Pain after childbirth: what, where and why it hurts

After being expelled from paradise, man acquired the ability to reproduce his own kind, and women had to give birth to children in agony... Doctors classify pain during childbirth and pain after childbirth as inevitable. Even after virtually painless childbirth, which is carried out under epidural anesthesia, women experience pain in the postpartum period.

Most often, nagging pain after childbirth in the lumbar region and lower back is associated with the displacement of the hip joints, as well as with the manifestation of those changes in the sacrococcygeal spine that occur throughout pregnancy and during the birth of the child.

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Causes of pain after childbirth

We will consider typical pains after childbirth and their most common causes, although, of course, there are many clinical cases when the symptoms of pain after childbirth are of an individual nature. For example, long-term severe headaches after childbirth torment women in labor who have undergone regional epidural (spinal) anesthesia, in which the pain-relieving drug for childbirth is injected into the spine at the border of the lumbar and sacral regions. A severe headache lasting the first three days after childbirth (with a veil before the eyes and nausea) can also be a sign of preeclampsia - if the expectant mother had a persistent increase in blood pressure in the second and third trimesters of pregnancy.

Chest pain after childbirth, or more precisely, chest pain with shortness of breath and cough, may indicate infectious diseases of the lungs, but these are also symptoms of pulmonary embolism (a blood clot entering the pulmonary artery). Pain in the legs after childbirth - in the calves of the legs - can be a sign of life-threatening deep vein thrombosis, which is accompanied by reddening of the skin, swelling and fever. And severe pain after childbirth in the abdominal area can be a sign of inflammation of the uterus at the site of attachment of the placenta.

However, typical causes of pain after childbirth are related to the fact that during the birth of the child, the birth canal is subjected to strong mechanical stress, which is often traumatic.

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Abdominal pain after childbirth

Hormones produced during pregnancy cause relaxation of ligaments and muscles. This is necessary for normal development of the fetus, and during the entire period of bearing a child, the size of the uterus increases by 25 times. After childbirth, the uterus begins to return to its "pre-pregnancy" state. And pain in the lower abdomen after childbirth, which many women in labor define as pain in the uterus after childbirth, is associated with a reduction in the size of the uterus.

These pains are most often cramping and increase during breastfeeding. All this is absolutely normal. The fact is that the hormone oxytocin, which is produced in large quantities by the hypothalamus of a woman who has given birth, enters the blood and stimulates the contraction of the smooth muscles of the uterus. 7-10 days after the birth of the child, such pains in the uterus after childbirth go away on their own.

The bottom of the uterus after childbirth is located approximately at the level of the navel. During the postpartum period, that is, 6-8 weeks, the uterus contracts to its previous size. But in women who had a large belly during pregnancy, the muscle tone of the peritoneum may be weakened, which often causes an umbilical hernia. It is this that provokes pain in the navel after childbirth. To solve this problem, you should see a gynecologist who monitored the pregnancy.

By the way, stomach pain after childbirth, as well as intestinal pain after childbirth, can occur due to constipation, which many women in labor suffer from. In addition, pain in this localization can bother those who have chronic gastrointestinal diseases: they can worsen in the postpartum period. So you can’t do without consulting a specialist.

Back pain after childbirth

As doctors note, the reason why different women feel differently after childbirth largely depends on how their body copes with the change or drop in the level of hormones that were produced during the period of bearing a child.

After childbirth and the delivery of the placenta, the production of certain hormones abruptly stops. For example, the hormone relaxin, which during pregnancy helps increase muscle elasticity and relax the ligaments of the pubic symphysis of the pelvic bones, almost completely stops being produced. But this hormone does not return to normal levels in the body of the woman in labor immediately, but approximately five months after childbirth.

Therefore, the entire musculoskeletal system of a woman after childbirth gradually returns to normal functioning. And some stages of this process cause symptoms of pain after childbirth.

Back pain after childbirth is associated with the fact that relaxin, relaxing the abdominal muscles during pregnancy, also weakens the ligaments around the spine. It is the increased instability of the spine during pregnancy and even some displacement of the vertebrae that leads to nagging back pain after childbirth. Joint pain after childbirth, including wrist pain after childbirth, leg pain after childbirth, and knee pain after childbirth, have the same cause.

Lower back pain after childbirth

Back pain after childbirth is partly a consequence of overstraining the quadratus lumborum muscle, which is located in the area of the back wall of the abdomen and connects the ilium, ribs and transverse processes of the lumbar vertebrae. When it contracts excessively or with prolonged static loads, pain in the lower back and throughout the back begins to be felt.

