Pelvic pain 4 months after childbirth. Why does the pubic bone hurt and swell after childbirth?

Delivery - difficult process, involving many systems of the body. After the birth of a child, the woman in labor feels weakness, fatigue, and sometimes pain. Thus, 50% of women have pain in their pelvic bones after childbirth, which causes them discomfort and prevents them from living fully and caring for their child.

Causes of pain

There are several reasons for the occurrence of unpleasant sensations in the pelvic bones. They are associated with changes that allow the body to adapt to pregnancy and ensure the passage of the child through the birth canal.

Drawing or sharp pain with shooting in the pelvic area is a reason to consult a doctor for examination and treatment.

Possible diseases

Many pregnant women experience a disease such as symphysitis. The pubic bones are connected to each other by a fibrocartilaginous disc called the symphysis. Under the influence of hormones and fetal pressure, the symphysis stretches by 5–6 mm or more. As this discrepancy increases and inflammation joins, symphysitis is diagnosed.

Symphysites are characterized by painful sensations when walking, changing body position, or physical activity. The gait changes (becomes similar to that of a duck), discomfort appears when urinating and defecating.

The disease is diagnosed by palpation. When pressing on the symphysis in pubic area arises sharp pain. Also used for diagnostics ultrasonography, which, however, allows for small errors. The most accurate degree of symphysitis can be determined by X-ray examination. If the discrepancy is more than 1 cm, doctors may decide to refer you for a caesarean section.

Rupture of the symphysis during childbirth is a rare phenomenon that requires surgical intervention and long-term bed rest for several months.

Postpartum recovery includes a number of measures to connect the separated parts of the symphysis pubis and limit their movement:

Bed rest and reduction physical activity. During the first time after childbirth, women need to reduce their workload and, if possible, entrust the care of the child to their relatives.
Bandage. Special bandages have been developed that wrap around the thighs, limiting the mobility of the hip joints and pubic bones.
Visiting an osteopath. As your condition improves, your doctor will prescribe a set of physical therapy exercises.
Restoring vitamin and mineral balance to strengthen bones and connective tissue.
Anti-inflammatory therapy and physiotherapy in a day hospital.

The course of treatment is drawn up individually after examination and consultation with a therapist, gynecologist, osteopath and surgeon. In some cases, surgery with the introduction of steel supporting structures is prescribed.

How to relieve pain

Severe pain in the coccyx and pubic area is relieved with painkillers, conditionally permitted for breastfeeding: Ibuprofen, Paracetamol. At artificial feeding You can take any effective painkillers for which the mother in labor has no individual contraindications: Pentalgin, Ketanov, No-shpa, etc.

It happens that stress and unstable hormonal levels depress the central nervous system and change the perception of pain. In this case, it is recommended to take sedatives that are relatively safe during breastfeeding: Glycine, Valerian, Motherwort tablets.

Preventive measures

Prevention of symphysitis during pregnancy helps to avoid postpartum complications.

Recommended to do special gymnastics, stretching and strengthening muscles pelvic floor.
During an uncomplicated pregnancy, you need to walk a lot, go for walks fresh air. Walking helps strengthen musculoskeletal system, and ultraviolet rays enhance the production of vitamin D, necessary for the absorption of calcium.
It is necessary to take a vitamin-mineral complex, which includes calcium and phosphorus, which help strengthen bones and connective tissue.
Proper nutrition combined with moderate exercise helps maintain normal balance. useful substances, providing wellness and the functioning of body systems that will be involved in childbirth.

Many pregnant and postpartum women experience pain in their pelvic bones. This is due to changed hormonal levels, increased workload and is a variant of the norm. Paying attention to yourself, observing your sensations, regular examinations and following your doctor’s recommendations will help you avoid injuries and quickly recover after the birth of your child.

Sometimes after childbirth there are complaints of pain or discomfort“crunching” in the symphysis pubis, which intensifies when changing position or walking up the stairs. A diagnosis is made: symphysitis. As a rule, a woman associates the resulting pathology with the birth. Is this fair?

