your diet may be needed to prevent calcium and uric acid stones.
• Medicines may be needed to prevent calcium and uric acid stones.
• A family history of stones or a previous history of stones may increase your risk of forming kidney stones.
• If you are at risk for developing stones, your doctor may perform certain blood and urine tests to determine how to reduce your risk.
• People with chronic urinary tract infections and kidney stones will often need to have problem stones removed. Patients must receive careful follow-up visits to be sure that the infection has cleared.