Pelvic bones after childbirth pain. After childbirth, the pelvis, pelvic bones (pelvic bones) hurt

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 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 uterine wall 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 blood pressure pregnant and increase blood clotting. Promotes increased fat deposition and relaxation 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 a 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 it hurts pelvic bones, lower back and sacrum 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 the birth canal. The cartilaginous disc of the symphysis pubis, interosseous, dorsal, and ventral sacroiliac ligaments of a similar joint are affected by 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. The pain syndrome is localized in the sacrum, lower back, and hip joints. After childbirth, the condition returns to normal within a few weeks. painful sensations subside.

Excessive action

With increased concentrations of the hormone relaxin and its metabolites in the blood or when 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 painful sensations usually pass and worsen 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, there are 3 stages, or degrees of severity, of symphysitis:

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.

Carrying and giving birth to a child puts a serious strain on a woman’s body, physical level. Under the influence of hormones, cartilage tissue softens, bones separate, ligaments and muscles stretch. This is necessary so that the baby's passage through birth canal it was painless. Reversal changes and restoration of the body can be delayed and occur with complications. Complaints from mothers that the pubic bone hurts after childbirth are common. Besides severe pain, pathological divergence of the symphysis pubis is accompanied by changes in gait and generally spoils a woman’s quality of life.

The symphysis pubis is a type of semi-movable skeletal joint located in one of the three pelvic bones – the pubis. In medicine it is called the pubic or pubic symphysis. Unlike joints, symphyses do not calcify over time, do not lose their cartilage layer, and have a cavity inside. For example, intervertebral discs are also symphyses.

During pregnancy and childbirth, transformation of the symphysis pubis occurs, often accompanied by moderate pain in the pubis. The gap between the branches of the pubic bone increases, on average, by 5-6, sometimes by 10 mm from the initial values. This is a physiological phenomenon.

Normally, in the postpartum period, the discrepancy of the pelvic bones is eliminated, the width of the cavity becomes denser and decreases. But, with favorable factors, changes in the structure of the joint sometimes go beyond the normal. In such cases, they talk about symphysiopathy, which means pathology of the pubic symphysis, in which the pubic bone hurts greatly.

Sometimes the term symphysiolysis or symphysiolysis is used synonymously with symphysiopathy. In obstetrics it is known as a syndrome that includes three stages. The first is pain in the pubis, the second is divergence of the symphysis pubis of varying degrees (symphysiolysis itself), and the third is rupture of the symphysis.

In practice, the word symphysitis is used to denote a collective diagnosis of excessive and painful divergence of the pubic bone. But in essence, symphysitis is translated as inflammation bone tissue articulation, manifested similar symptoms, but with differences in diagnosis.

Reasons

There is no consensus on why pathology occurs. The trigger for a situation where the pubis hurts after childbirth is a number of factors. This is also anatomical narrow pelvis, and a large fruit, and multiple pregnancy. In combination with rapid, violent labor or use obstetric forceps. This leads to the fact that the pelvic bones do not return to their previous state in a timely manner, and sometimes become even more damaged.

These factors and mechanical injuries do not always cause complications in the form of symphysiopathy or rupture of the articulation. Bosom in healthy body Can withstand loads up to 200 kg. But the dispositional moments lead to the fact that during the birth process it is overstretched and damaged.

Why does the pubic bone hurt after childbirth:

acute deficiency of vitamins and minerals leads to pathological “weakness” of the skeleton;
Excessive production of the hormone relaxin contributes to excessive relaxation of the tissues of the pubic joint.

The main role in the development of symphysiopathy belongs to vitamin D deficiency and failure of calcium-phosphorus metabolism. This happens in the background concomitant diseases. For example, when diabetes mellitus, renal failure, problems in the gastrointestinal tract and often with an unbalanced diet of pregnant women.

As a result, weak mineralization of the woman’s bone tissue occurs. During pregnancy, in order to meet the fetal needs for calcium, it is “redistributed” to the detriment of the mother’s body. In this case, the pathology manifests itself earlier, pain in the pubis occurs even before childbirth.

Second version - hormonal imbalance. Relaxin is responsible for the relaxation of bone tissue and the physiological divergence of the symphysis pubis. Excessive hormone production leads to pathological increase symphysis fissures and discomfort in the pubic area.

Symptoms and complications

Typically, signs of pathology appear during pregnancy. At the end of the second and third trimester of pregnancy, the pubic bone begins to ache before childbirth, and the sensations intensify. Articulation discrepancy can be suspected if there are concomitant problems with teeth, hair loss, or the appearance of convulsive twitching of the calf muscle.

It is not uncommon for the first symptoms of pubic bone dehiscence to occur only after the birth of the child. Due to constant tone Abdominal muscles holding the growing uterus, a kind of fastening of the symphysis occurs. After childbirth, the flabby abdominal muscles no longer hold back the joint, and the gap appears, accompanied by pain.