A little anatomy to find out Why do my pelvic bones hurt after childbirth??
During childbirth, the fetus passes through the woman's bony pelvis, which is formed from the sides by two pelvic bones(fused pubic, ischial and ilium), and behind - the sacrum. Both pelvic bones are connected in front by the pubic joint - the symphysis, and in the back - by two sacroiliac joints.
The pubic symphysis is the pubic fusion of both pubic bones of the pelvis through a fibrocartilaginous disc, in the center of which there is an articular cavity in the form of a slit filled with articular fluid. In front and behind, above and below, the symphysis is strengthened by ligaments that give strength to this joint. The pubic symphysis is a semi-joint, i.e. has an extremely limited range of movement. Normally, the width of the symphysis (the distance between the pubic bones) can be up to 1 cm.
In front of the pubic symphysis is the pubis with its fatty lining and the ligament that elevates the clitoris. Nerves and blood vessels pass below the symphysis. Behind the pubic symphysis are the urethra and bladder.Symphysitis- This common name changes and damage to the symphysis pubis, which hides up to 16 components: loosening, softening, edematous impregnation, stretching, expansion, divergence, rupture, inflammatory process, special shape hypovitaminosis, symphysiopathy, symphysitis itself, etc. Most often, these changes arise and manifest themselves during pregnancy, childbirth and postpartum period. This article will discuss the consequences that they can lead to. Divergence of the symphysis pubis.
It arises as a result of events physiological changes as an adaptive process to facilitate childbirth; those. these are normal changes.
At physiological pregnancy the ovaries and placenta secrete a substance called relaxin, which has a specific relaxing effect. Under the combined action of relaxin and female sex hormones articular cartilage and the ligaments swell, loosen, additional gaps filled with fluid appear in the joints, resulting in an increase in mobility in the pelvic joints and an increase in the distance between the bones that form each joint.
These changes are especially pronounced in the symphysis pubis, there is an increase in blood supply, swelling and loosening of everything ligamentous apparatus. The width of the pubic articulation increases by 5-6 mm, small movements (up to 10 mm) of the articular ends of the pubic bones up and down are possible, like the keys of a piano. The width of the pubic joint reaches 1.5 cm, the divergence of the sacroiliac joint increases to a lesser extent.
In the postpartum period, all these changes are gradually eliminated - the cartilage in the joints becomes denser, the ligaments acquire their former elasticity and density, and the width of the joint space decreases. Symphysiopathy. This is the name for excessive relaxation of the symphysis pubis as a manifestation of toxicosis in pregnant women with a predominant lesion osteoarticular system woman's body. For some women these changes in the structure of the joints go beyond physiological processes, acquire pathological character and lead to excessive divergence of the pelvic joints. Symphysiopathy is characterized by the appearance of complaints and symptoms in the presence of discrepancies in the symphysis pubis. There are three degrees of divergence of the symphysis (above the physiological discrepancy of 5-6 mm):
I degree - discrepancy by 5-9 mm;
II degree - by 10-20 mm;
III degree - more than 20 mm.
The leading role in the development of symphysiopathy is played by disturbances in phosphorus-calcium metabolism and lack of vitamin D. Calcium is the main structural component skeletal bones and teeth. The metabolism of calcium and phosphorus is regulated mainly by the hormone pair thyroid gland, calcitonin - a thyroid hormone - and vitamin D, depends on quality composition food, the ratio of calcium, phosphorus and magnesium in it. When the phosphorus-calcium balance is disturbed in the direction of decreasing calcium, these elements come to the fetus from the “reserves” of the mother’s body - bones and teeth.
With a lack of vitamin D, bone mineralization is impaired due to impaired absorption of calcium and phosphorus from the intestine, as well as their mobilization from bone tissue. A decrease in blood calcium levels may also occur with concomitant pathology: diseases gastrointestinal tract, chronic enteritis, dysfunction of the parathyroid gland, renal failure, diabetes mellitus, as well as with a diet insufficient in calcium, vomiting during pregnancy and other conditions. Against such a painful background, pregnancy and breastfeeding can aggravate calcium deficiency.
As a rule, symphysiopathy manifests itself long before childbirth. Against the background of calcium starvation, tooth decay, brittle nails, general fatigue, paresthesia (the appearance of a tingling sensation and changes in skin sensitivity), twitching and contraction of individual muscles are characteristic, night cramps in the calf muscles. With minor discrepancies in the symphysis, the appearance of “flying” pain in the pelvic bones and lower back is regarded as radiculitis, osteochondrosis, or threat of miscarriage. In the second and third trimester of pregnancy, symphysiopathy is characterized by pain and discomfort in the pelvic bones when walking and standing.
The disease is not uncommon. Symphysiopathy may not make itself felt before childbirth and may be hidden. In the second half of pregnancy, the pubic bone ratio is constrained by the tension of the abdominal muscles due to the enlargement of the uterus. Immediately after childbirth, flabbiness of the abdominal muscles occurs and the discrepancy of the pubic bones can increase to 20 mm or more. For divergence of the symphysis pubis II and especially III degree during pregnancy and childbirth, diagnosis is not difficult: a change in the nature of pain in the symphysis occurs, which intensifies when turning in bed, when active movement legs, often a woman cannot walk. In bed, the patient takes a certain position - the “frog pose”: she lies on her back with her hips turned outward and her hips turned outward and her knees slightly bent.