In addition, during pregnancy, the abdominal muscles stretch and lengthen, and the lumbar muscles, which are responsible for bending and straightening the torso and for the stability of the lower spine, become shorter. And this also causes lower back pain after childbirth. Stretching of the ligaments of the pubic symphysis, spine and pelvic floor muscles are also causes of discomfort and pain in the lumbar region.

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Pelvic pain after childbirth: pain in the sacrum and tailbone

Women usually do not differentiate between pain in the sacrum and coccyx after childbirth, and pain in the coccyx is mistaken for pain in the sacrum. Meanwhile, the coccyx bone consists of several fused rudimentary vertebrae, and the sacrum is a large triangular bone that is located at the base of the spine, just above the coccyx. Together, the coccyx and sacrum make up the lower, immobile section of the spine.

From the front and back surfaces of the sacrum to the pelvic bones there are ligaments that firmly hold the bones of the pelvic ring. But during pregnancy - literally from the very beginning - the woman's musculoskeletal system begins to prepare for childbirth. How?

First, the lumbar vertebrae deviate backward from the spinal axis. Second, the lower limbs begin to move away from the iliac bones, and the hip heads even come out of the acetabulum. Third, the bones of the pubic and sacroiliac joints diverge slightly. Finally, the arc of the coccyx changes, and the usually immobile sacrum bone moves slightly backward. All these changes in the pelvic bones are provided by nature and allow the child to leave the mother's womb.

If the baby is large or its presentation is incorrect, or if the birth was too fast, then pain in the sacrum after birth and pain in the coccyx after birth appear due to excessive pressure on the joints in the pelvic area. Pain in the pelvis after birth is also provoked by overstretching of these joints in the case of forced manual release of the passage for the baby's head during birth.

The more the sacrococcygeal joint was overloaded, the stronger and longer the pelvic pain will be after childbirth and the longer the recovery process will be.

Often, when complaining about pain in the sacral area, women in labor specify that this is pain during defecation after childbirth. Indeed, pain in this localization can become stronger in the case of expansion of the sigmoid colon with the accumulation of feces or in the acute phase of chronic colitis, which is a complication of postpartum constipation. How to get rid of constipation in the postpartum period, we will tell you a little later.

Pain in the pubic area after childbirth

Under the influence of hormones, which "signal" to all systems of the mother's body about the end of the process of childbirth, the mechanism of postpartum recovery is launched. And usually immediately after childbirth, the pubic symphysis is restored, the bones of which slightly diverge during pregnancy.

If everything is normal, then the process of restoring the normal anatomical position of this joint occurs without noticeable consequences.

But if a woman who has given birth complains of pain in the pubis after childbirth, it means that the cartilage connecting the pubic bones is injured due to overstretching of the pelvic floor (which occurs when the head of the child emerging from the womb is straightened). In this case, a violation of the symmetry of the right and left pubic bones is likely. Doctors diagnose this pathology as symphysitis - dysfunction of the pubic articulation, in which the patient feels pain in the pubic area when walking and is forced to walk in a waddling manner.

If the pain is very strong and radiates to all the bones and joints of the pelvis, then this is no longer just a stretch of the cartilage, but a rupture of the pubic symphysis - symphysiolysis.

Pain in the perineum after childbirth

The perineal area (regio perinealis) forms the bottom of the pelvis and consists of muscles, fascia, fatty tissue and skin. Pain in the perineum after childbirth occurs when it is injured - torn or cut (perineotomy).

According to obstetric practice, perineal injuries most often occur in women with well-developed muscles, in elderly primiparous women, with a narrow vagina with inflammatory changes in tissues, with tissue edema, and also in the presence of scars from previous births.

Perineotomy involves cutting only the perineal skin, while episiotomy involves cutting the perineum and the posterior vaginal wall. Both procedures are performed when there is a risk of spontaneous perineal rupture, as well as to avoid craniocerebral trauma to the newborn. If the perineum is torn or cut, it is sutured immediately after birth. External sutures are removed the day before discharge from the hospital, while internal sutures dissolve over time.

In this case, surgical dissection of the perineum is better than rupture, since the wound is smooth and clean and in 95% of cases heals, as doctors say, prima intentio (primary intention) - that is, quickly and without consequences.

However, pain in the perineum after childbirth is inevitable. If hygiene is observed, the wound heals in a couple of weeks, during which the woman should not sit so as not to disturb the stitches. With an episiotomy, the stitches can cause pain in the vagina after childbirth, which will bother you longer - while the healing process of the internal tissues is underway.

