Giving birth is an intensely painful yet beautiful experience. Many women choose to have an epidural injection for pain relief during labor and delivery. While epidurals are generally safe, some women experience back pain after receiving one.
If you have lingering back discomfort following your epidural, you likely have questions and concerns.
Read on to learn what causes this symptom, treatment options, and tips to support healthy recovery.
What is an Epidural Injection?
An epidural is a form of regional anesthesia delivered into the epidural space surrounding the spinal cord and nerves. A skilled anesthesiologist inserts a thin catheter near the lower back, through which medication is administered. This blocks nerve signals from the lower body, providing pain relief especially in the abdomen, pelvis and legs.
Epidurals allow a woman to remain awake during childbirth while significantly reducing discomfort.
What Causes Back Pain After an Epidural Injection?
Up to 1 in 3 women report back pain following an epidural. There are several potential causes for this symptom:
- Needle injury during insertion if improper technique is used or anatomic challenges present. Touching bone, ligaments or nerves can cause irritation.
- Inflammation around the nerves or epidural space from medication or inserted catheter. This can cause nerve impingement or irritation.
- Awkward positions during labor with an epidural block in place can strain soft tissues and put pressure on nerves.
- Side effects from medications used in the epidural cocktail, like bupivacaine or fentanyl, may worsen back muscles spasms or nerve pain.
- Rare complications like bleeding or abscess in the epidural space can cause severe back discomfort.
For most women, the back pain after an epidural is temporary and improves within days or weeks. But rarely can it become a chronic issue lasting months.
What is the Connection Between Back Pain and Epidural?
Research shows that back pain is a relatively common side effect after an epidural.
In studies, 24-37% of women report back pain following epidural analgesia. This data indicates some correlation, though many factors contribute to postpartum discomfort. The suspected mechanism is unintentional irritation or inflammation of spinal nerves during epidural placement and infusion.
Can Epidural Cause Pain at the Injection Site?
Yes, you may experience soreness or tenderness at the epidural insertion site for a few days. Contributing factors include:
- Bruising from pressure needed to insert the needle and catheter into the epidural space.
- Nerve irritation if the needle came in contact with peripheral nerves during placement.
- Infection risk, although rare if proper sterile technique is used.
- Muscle aches if you had to hold still in an awkward bent-over position during insertion.
- Potential small hematoma or swelling around the injection site.
- Tingling if medication pooled too close to a nerve.
To help avoid injection site pain, your anesthesia provider will use landmarks like the iliac crest to guide optimal needle placement. They will also inject local anesthetic first to numb the puncture location. Take note of any intense or lasting pain at the injection site and notify your doctor promptly.
What is the Connection Between Lower Back Pain and Epidural?
It is very common to experience lower back pain after an epidural, given the anatomy. The epidural space spans from your mid-back through the sacral area surrounding nerves exiting the lumbar spinal cord. So any irritation to these low spinal nerves may be felt as referral pain in the low back.
Plus, strain placed on pelvic ligaments and tissues during delivery can radiate up into the lumbar region. While pain higher up is possible, most women experience discomfort concentrated in the lower back. Try a heating pad on the area and talk to your doctor if leg weakness arises.
Can Epidural Injections Cause Long-Term Back Pain?
While rare, an epidural does carry risks that could result in lasting back discomfort including:
- Anatomical issues like spinal stenosis make needle placement difficult, increasing risk of hitting a nerve or ligament.
- Adhesions or scar tissue forms in the epidural space that presses on nerves.
- Abscess or infection develops, causing inflammation.
- Hematoma forms, putting pressure on nerve roots.
Can Epidural Cause Back Pain Years Later?
A small percentage of women do complain of back pain persisting months or years after receiving an epidural. One study found that a small percentage of women still reported back pain 6 years later.
However, researchers have not found a clear causal link. Other individual factors likely contribute, like arthritis, disk degeneration, musculoskeletal issues unrelated to the actual epidural. There does appear to be a subset of patients more prone to lasting neuropathic pain.
How Long Does Back Pain Last After Epidural?
Most women experience improvement in back pain within 1 week after delivery, though it can persist up to 6 weeks. Exact duration depends on factors like:
- Skill of anesthesiologist performing the epidural.
- Number of epidural attempts needed.
