Is Lower Back Pain Early Pregnancy Sign Of Miscarriage? (First Trimester)

Question: Is lower back pain early pregnancy sign of miscarriage?

If you are getting pregnant for the very first time, you may begin to worry when your back hurts in early pregnancy.

The truth is you are not alone; a lot of women will experience back pain during pregnancy and generally, it’s nothing serious. Back and pelvic pain are common in pregnancy, especially in the second and third trimester, and most of the time it is due to normal changes in your joints, ligaments and posture rather than a problem with the baby. 

Lower back pain is not only common in women that are pregnant for the first time. If you had a baby before, a low back pain could occur in your next pregnancy.

The most common reasons pregnant women will have back pain are hormonal changes that occur during pregnancy and the effect of the growing baby on ligaments, muscles and nerves.

During pregnancy, your body begins to produce hormones that help relax your joints and ligaments so the pelvis can stretch for birth. Hormones such as relaxin and progesterone, plus the weight of your growing uterus, may also affect the stability of your spine and pelvis, causing pain in your back. Wikipedia+1

About half to two-thirds of women will have some back or pelvic pain when pregnant, so don’t feel it’s just you. Pain may become worse depending on your weight during pregnancy, the size of your belly bump, your posture and stress. 

If you’re now pregnant and not engaging in any form of body stretching or exercise, there is an increased chance you will get a back pain. This pain in the back, in most women, will not affect the growth and safety of their baby.

Frequently, back pain will not show up till you are in the second trimester. However, it may come early (even from around 8 weeks of pregnancy) if you’ve previously suffered from back pain before pregnancy or you have a physically demanding job. East Sussex Healthcare NHS Trust+1

Having said that, severe back pain during pregnancy between 4 to 8 weeks could mean something different from the usual pregnancy back pain.

An ectopic pregnancy (pregnancy outside the womb) or a miscarriage (also called early pregnancy loss) may cause back pain in addition to vaginal bleeding and belly cramps. Sometimes the pain can be one-sided or associated with shoulder-tip pain, dizziness or feeling very unwell, which can be a warning sign that needs urgent medical care. 

It’s important you understand the usual types of back pain during pregnancy, signs of miscarriage in early pregnancy and when it’s important to talk to a doctor or go to hospital.

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What causes lower back pain in early pregnancy?

It’s not abnormal that you will get pain at your back during pregnancy. More than one-third of pregnant women will get back or pelvic pain at some stage of pregnancy and it may get worse as your baby grows. 

Back pain in pregnancy can result from:

• Hormones (like relaxin) that loosen the sacroiliac joints and ligaments around your pelvis and spine, making the joints a bit less stable and putting more strain on your back muscles. Wikipedia+1

• Change in posture as your bump grows, making you lean backwards.

• Weak abdominal muscles and increased weight.

• Pelvic girdle pain (pain around the joints at the front and back of your pelvis). Wikipedia

Another reason sometimes blamed for back pain is stretching of the round ligaments of the uterus as your baby increases in size. Round ligament pain usually starts in the second trimester and is felt more in the lower tummy or groin, but some women describe it as pain that seems to pull towards the hip or back. Cleveland Clinic+1

There are three types of back pain you may experience when pregnant.

1. Lumbar pain

Lumbar pain is usually located in the middle or upper part of your lower back, around or above the waist region. If you have this type of pain, it is often not the first time you are experiencing it.

Before getting pregnant, you may have experienced a sharp back pain that comes and goes when bending forward.

Usually, pain can also be felt when you lean forward to carry an object. If you’ve been standing for a long time, you may also get this type of pain.

2. Pelvic pain

Pelvic pain is the most common type of pain women experience when pregnant. It is a sharp or aching pain you will feel inside your buttocks and may also occur with lumbar pain.

Pelvic pain can be located at either one or both buttocks and may extend to your groin and thighs.

Usually, turning from one side to another swiftly will cause this type of pain during pregnancy. Other causes are walking a long distance, lifting objects or climbing stairs at home.