Pain in the groin after childbirth

Many women begin to experience pain in the groin area during pregnancy. Groin pain can be caused by the growth of the uterus, as well as the gradual divergence of the pelvic bones. In addition, groin pain after childbirth (radiating to the lower back) can be associated with the presence of a stone in the kidney or ureter. It is also impossible to rule out such a cause as inflammation of the inner mucous membrane of the uterus - endometritis. As noted by gynecologists, acute postpartum endometritis occurs when the uterus is infected during childbirth quite often, while after a cesarean section it occurs in almost 45% of cases.

Acute postpartum endometritis is characterized by symptoms such as pain in the lower abdomen and groin, fever, purulent discharge and uterine bleeding. If you have these signs, you should immediately seek medical help.

In addition, pain in the groin after childbirth is caused by genital herpes, which was diagnosed in a pregnant woman.

Headaches after childbirth

Specialists associate headaches after childbirth with several reasons. First of all, this is a change in hormonal levels in the postpartum period: instability of estrogen and progesterone levels. Moreover, if the mother does not breastfeed, headaches occur much more often than in nursing women. Taking contraceptives containing estrogen also contributes to headaches after childbirth.

Stress, overwork, lack of sleep, etc. have a negative impact on a woman's health in the postpartum period. Against the background of hormonal changes, these factors can lead to the fact that the new mother will be bothered by frequent and quite intense headaches after childbirth.

Muscle pain after childbirth

Muscle pains of various localizations (in the lower back, pelvic muscles, legs, back, chest, etc.) are a natural phenomenon after such strong muscle tension, which they experience during the birth of a child. Such pains pass naturally and do not require any therapy.

However, it should be kept in mind that all the changes that the body of a woman who has given birth has to go through again must be monitored and existing diseases must not be exacerbated. For example, diseases of the spine, genital area, gastrointestinal tract, which can manifest themselves with renewed vigor after the stresses endured during childbirth.

Chest pain after childbirth

We have already talked about the hormone oxytocin, which stimulates contraction of the uterus after childbirth. In addition, oxytocin has another important function. During lactation, it causes contraction of the myoepithelial cells surrounding the alveoli and ducts of the mammary gland. Due to this, breast milk produced under the influence of the hormone prolactin passes into the subareolar ducts of the mammary gland and is released from the nipples.

Milk appears in the breast after the birth of the child - first in the form of colostrum. The timing of the "arrival" of the milk itself is individual, but obstetricians consider 48-72 hours after birth to be the norm for the onset of lactation. This process occurs literally before your eyes - by swelling of the mammary glands, which is often accompanied by pain in the chest after childbirth. In the future, the process of milk production will be regulated, and all unpleasant sensations will pass.

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Pain during menstruation after childbirth

Very often after childbirth, women's periods become less regular than before pregnancy. And for 5-6 months after the birth of the baby, this should not be a cause for concern. In addition, the first 4 months after childbirth, the periods can be of varying intensity and duration. Which is also not a pathology, since hormonal changes to the "pre-pregnancy" regime continue.

It has been noted that most women who had algomenorrhea (painful menstruation) before pregnancy are freed from these pains after childbirth, or at least the pains become much weaker. But the opposite also happens - menstrual pains after childbirth begin in those who have never experienced them before.

If you have the slightest concerns about the restoration of your menstrual cycle after childbirth, including pain, you should consult a gynecologist.

Pain when urinating after childbirth

Pain when urinating after childbirth and an unpleasant burning sensation during this physiological process is a very common occurrence in the first days of the postpartum period.

Often, women in labor also face such problems as the inability to empty the bladder due to a complete lack of urges. All these symptoms have causes. The fact is that the space for the expansion of the bladder after childbirth has increased, or the bladder may have been injured during childbirth, then the urge may be absent for some time.

Pain when urinating after childbirth is caused by swelling of the perineum, as well as soreness of the stitches applied when suturing a tear or incision in the perineum. In any case, 8 hours after the completion of childbirth, the woman should empty her bladder. This is extremely important both for contraction of the uterus and for preventing possible infection of the urinary tract.

If pain during urination after childbirth continues after the perineal suture has healed, then this is already a sign of trouble: probably inflammation of the bladder, which is accompanied by an increase in temperature. In this case, you should immediately seek medical help.

Pain during sex after childbirth

Postpartum recovery normally takes at least two months. Before this period, doctors do not recommend resuming sexual relations between spouses. However, even after these two months, at least a third of women feel physical discomfort and even pain during sex after childbirth.

Pain in the vagina after childbirth can be caused by various local infections that have led to inflammation of the mucous membrane of the genitals, and this is the reason for painful sensations during sex after childbirth. And pain in the clitoris after childbirth is associated with its swelling and the presence of stitches in the perineum, especially after an episiotomy.