When pressing on the pubic symphysis, both from the front and from the vagina, severe pain is determined. In addition, you can determine the discrepancy itself - the fingertip is placed in it. A significant discrepancy of the symphysis pubis (more than 2 cm) is also indicated by the appearance of a waddling, duck-like gait.
The diagnosis is clarified by x-ray and ultrasound diagnostics. During pregnancy, preference is given to ultrasound diagnostics, considering bad influence x-rays for the fruit. Typically, an X-ray of the pelvis reveals discrepancy of the symphysis pubis of varying degrees, but there are no pathological changes in the bones.
When determining the concentration of calcium and magnesium in the blood and urine, their amount in the blood decreases by almost half, and their content in the urine is slightly increased. Only by determining the content of calcium and magnesium in the blood and urine of a pregnant woman in the absence of complaints can one predict the divergence of the symphysis pubis.
The course of symphysiopathy is usually favorable. This disease in itself during pregnancy is not an indication for delivery through surgery. caesarean section- neither as planned nor in urgently. For determining obstetric tactics In choosing a method of delivery, the size of the divergence of the symphysis pubis is important.
If there is pronounced divergence of the symphysis during pregnancy and there is a risk of injury to the pelvic bone during childbirth, delivery is performed by cesarean section. With a narrowing of the pelvis and a relatively large size of the fetus with a voluminous dense head, the critical distance of divergence should be considered 10 mm.
Rupture of the symphysis. This severe form of symphysis injury is rare. It is characterized by a violation of the integrity of the joint, is most often associated with childbirth and occurs when the divergence of the symphysis pubis of the third degree is more than 2 cm. Rupture of the symphysis pubis with damage to the ligaments is often combined with damage to one or both sacroiliac joints and usually occurs during childbirth with operative delivery ( obstetric forceps) or when a narrowed pelvis is combined with violent labor.
Mechanical trauma itself does not have a dominant significance: the tensile strength of the pubic symphysis is on average 200 kg. Of primary importance are changes associated with symphysiopathy, as well as previous inflammatory changes in the pubic bones and pubic symphysis, and even minor mechanical impact is an impetus for breaking the weak adhesion of the ligamentous apparatus.
In most cases, during childbirth there is a slow spreading of the tissues of the symphysis pubis, so complaints of pain in the pubic area, aggravated by moving the legs, appear a few hours or on the 2nd -3rd day after birth. Only in in rare cases the woman in labor feels a sharp pain in the pubic area, sometimes audible characteristic sound ruptured ligaments, after which even a large fetal head quickly descends through the expanded bone ring.
Rupture of the pubic symphysis is sometimes accompanied by injury to the bladder and urethra, the formation of hematomas in the pubic area and labia, and the addition of an inflammatory process - symphysitis.
The postpartum woman cannot raise her legs (symptom of “stuck heel”) and turn on her side; in bed she takes a forced position (“frog pose”). On palpation both from the front and from the side of the vagina, severe pain is determined and, in addition, mobility of the pubic bones and retraction due to their wide distance from each other.
The nature of the damage is clarified when X-ray examination. A rupture of the symphysis pubis is indicated by: divergence of the pubic bones up to 7-8 cm,
the presence of a vertical displacement of the horizontal branch of the bone by 4 mm or more.
Without special treatment symphyseal ligaments do not fuse or are connected by scar tissue, forming false joint, therefore, when walking, both halves of the pelvis subsequently make rocking movements, a “duck walk” appears, and constant complaints of lumbosacral pain are regarded as radiculitis.
In severe cases of damage to the symphysis pubis (rupture, severe sprain), as well as in the absence of effect from conservative treatment are usually used surgical treatment using metal structures, applying lavsan and wire sutures. Working capacity is restored 3-4 months after surgery.
Symphysitis. This term means changes in the pubic symphysis caused by the inflammatory process. Symphysitis is characterized by the fact that in the presence or absence of a pronounced divergence of the pubic bones, the disease is accompanied by a characteristic inflammatory reaction: pain, impaired movement in the limbs, swelling and redness in the pubic area, and a feverish state. The x-ray shows the discrepancy of the symphysis pubis with the phenomena of osteoporosis (rarefaction) in the bone tissue.
Chronic inflammatory processes in the bladder (cystitis) and urethra(urethritis) may be accompanied focal changes in the pubic symphysis. The disease develops when there is chronic infection in the genitourinary tract (ureaplasma, mycoplasma, herpetic infection, staphylococcus carriage) in pregnant and postpartum women against the background of calcium and magnesium deficiency, with hypovitaminosis D. The use of antibacterial therapy in combination with calcium and magnesium preparations, UV irradiation gives excellent and rapid therapeutic effect even with severe course symphysitis with pronounced divergence of the symphysis pubis.
For the prevention of symphysiopathy and other damage to the symphysis pubis, the following are important:

A diet rich in minerals and trace elements involved in the formation of the skeleton (calcium, phosphorus, magnesium, zinc, manganese), as well as rich in vitamin D: milk, lactic acid products, yoghurts, low-fat cheeses, eggs (yolk), meat and liver of mammals and birds, fatty fish meat, fish liver, caviar, seafood, as well as legumes, mushrooms, herbs, nuts.
Sufficient physical activity during pregnancy, visiting schools for expectant mothers where it is used physiotherapy to strengthen the muscles of the back, abdomen, buttocks and stretch the pelvic floor ligaments.
Prolonged stay in the fresh air. Under influence ultraviolet rays sunlight Vitamin D is produced in the skin.
Taking multivitamins for pregnant women, biologically active additives with trace elements and antioxidants.
For poor calcium absorption associated with gastrointestinal disease, take digestive enzymes, fight against dysbiosis.

Treatment of symphysiopathy
If the pubic symphysis diverges during pregnancy and childbirth, as a rule, surgery can be avoided.
In case of development of symphysiopathy with slight divergence of the symphysis pubis during pregnancy or after childbirth, restriction is recommended physical activity, wearing a bandage, sleeping on an orthopedic mattress, taking calcium supplements in a well-absorbable form (CALCIUM CARBONATE, CALCIUM L ACT), CaDs NYCOMED, FISH OIL (preferably in capsules), MAGNE Be, B vitamins, UV irradiation. In the presence of a urogenital infection, it is prescribed antibacterial therapy taking into account sensitivity to antibiotics. It is also recommended to use painkillers in the form of gels, ointments or suppositories and tablets.
At II and III degrees divergence of the pubic bones in the postpartum period, the main thing is to bring the ends of the pubic bones closer together and hold the pelvic bones in a certain position. This is achieved by bed rest (you cannot get up and walk for 2 to 6 weeks after birth), as well as by using a bandage or tight bandage. On the first day after birth, cold is used, and subsequently physiotherapeutic procedures are used on the area of the symphysis pubis. Calcium supplements and painkillers are used; if inflammation occurs (symphysitis), antibacterial therapy and a diet with increased content calcium.
After the expiration of the period, X-ray control is carried out, after which the woman begins to wear a bandage.
Currently, special corsets are used that help hold the pelvic bones in a certain position, which allows for expansion bed rest. Usually, after 3-5 days of bed rest in a corset, a woman can already get up and care for her child. The corset is worn from 3 to 6 months.
In order to facilitate childbirth, eliminate the existing obstacle to the passage of the fetus, especially the head through the bone ring in the presence of pelvic narrowing, from ancient times to the present in some countries of Africa and Latin America They use a pelvic dilatation operation - symphysiotomy (dissection of the symphysis).

Orthopedic traumatologist, first category surgeon, Research Institute, 2009

Pregnancy is always a huge burden on a woman’s body. It especially increases in the third trimester, when the baby grows up and puts pressure on almost everything. internal organs. However, childbirth can also be a serious challenge.