3. Sciatica pain

Sciatica pain is usually common in the lower back (lumbar region) and radiates down your thighs, knees, leg and foot.

This type of pregnancy back pain usually occurs because you have irritation or compression of the sciatic nerve (for example from a herniated disc) and may be worse when you are sitting. However, true sciatica is not very common in pregnancy – only a small percentage of pregnant mothers will get this type of pain. Wikipedia

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Is lower back pain early pregnancy sign of miscarriage?

Because there are many causes of low back pain when pregnant, it’s important you understand what’s normal and what’s not.

Firstly, having lower back pain is very common after your third month of pregnancy and may continue till you are term.

Secondly, having low back pain is possible in the first trimester and often does not mean a miscarriage, especially if you’ve experienced back pain before your pregnancy or after certain movements or posture.

Thirdly, a mild or severe lower back pain together with vaginal bleeding and stomach (pelvic) cramps is not normal in pregnancy and you should be checked.

Back pain in early pregnancy with vaginal bleeding and cramping can be a sign of miscarriage or ectopic pregnancy and needs urgent medical assessment. However, not all bleeding and pain end in miscarriage. About half of women who have bleeding in early pregnancy will continue to have a healthy pregnancy, so you should never assume the worst without seeing a doctor. ACOG+2RCOG+2

Miscarriage (early pregnancy loss) is relatively common. Overall, about 10–20 percent of known pregnancies end in miscarriage, and most of these happen in the first 12 weeks. The risk is highest very early in pregnancy (before or just after a missed period) and usually drops once a heartbeat is seen on ultrasound and again after the first trimester. 

You can read more detailed information on miscarriage symptoms from Mayo Clinic and miscarriage: causes, symptoms, risks and treatment from Cleveland Clinic. 

Other symptoms you may experience if back pain is due to a miscarriage are:

⇒ Blood clots from vagina

Blood clots that are big, dark or red with increased vaginal bleeding can be a sign you are having a miscarriage. Sometimes there may also be greyish-white pregnancy tissue mixed with the blood. Cleveland Clinic+1

⇒ Fading pregnancy symptoms

Depending on your gestational age, you may already have had symptoms of pregnancy.

Very early in pregnancy, you may feel like vomiting with body weakness. Other symptoms during early pregnancy are food craving and aversion, increased urination, belly cramps and mood changes.

If it becomes clear over a few days that you no longer have these symptoms together with bleeding and cramping, it may mean your pregnancy is no longer viable. At the same time, some women with healthy pregnancies also notice that symptoms come and go, so changes in symptoms alone are not a reliable way to diagnose a miscarriage. NKC Health Library+1

⇒ Fetal tissue from vagina

Vaginal bleeding during pregnancy is one of the commonest ways to tell you may be having a miscarriage. Some women will pass blood clots or pieces of tissue from the vagina along with back or abdominal pain.

If you notice passage of tissue, heavy bleeding or worsening pain, don’t wait – talk to your doctor or go to the nearest emergency unit immediately. Fever, foul-smelling discharge, feeling very unwell or collapsing are emergency warning signs of possible infection (septic miscarriage). NCBI

For clear patient information, see RCOG’s leaflet on bleeding and/or pain in early pregnancy and ACOG’s FAQ on early pregnancy loss. ACOG+3RCOG+3RCOG+3

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I’m bleeding and cramping with back pain, what to do?

If you have vaginal bleeding, low back pain, abdominal cramps with fading pregnancy symptoms, you should see your doctor immediately or go to an emergency/early pregnancy unit.

If it’s due to a miscarriage, bleeding may be heavy and may sometimes cause you to feel dizzy and exhausted.

After your doctor or midwife examines you, they may do an ultrasound scan and blood tests to check your baby and your hormone (hCG) levels. If a miscarriage is confirmed, there are usually three options:

• Expectant (natural) management – waiting for the pregnancy tissue to pass on its own.

• Medical treatment – using tablets such as misoprostol to help your uterus empty.

• Surgical treatment – removal of the tissue through vacuum aspiration or D & C.