Diagnosis of pain after childbirth

In order to timely detect possible pathologies after the birth of a child, every woman needs to visit her doctor - one and a half months after childbirth. This visit will not be superfluous, even if the woman feels well and does not complain about anything.

A gynecologist's examination will first of all show how things are with a woman's reproductive organs. The health of a woman largely depends on their health.

If there are any complaints, the diagnosis is made on the basis of the same examination and collection of anamnesis, including the history of labor, which indicates all stages, complications and manipulations performed.

If there is a need to see a doctor of another specialty (for example, an orthopedic neurologist, gastroenterologist, nephrologist), the patient is given a corresponding referral. And then the diagnosis of the existing pathology is carried out by a narrow specialist - using appropriate methods. For example, in case of pain in the pubis after childbirth, the diagnosis of symphysitis or symphysiolysis is made on the basis of an examination using an X-ray or a CT scanner.

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Treatment of pain after childbirth

Lower abdominal pain after childbirth will disappear on its own in a maximum of 7-10 days, but this will happen faster if the woman establishes normal emptying of the bladder, which will allow the uterus to contract.

Doctors say that you can use Panthenol spray for pain in the perineum after childbirth (usually it is used to treat burns). This bactericidal and local anesthetic drug is used to speed up the healing of various skin and mucous membrane injuries and postoperative wounds. Panthenol is applied to the damaged skin several times a day, it can be used during pregnancy and breastfeeding.

In order to cause as little trauma to the perineal sutures as possible, doctors recommend using not regular pads, but special postpartum pads, in which the top layer is made of a material that does not stick to the suture.

For back pain after childbirth and back pain after childbirth, physical exercises are recommended:

• lying on your back, bend your right leg at the knee, the left one remains in a horizontal position,
• place the toe of the bent right leg under the calf of the lying left leg,
• With your left hand, grab your right thigh and tilt your right knee to the left.

This exercise is performed 8-10 times, then the same is done with the left leg.

If you have back pain, try to bend over less, do not lift anything heavy, and choose a position during feeding that is most comfortable for your back - with mandatory support under the lumbar region.

The most important task in the postpartum period is to get rid of constipation! Since problems with stool can increase pain in the coccyx and sacrum. No laxatives, except - in extreme cases - enemas or glycerin suppositories. The best and safest thing is to eat dried fruits, oatmeal, fermented milk products; take a tablespoon of sunflower oil in the morning, and drink a glass of cold purified water without gas on an empty stomach.

Remember that any laxative medication during breastfeeding will have a similar effect on your baby. But constipation in the mother will also cause intestinal problems in the baby.

But when treating pubic pain after childbirth, especially in the case of a ruptured pubic symphysis (symphysiolysis), bed rest, painkillers, physiotherapy procedures and a pelvic bandage to fix the bones are necessary. All this should be prescribed by a doctor - after making a diagnosis.

Folk remedies for treating postpartum pain include decoctions and infusions of medicinal plants. Thus, shepherd's purse is not only an excellent hemostatic agent, but also promotes uterine contraction. A decoction of shepherd's purse is prepared at the rate of one teaspoon of the herb per glass of boiling water (poured and infused for about half an hour). It is recommended to drink it three times a day, one tablespoon at a time.

Aloe will help in healing perineal tears: squeeze the juice from a leaf onto a sanitary pad. A compress with a decoction of ginger root will reduce pain from a cut or tear in the perineum, and will also soften the breast, hardened by the flow of milk: 50 g of ginger per liter of water.

You can relieve a headache after childbirth with the help of essential oils (lavender, lemon, grapefruit, basil, rosemary and lemon balm), which are rubbed on the temples, behind the ears and the area of the cervical vertebrae.

If the pain after childbirth does not stop (or intensifies) three months after the birth of the child, then treatment is necessary. But the use of any medications by a nursing woman, primarily painkillers, without a doctor's recommendation is unacceptable!

Prevention of pain after childbirth

Prevention of postpartum pain should begin during pregnancy. For example, to reduce postpartum pain in the lumbar region, expectant mothers need to do special fitness or water aerobics, master and correctly apply breathing techniques during labor. To avoid problems with pain in the spine, legs and muscles, it is necessary to strictly monitor your weight throughout pregnancy and prevent persistent swelling of the legs.

The postpartum period normally lasts from six to eight weeks. During this time, the mother's body is rebuilt again, and her reproductive organs return to their pre-natal state - they involution. Unfortunately, most women who have given birth experience pain after childbirth. But the pain quickly passes, and the joy of motherhood remains for life!

And so that the pain after childbirth does not spoil this joy, do not forget to consult with your gynecologist. His recommendations will help you to get back to normal faster and stay healthy.