According to statistics, more than half of new mothers complain that their pelvic bones hurt after childbirth. This syndrome may indicate serious problems in a woman’s body, and therefore there is no point in delaying a visit to the doctor. Deals with such issues narrow specialist– a vertebrologist who will not ignore any pain in the hip joint after childbirth, will prescribe a serious examination, and after receiving its results will give recommendations for treatment.

Disappointing statistics indicate that pelvic bones hurt after childbirth not only in women predisposed to diseases of the pelvis and spine. Even quite healthy young ladies that lead passive image life, move little, eat poorly and work in a sedentary job, and may complain of hip pain after childbirth. Lack of movement significantly weakens the body of the expectant mother, this applies to both the pelvic bones and muscles. After delivery naturally such women may complain about unpleasant symptoms, including on:

Pulling and dull pain, which can be constant and worsen during movements or even during sleep;
Feeling of tightness in the muscles;
Limited movement;
Muscle spasm that long time does not pass.

Immediately after these symptoms appear, you should consult a doctor. He will conduct an examination, prescribe a diagnosis and find the root cause of the pain.

Features and needs of diagnostics

Pelvic pain after childbirth is a condition that, in pathology, almost never goes away on its own. Over time, unpleasant sensations can only increase, and therefore you can’t procrastinate, you should immediately consult a doctor. The doctor will decide what kind of research will be needed to identify the cause of pelvic pain after childbirth. Among the methods used:

After necessary examination You can make a diagnosis and establish the cause of the pain that occurs. The patient may be diagnosed with symphysitis, the severity of which will depend on the distance between the pelvic bones. There are several stages of the disease: I – up to 1 cm, II – up to 1.99 cm, III – 2.0 cm or more. If the third stage is detected, the doctor may make another diagnosis - “rupture of the symphysis pubis.”

Causes of pain syndrome

If after childbirth your leg hurts in the hip and pelvic area, an examination will be required. It can reveal displacement of the pelvic bones during childbirth. In some cases, the tailbone and pelvic bones may also become displaced. This is necessary to free the fetus to pass through the birth canal. Nature intended for this process to be virtually painless, since the woman’s body prepares for this for a long time. And while the woman may not notice the displacement itself, the process of return is quite noticeable, and therefore can bring a lot of suffering. Often young mothers complain that their hips hurt after childbirth. This may indicate that:

There is a lack of calcium in the body - during gestation and during delivery, calcium is simply washed out of the body, and therefore the body lacks resources, which is indicated by pain syndromes.
Softening of the tissues has occurred - this is natural process, which is due to an increase a certain hormone, which is secreted by the body to calm the woman in labor. Since the tissues cannot perform the functions assigned to them, this leads to pain.
Sprained ligaments and muscles are a condition that can also cause discomfort.
Birth trauma is what most often explains why the hip joint hurts after childbirth. Dislocation, bone fracture, tissue rupture - all this can cause severe pain. Failure to see a doctor in a timely manner can lead to bones not healing properly. And this will already entail a change in gait.

The role of calcium in the mother's condition

Already at 30–34 weeks, you can notice that the pregnant woman begins to involuntarily tilt her body back, trying to shift her weight. Nature has also provided something else - a change in gait to a “duck” one, when a woman shifts from one foot to the other. But by this point future mommy He already has time to get used to the unpleasant stretching in the lumbar region, even to the pain. They may be provoked insufficient quantity calcium. This causes the development of symphysiopathy, which is why the doctor observing the pregnant woman necessarily prescribes calcium.

Medicines strengthen bones and also reduce pain. However, you should not be zealous in taking it - the dosage is strictly observed to avoid negative consequences, which includes the formation of kidney stones. The right approach to solve this problem eliminates pain even after childbirth.

Symphysis

If the pelvis hurts after childbirth, the cause may be a change in the structure of soft tissues - dense cartilage and symphysis, located in the area of the pubis and pelvic bone. Disjunction of bone tissue after childbirth is no longer uncommon, and this condition can lead to sharp and severe pain, which often does not go away, but only increases. Painful condition can be so strong that it is difficult for a woman to walk or stand normally.

