Treatment of Iliopsoas Bursitis in Pregnancy
Conservative management with physical therapy focusing on hip rotation strengthening exercises, activity modification, and acetaminophen for pain control is the recommended first-line treatment for iliopsoas bursitis in pregnancy, avoiding NSAIDs and corticosteroid injections when possible.
Initial Conservative Management
The treatment approach should begin with non-pharmacologic interventions that are safe throughout pregnancy:
Activity modification is essential, requiring reduction or temporary cessation of aggravating movements, particularly repetitive hip flexion activities 1
Physical therapy with hip rotation strengthening exercises forms the cornerstone of treatment, with evidence showing 77% of patients achieving pain and function improvement, and most returning to full activity 2
Stretching programs targeting the iliopsoas musculotendinous unit should be incorporated alongside strengthening exercises 1, 2
Pain Management in Pregnancy
For symptomatic relief during conservative treatment:
Acetaminophen is the safest analgesic option throughout pregnancy for managing pain associated with iliopsoas bursitis
NSAIDs should be avoided during pregnancy, particularly in the third trimester due to risks of premature closure of the ductus arteriosus and other fetal complications 1
Corticosteroid injections into the iliopsoas bursa, while effective in non-pregnant patients (showing improvement in pain scores from 7.33 to 2.47 and Harris Hip Scores from 58.49 to 89.91), should be deferred until postpartum when possible 3
Treatment Timeline and Expectations
Conservative management typically requires:
Initial trial of 3-6 months of physical therapy and activity modification before considering other interventions 1, 2
Symptoms may have been present for an average of 12.6 months before diagnosis, so patience with conservative treatment is warranted 2
Follow-up assessment at 3 months to evaluate response to therapy and adjust the treatment plan accordingly 2
When to Escalate Care
Urgent evaluation is needed if:
Fever, severe pain, or systemic symptoms develop, as these may indicate progression to iliopsoas abscess, which is a rare but serious complication in pregnancy requiring CT-guided drainage and intravenous antibiotics 4
Progressive weakness or inability to bear weight occurs, suggesting more severe pathology 4
High-risk factors are present, including intravenous drug use or immunocompromised states 4
Postpartum Considerations
If conservative management fails during pregnancy:
Defer corticosteroid injections targeting the iliopsoas bursa until after delivery, as these have demonstrated efficacy with low complication rates in non-pregnant populations 3
Surgical intervention (arthroscopic iliopsoas lengthening or tenotomy) should be reserved for postpartum period if symptoms persist despite conservative measures and injections, with approximately 28.9% of patients ultimately requiring surgery 1, 3
Critical Pitfalls to Avoid
Do not use NSAIDs during pregnancy, especially in the third trimester, despite their common use in non-pregnant patients with iliopsoas bursitis 1
Do not delay evaluation of worsening back pain with fever in high-risk pregnant women, as this may represent iliopsoas abscess requiring urgent intervention 4
Do not rush to surgical intervention during pregnancy, as conservative management with hip rotation exercises shows good success rates and surgery can be safely deferred to the postpartum period 1, 2