- Gauge of needle used.
- Positioning during labor and delivery.
- Medications administered, dosages.
- Your individual anatomy and healing factors.
- Onset of any postpartum exercises and mobility.
What are the Side Effects of Back Pain from Epidural Injection?
Lingering back discomfort after an epidural can negatively impact the joy of new motherhood:
- Difficulty caring for a baby if bending and lifting cause pain.
- Interrupted sleep from discomfort if unable to find positions comfortable for rest.
- Interference with optimal breastfeeding positions and techniques.
- Inability to fully enjoy time with a newborn due to pain and frustration.
- Anxiety about ongoing or worsening back pain.
- Stress within family relationships.
- Depression if prevented from typical activities.
Seeking prompt treatment helps minimize these undesirable effects. Be open with your support system about physical and emotional struggles.
Can an Epidural Cause Back Issues?
While an epidural does not directly cause structural spine problems, some secondary changes that provoke discomfort are possible:
- Strained muscles and ligaments from birthing positions.
- Pelvic floor or abdominal muscle weakness after pregnancy.
- Postural and gait changes following delivery.
- Nerve inflammation and muscle spasms.
- Stress placed on spinal segments.
Proper rest, spinal alignment, targeted exercise, and physical therapy can help retrain muscles and nerves after delivery to prevent or reduce back issues. Gentle massage and nerve stimulation techniques may also provide relief.
What is the Treatment for Back Pain After Epidural?
If back discomfort lingers more than 1-2 weeks after giving birth, call your physician to discuss options. Postpartum back pain treatment may include:
- Resting positions to take pressure off sore areas.
- Ice packs and heat therapy for pain relief.
- Over-the-counter nonsteroidal anti-inflammatories or APAP.
- Physical therapy evaluation and exercises to improve mobility.
- Massage or stim therapy to relax muscles.
- Chiropractic adjustment if spine mobility is compromised.
- Acupuncture to reduce muscle spasms and improve healing.
- Additional epidural steroid injection is rarely used for treatment.
- Oral steroids like prednisone if severe nerve inflammation is present.
- Surgery if conservative measures fail and severe pathology like abscess, hematoma or slipped disc present.
Focus on building core strength, maintaining proper posture and opening up restricted joint movement after delivery. Avoid activities that exacerbate pain.
Can Epidural Provide Relief from Back Pain?
The medications administered through an epidural effectively reduce pain during labor and delivery by numbing sensations from the uterus and birth canal. However, they do not specifically treat pre-existing back pain. An epidural only minimizes discomfort associated with the birthing process itself, such as uterine cramping and vaginal stretching.
What is the Recovery Process from an Epidural Steroid Injection?
After receiving an epidural:
- Remain in bed for prescribed time, usually 1-2 hours after birth or until sensation returns.
- Avoid straining, bending or lifting anything heavier than a baby to prevent injury.
- Expect numbness or tingling to persist for 1-6 hours post-delivery as medication wears off.
- Drink fluids to prevent spinal headache from leakage of cerebrospinal fluid.
- Take over-the-counter pain relievers as needed for soreness.
- Apply ice to the injection site for swelling.
- Call a doctor if you experience fever, chills, severe headache, difficulty urinating or weakness.
- Schedule a follow up visit if you have any concerns about ongoing back pain.
- Begin postnatal exercises once approved by OB-GYN.
Stages of Epidural Recovery
| Stage | Timeline | Activities |
| 1 | 0-24 hours | Bed restMonitor vitalsIce pack injection site |
| 2 | 1-3 days | Manage sorenessBegin postpartum exercises |
| 3 | 1 week+ | Follow up doctor visitSeek treatment if back pain persists |
Listen to your symptoms and notify your provider promptly about any troubling signs.
Finding Relief from Back Pain After Your Epidural
If you’re reading this, you’re likely one of the many new mothers dealing with lingering back pain after receiving an epidural during labor.
We completely understand the frustration and discomfort you must be experiencing. As your partner in managing chronic back pain, we want you to know that you don’t have to suffer silently. Help and hope are out there.
At Kaly, we have experts who have helped thousands of moms effectively manage discomfort following their epidural and get back to enjoying time with their new baby.
Schedule a consultation with us today, because you and your baby deserve to enjoy this special time— we’re here to make that happen!