Treatment of symphysis

What to do if your pelvis hurts after childbirth? Contact a verterbrologist or another doctor who will examine the patient and take rational decision about the need for treatment. Sometimes the body copes on its own, but this is in the case of minimal damage. If the pain continues for a long time after childbirth, serious treatment will be required. The doctor decides whether it is necessary:

Quite often, doctors advise combining bed rest with exercise. You should not select exercises yourself; an osteopath should work with the patient. He also assesses the condition and makes a decision about the possibility/impossibility of performing a group of exercises.

Preventive measures

To prevent injury during childbirth, as well as the development pathological conditions, follows:

Pregnancy is a difficult process for a woman. A body passes through a row various changes that require time to recover. Hip pain after childbirth common complaint. Learning why body changes occur can help prepare moms to undergo postnatal period less painful.

random sharp pain just sitting or resting;
discomfort in the groin area due to physical activity;
pelvic bones hurt after childbirth, when you spend half or the whole day standing on your feet;
painful feeling during sex;
urinary incontinence (inability to hold urine when you sneeze or cough).

Causes

Why does the pelvis hurt after childbirth? The reasons may be the following:

The main reason is the expansion of the pelvic bone and tailbone to make way for the child. After childbirth, the pelvic bones converge to their original position, which causes pain.
Increased weight during pregnancy also has a negative impact. Women carry a growing baby in the womb during pregnancy, and the weight gradually increases. The body shows some visible changes from increased stress, including discomfort in the hip and pubis after the birth of the baby.
Another reason is the original chronic disease or arthritis.
For mothers who previously suffered from pain in the tailbone, the pelvic bones after childbirth may hurt even more.
Relaxin is a hormone that causes bones to soften. The main effect of this hormone is to relax the ligaments of the body, which helps women bear the additional weight of the child. But the ligaments of the body take a long time to restore their actual position. This affects recovery.
Moms who are unable to exercise regularly during pregnancy are exposed to greater risk have health problems.

Recovery duration

How long after childbirth does your hip hurt? The time of recovery and restoration of the body depends on the woman’s health. This process can last from several weeks to six months. Those mothers who had a healthy pregnancy who follow healthy diet and implement correct mode, will be restored soon.

Other factors such as rest, care, previous injuries or joint complaints and general state health, including affecting the process of hip restoration in the postpartum period.

Some reasons that prolong the recovery period:

Inappropriate posture of the mother when she breastfeeds or rocks the baby in her arms.
All of the daily responsibilities of a mother that involve other strenuous activities can take a toll on physical health.

Treatment at home

If they hurt hip bones, it can be easily treated without neglecting proper rest after the pregnancy period. Enough time for rest is necessary, because mommy has to fulfill many responsibilities. Consultation with a doctor will provide correct treatment and prevention, he will tell you what to do and how.

If you are planning treatment using home remedies, then you will be helped with this:

Alternating hot and cold. Take a bath with hot water or use heating pads to relax your muscles. After this, place an ice pack on the part of the body where there is discomfort. But remember that you should not apply the ice directly, you need to wrap it in a towel and only then use it.
Many mothers feel better with good massage, with oil or any other medicinal lotion which acts as a lubricant and helps control correct location bones.
You may find relief from acupuncture, which also helps you relax.
Healthy diet and relaxation techniques (such as meditation) excellent remedy. Nutritional supplements are possible after medical consultations to consolidate recovery.
Maintaining water balance.
Stabilizing tapes in the hips and pelvis area, including support normal condition this area.

Exercises

The best choices include relaxation training in both sitting and standing positions. Regular exercise will keep you active in your life. Suitable:

Kegel types of pelvic floor exercises help maintain organ weight and body weight above the pelvis.
Non-stretching yoga positions.
Walking is a great way to get back into shape.
Riding a bicycle if the seat is comfortable.
Swimming that doesn't cause high pressure on the bones, but at the same time trains the muscles.

Skip the squats and stick to isometric strengthening abdominal cavity(isometric exercises are static exercises where muscles are tensed in a stationary position, rather than through movement).

But most importantly, be sure to follow any restrictions set by your doctor.

Breathing exercises

Some breathing exercises also help in restoring the pelvic floor. Practice diaphragm yoga trick with healthy medical support. Here's the best way to do it:

As you inhale, try to expand as much as possible. chest and belly.
Then, as you exhale, draw in your stomach and lift your pelvic floor “up.”