The severity of symptoms depends on how much the bones have separated. In addition to pain in the pubic bones, the woman complains of pain in the groin, lower abdomen, lower back and pelvis that occurs at night or after physical activity. Discomfort increases when walking, changing position, moving your leg to the side, turning in bed or rising from a chair.

In addition to pain, the pathology provokes poor posture. A pronounced divergence of the articulation contributes to the appearance of a waddling gait, called a “duckling”, up to a complete loss of the ability to move. Sometimes upon palpation you can hear a cracking or clicking sound coming from the pubis, while the pubic bone is painful.

A dangerous type of injury is rupture of the symphysis during childbirth. The condition is rare and is characterized by a violation of the integrity of tissues and ligaments. Occurs when pathological expansion pubic fissure of more than 20 mm and lack of adequate labor management tactics.

A ruptured joint damages the bladder and urethra. Often the pubis after childbirth turns blue and swells, a hematoma appears in its area and an inflammatory process occurs - symphysitis.

Diagnostics

Discrepancies of the pubic bone during childbirth are determined based on the woman’s complaints of characteristic pain. At gynecological examination the doctor can literally feel the gap in the womb and feel its asymmetry.

The diagnosis is confirmed after X-ray, ultrasound or MRI of the symphysis, where the discrepancy of the symphysis pubis is clearly determined by more than 0.8-1.0 cm. In this case destructive changes are not found in the pelvic bones. A rupture of the symphysis is indicated when an X-ray shows a gap in the pubis 7-8 cm wide and there is a horizontal displacement of the bones.

Pathological discrepancy of the symphysis pubis is divided into three stages:

I – increase in the symphysis gap by 5-9 mm exceeding the physiological expansion during pregnancy;
II – by 10-20 mm;
III – more than 20 mm.

Regardless of the results additional examinations, the fundamental factor for the medical conclusion is the well-being of the woman in labor. Thus, a discrepancy of 1 cm in one woman indicates symphysiopathy and becomes a reason for a caesarean section, while in another it does not cause any discomfort.

When visualizing the destruction of bone tissue, that is, with porosity, friability, the question arises about the addition of inflammation and then the diagnosis of symphysitis is made. In this case, usually simultaneously with the appearance of pain, the woman notes that her pubis has become larger after childbirth and has turned red. This occurs due to swelling of the soft tissues. During the inflammatory process in the womb, an increase in body temperature is observed.

Clinical blood tests show a decrease in the level of calcium and magnesium, urine, on the contrary, - slight increase. With symphysitis, unlike symphysiopathy, leukocytes are also found in the urine. Differential diagnosis carried out with radiculitis, inflammation sciatic nerve, hernias, pelvic vein thrombosis.

Treatment

The divergence of the symphysis can be corrected without surgical intervention. Severe ruptures of the symphysis pubis do not go away on their own; surgery is required using lavsan, wire sutures, knitting needles, and titanium structures. Recovery period takes 3-4 months after surgical treatment.

The existing inflammatory process (symphysitis) is controlled by taking antibiotics to eliminate the source of infection. At the same time, therapy is carried out aimed at eliminating the causes that caused the discrepancy of the pubic bones. Prescribed calcium and magnesium supplements, vitamins D, group B, fish oil. Conducted ultraviolet irradiation womb area.

What to do if your pubic bone hurts after childbirth:

consult a doctor and do not self-medicate;
take medications and perform physical procedures and exercises for the pelvic muscles prescribed by a doctor;
enrich the diet with foods containing calcium, magnesium and other elements;
limit or eliminate physical activity;
provide support for the pelvic bones with a bandage or corset;
For pain relief, use special gels, ointments, creams or tablets.

Self-medication for pubic pain is extremely contraindicated. Only a doctor can accurately determine the width of the articulation divergence and, therefore, select effective therapy. If at the first stage of symphysiopathy it is enough to limit activity and take vitamins, then for the second and third stages more serious measures are necessary. Bed rest lasts at least 3-6 weeks, often using tight or postpartum swaddling. The goal of the measures is to achieve maximum approximation of the edges of the symphysis.

The lack of adequate help leads to the fact that pubic pain does not go away for more than 6 months, sometimes even several years. This occurs as a result of improper fusion of damaged tissues, their replacement with scars and development chronic pathology. Prevention postpartum complications symphysis consists of obligatory healthy diet, taking special vitamin-mineral complexes and providing physical activity even at the stage of pregnancy.