These options are described in more detail in ACOG’s early pregnancy loss information and Mayo Clinic’s page on miscarriage diagnosis and treatment. ACOG+2Mayo Clinic+2

On the other hand, if your back pain and spotting are not severe and ultrasound shows that your baby is still fine (threatened miscarriage), your doctor may advise rest, observation and repeat scans. In these cases, many pregnancies continue normally. 

At this point, smoking, alcohol and recreational drugs should be completely avoided, and you should only take medicines that your doctor or midwife says are safe in pregnancy. Some infections, alcohol, smoking and certain drugs are known risk factors for early pregnancy loss. NCBI+1

If you have sudden severe one-sided abdominal pain, pain in your shoulder, feel faint or collapse, or have very heavy bleeding (soaking more than one pad per hour), this may be an ectopic pregnancy or severe bleeding and you should seek emergency help straight away. 

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I have back pain, no bleeding or cramping?

If you have only mild or moderate pain at your back or buttocks, and no bleeding or cramps, it is usually more likely to be normal pregnancy back or pelvic girdle pain rather than miscarriage. You can ease off pain with any of these steps.

⇒ Use heat and cold compress

This is an easy and effective way to feel better during pains. It involves using ice packs and a warm (not very hot) water bottle or heating pad intermittently over your lower back, with a cloth between your skin and the heat or ice. This could ease off your pain for a while. nhs.uk+1

⇒ Exercise

It’s common to see women relaxing and not engaging in any exercise when they get back pain. But you shouldn’t stop all movement.

Gentle exercise, either by swimming, walking around or simple pregnancy stretches advised by a physiotherapist, can help stretch and strengthen your back muscles and ease pains. nhs.uk

⇒ Be cautious of wrong movements

When pregnant, walking for a very long distance, sitting for too long, turning very fast, getting out from your car, lifting heavy loads and climbing stairs can cause back pain. It’s important you learn what causes pain for you and avoid such posture or movements.

Using a pillow between your knees and under your bump when you lie on your side, wearing flat supportive shoes and avoiding standing on one leg (for example when dressing) can also help. nhs.uk

⇒ Use pain relief medications

Talk to your doctor if back pain is not subsiding. Your doctor may prescribe or recommend acetaminophen (paracetamol) to ease your pain for a while, as this is usually the first-choice painkiller in pregnancy.

Be careful not to take a drug without doctor consult. At early pregnancy, some medications (for example, certain anti-inflammatory painkillers) may cause problems for your baby and should only be used on medical advice. Pregnancy Birth Baby+1

If your back pain is very severe, prevents you from walking, comes with fever, burning when passing urine, numbness or weakness in your legs, or you are worried about your baby’s movements (later in pregnancy), you should also see a doctor or midwife urgently. nhs.uk

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What does miscarriage back pain feel like?

Pain in the back during a miscarriage may be mild, severe or not present at all. Symptoms will vary from woman to woman though may be worse during a later stage of the first trimester.

Some women describe a low, dull back ache that becomes stronger and more cramp-like, often together with period-like or stronger cramps in the lower abdomen and increasing vaginal bleeding. Others mainly notice bleeding or loss of pregnancy symptoms and only mild back pain. Cleveland Clinic+

If your pain is severe with severe belly cramps or heavy bleeding, talk to your doctor or go to an emergency unit immediately.

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Is lower back pain first trimester sign of pregnancy

In the first trimester, about 10–20 percent of known pregnancies will end in miscarriage. A common symptom is vaginal bleeding. However, you may also experience abdominal cramps, vomiting, body weakness, lower back pain and a sudden decrease in pregnancy symptoms. Medical News Today+

At the same time, many women with completely normal pregnancies have back pain, cramps or spotting and go on to have healthy babies. Lower back pain by itself, without bleeding or other worrying symptoms, is usually a normal part of pregnancy and not a sign that you are definitely miscarrying. For balanced information, you can read ACOG’s FAQ on early pregnancy loss and NHS guidance on back pain in pregnancy. 

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