This method of focused breathing creates stability, which helps with any exercise. The more relaxed you are, the better the result.

Caring for a newborn can be a time of excitement, joy and exhaustion. New hours of sleep and responsibilities are exhausting, so be sure to take time to relax. For best effect The following recommendations should be followed:

Wearing comfortable clothes depending on the weather will make motherhood easier.
It is better to avoid shoes with high heels after pregnancy.
Wait until you stop about 4-6 weeks before you start having sexual intercourse.
Learn proper ways to hold your baby. Maintain your position big amount pillows to prevent your shoulders and back from getting tired.
Correct positioning while working and managing stress also improves the healing process.

Rest - important thing for every new mother. It is an excellent home remedy for treating joint pain.

Having help from loved ones for daily responsibilities can allow mom to get adequate rest, so don't give up on her.

All these relaxation methods and exercises after the birth of the baby - effective ways control pain in the hip joint after childbirth and not only in it. If pelvic pain does not disappear after a long period, seek advice and help from a medical specialist to normalize joint and muscle function.

Call your doctor immediately if you feel:

loss of feeling in one or both legs, or sudden weakness.
loss of sensation in the buttocks, groin, or genital area (including the bladder or anus). This can either make it difficult to urinate or have bowel movements, or cause incontinence.
if the pelvic bones hurt after 4 months.

Pregnancy is special condition women, which is accompanied by changes hormonal levels. All changes are aimed at adapting the body to bearing a child and childbirth. However, due to certain characteristics of a woman’s body or due to the fact that the concentration of hormones increases several times, various painful sensations may appear.

These are the pelvic and lumbar pain, occurring in 25-50% of pregnant women and women in the postpartum period. They are most often affected by recent months gestation. This is due to the fact that the fetus becomes quite heavy, and the concentration of some hormones in the blood is at a maximum.

An important point is that the concentration of some hormones increases, while others decrease in different periods gestation. In this regard, the severity of their effect on the fetus and the pregnant woman’s body changes.

Hormone name	Mechanism of action	Trimesters			Postpartum period
Hormone name	Mechanism of action	I	II	III	Postpartum period
Progesterone	Stimulates the mammary glands of a pregnant woman to increase the number of glandular cells, ensures the attachment of the embryo to the wall of the uterus and its development by suppressing the mother’s immunity, reducing its contractility. Promotes fluid retention in the body.	18.50 – 44.80 nmol/l	46.80 – 83.90 nmol/l	91.50 – 273.30 nmol/l	16.50 – 19.00 nmol/l
Estrogens	Improve functional state uterus, and also increase blood flow in its tissues. The breasts are prepared for feeding by enlarging the alveolar ducts. Stimulates the growth of the uterus. Reduce arterial pressure pregnant and increase blood clotting. Promote increased fat deposition and relaxation of the ligamentous apparatus in the pelvic area.	0.205 – 3.50 ng/ml	4.10 – 12.10 ng/ml	13.10 – 39.50 ng/ml	40.00 – 45.50 ng/ml
Chorionic gonadotropin (hCG)	Controls the course of pregnancy early stages and executes protective function. Stimulates the release of hormones by the adrenal glands, which protect the fetus from attack by its immune system. After all, 50% of the body perceives it as foreign body. Improves the functional activity of the placenta due to increased blood flow in her tissues.	45 – 90000 IU/ml	10000 – 35000 IU/ml	10000–60000 IU/ml	-
Relaxin	Reduces the tensile strength of ligaments in the pelvic area, pubis and sacroiliac region. Stimulates the opening of the cervix, reduces blood pressure and dilates blood vessels.	-	-	-	-
Prolactin	Increases the growth of the mammary gland due to glandular cells, which in the future will synthesize colostrum and milk for the child.	9 – 190 ng/ml	45 – 265 ng/ml	50 – 350 ng/ml	70 – 450 ng/ml
Somatomammotropin	The action is aimed at the growth of the mammary gland and its preparation for milk production. The hormone has very high activity.	0.05 – 1.7 mg/l	0.3 – 6.6 mg/l	2.6 – 11.5 mg/l	-

Let's figure out why the pelvic bones, lower back and sacrum hurt during pregnancy and after childbirth? Is this kind of pain normal after childbirth?

Physiological action

It is believed that the hormone relaxin weakens the ligaments and helps soften the cartilage of the pubic and iliosacral joints. Its concentration increases at the end of the third trimester, thereby preparing birth canal. The cartilaginous disc of the symphysis pubis, interosseous, dorsal, and ventral sacroiliac ligaments of a similar joint fall under the influence of relaxin. During pregnancy and in the first days after childbirth, the pelvic bones hurt most intensely; it may be difficult for a woman to lie on her side and back. Pain syndrome localized in the sacrum, lumbar region, hip joint. After childbirth, the condition returns to normal within a few weeks, and the pain subsides.

Excessive action

With an increased concentration of the hormone relaxin and its metabolites in the blood or with high sensitivity to it, it can cause excessive relaxation of the pelvic ligaments and cartilage. With pathological relaxation of the cartilage of the symphysis pubis, the pelvic bones diverge and symphysitis occurs, and if the sacroiliac is affected, sacroiliopathy occurs.

These diseases are accompanied by the sacrum, coccyx and hip joint area. Pain of moderate or moderate intensity increases with palpation in the pubic area and when getting out of bed. Patients complain that the pelvis and its bones hurt when going to the toilet. After rest, the pain usually goes away and worsens with any physical activity.

Injuries during childbirth

Increased relaxin activity large fruit, complications labor activity can lead to rupture of the symphysis pubis or damage to the coccyx. When the symphysis pubis ruptures, the pelvic bones diverge in this area up to 5-7 cm and immediately after childbirth cause painful sensations of moderate or high intensity. The pain worsens with any movement, and in bed after childbirth the postpartum woman is in a forced position - the “frog pose”.

If the coccyx is injured, the postpartum woman will feel pain only when she stands on her feet or sits for a very long time, during the act of defecation. The pain is intense, nagging in nature, intensifies when standing up from a sitting position, bending forward, or straining the pelvic floor muscles. The injury may be accompanied by curvature of posture and spine - antalgic posture.

Objective data.

In addition to collecting complaints about pain in the relevant area, studying the anamnesis, the doctor conducts an examination and palpation to find out the distance between the pelvic bones and evaluate the function of the joints. Also, if there is a rupture of the symphysis pubis or symphysitis, the patient will not be able to raise her legs in an extended position upward while lying on a hard couch. There may be difficulties when moving up stairs, a change in gait, which is diagnostic criteria to make this diagnosis.

Radiography.

The main research method, which is a litmus test in the diagnosis of postpartum injuries and lesions of the pelvic ligamentous apparatus, remains radiography. It is thanks to her that diagnoses such as “symphysitis”, “rupture of joints”, “fracture and dislocation of the coccyx”, “sacroiliitis” can be made.

According to X-ray data, 3 stages, or degrees of severity, of symphysitis are distinguished:

Stage I – the distance between the pelvic bones is from 0.5 cm to 1 cm;
Stage II – from 1 cm to 1.9 cm;
Stage III – more than 2 cm.

If the distance increases by more than 2-3 cm, you should think about rupture of the symphysis pubis.

Treatment of diseases associated with damage to the ligamentous apparatus of the pelvis after childbirth is aimed at creating favorable conditions for healing and strengthening of surrounding ligaments. For this purpose, postpartum women are prescribed orthopedic pillows in the shape of the letter C, seat cushions in the shape of a ring (donut), massage, water aerobics and swimming.

A good assistant in treatment is a bandage, which provides quick and effective strengthening ligaments, restoration of function musculoskeletal system, with its simultaneous unloading. The bandage is worn throughout the entire illness. There are also special corsets that ensure the immobility of the tailbone and help heal it. Medicines are also prescribed that are aimed at reducing inflammation and relieving pain - paracetamol, ibuprofen, B vitamins.

Timely contacting a doctor with complaints, a detailed medical history and pain characteristics (where and how it hurts) allows for early stages treat the disease as much as possible effective treatment, is protection against the development of complications.

Sources:

Obstetrics / V.I. Duda - Minsk - 2013 - 576 pages.
Obstetrics and gynecology T.1 / V.M. Zaporozhan – 2005 – 472 pages.
Obstetrics. National benefit / E.K. Ailamazyan, V.I. Kulakova, V.E. Radzinsky, G.M. Savelyeva – 2009 – 1200 pages.