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 laterally by two pelvic bones (fused pubis, ischium 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.
Pubic symphysis - pubic fusion of both pubic bones 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. Front and back, 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 occur and manifest themselves during pregnancy, childbirth and the 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 joints of the pelvis 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 the entire 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 parathyroid 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 calcium levels in the blood can also be observed with concomitant pathologies: diseases gastrointestinal tract, chronic enteritis, dysfunction of the parathyroid gland, renal failure, diabetes mellitus, as well as a diet with insufficient calcium content, 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, especially 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, taking into account the harmful effects 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. To determine obstetric tactics In choosing a method of delivery, the size of the divergence of the symphysis pubis is important.
In case of pronounced divergence of the symphysis during pregnancy and the risk of injury bony pelvis In labor, delivery is carried out 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 sharp pain in the area of the womb, sometimes a characteristic sound of tearing ligaments is heard, after which even the large head of the fetus 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, subsequently both halves of the pelvis 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 refers to changes in the pubic symphysis caused by an 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 V 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 therapeutic exercises are used to strengthen the muscles of the back, abdomen, buttocks and stretch the pelvic floor ligaments.
Long stay fresh air. Under the 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 the case of the development of symphysiopathy with a slight divergence of the symphysis pubis during pregnancy or after childbirth, it is recommended to limit physical activity, wear a bandage, sleep on an orthopedic mattress, take calcium supplements in a well-absorbed form (CALCIUM CARBONATE, L ACT AT CALCIUM), CaDs NYCOMED, FISH OIL (better 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 extended bed rest. Usually within 3-5 days bed rest wearing 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).

The birth of a baby is one of the happiest events in a woman’s life. It is also the most painful. After all, the process of childbirth is not always calm and quick. It involves complex mechanisms the work of the reproductive system, the components of which are the divergence of the pelvic bones. The woman’s body prepares for this process in advance, which is accompanied by significant discomfort and pain. When, after childbirth, do the pelvic bones return to their proper position? natural position? What are the features of this process?

About the timing of the convergence of the pelvic bones

The postpartum period is a time no less important than pregnancy itself. This is why many experts call it the tenth month. For nine months female body actively prepared for the birth of the baby, adjusted to his needs, and endured discomfort. Therefore, it is not surprising that the recovery period after childbirth cannot be quick. Only to recover reproductive system, it takes at least 6-8 weeks, after which the woman needs to see a gynecologist.

Major changes to female body When carrying a child, they occur due to the action of hormones. During pregnancy, they are actively produced, which is necessary for the healthy development of the fetus, preparing ligaments and bones for the upcoming birth. After the baby appears, the woman’s body again undergoes hormonal changes. Those hormones that were responsible for the development of the child fade into the background; the hormone prolactin, necessary for the production of breast milk. The process of restoration of a woman's body after childbirth is called involution. It also provides for the convergence of the pelvic bones.

What happened to them before the baby was born? Obstetricians-gynecologists state that the divergence of the pelvic bones occurs immediately before childbirth. Essentially this is softening cartilage tissue in the area of the pubic symphysis, the divergence of the bones does not go beyond one and a half to two centimeters. After childbirth, there cannot be a lightning-fast return to their original state. Even if the birth was easy and quick, the bones are still long time will return to their natural position. Often this takes all postpartum period, that is, 6-8 weeks.

About gymnastics after childbirth

Experts recommend that new mothers do not delay in completing special exercises postpartum gymnastics. As soon as your health allows, you need to start. The main task of such gymnastics is to prevent negative consequences birth in the pelvic area, for example, urinary incontinence or symphysitis, uterine prolapse.

After the birth of a child, the pelvic bones return to their place after some time, but some mothers are sure that the volume of their hips increases during childbirth, but this is not so.

Thanks to restorative gymnastics, the pelvic floor muscles are strengthened and the contractile activity uterus and it returns to its original size. So, you should start doing these exercises:

Abdominal retraction. You need to lie on your back, bend your knees, and press your feet to the floor. Your palms should be on your stomach. It must be pulled in very strongly as you exhale and hold this position, first for 3-4 seconds, then 6-10. The exercise is repeated after taking a deep and slow breath.
Bridge. The starting position of the body is the same. After exhaling, you need to raise your pelvis, tighten your buttocks and pull in your stomach. At the same time, the head is raised and the chin is pressed to the chest. This is a difficult exercise, the number of repetitions must be increased gradually.
Raising your legs. Lying on your back with your legs straight, you need to slowly lift each of them up in turn. In this case, you need to pull the sock towards you. Exercises must be performed at a slow pace.
Cat. The exercise is performed from a position on all fours. You need to bend your back and round it with a wheel, while drawing in your stomach. The exercise tightens the muscles of the abs, back, and buttocks.
Squats. Performed slowly from a standing position. You need to squat so that your hips form a right angle with the floor. At the same time, straight arms are extended forward. At the end of the execution, you can spring on your bent legs, increasing the static load and straining your abs.

So, performing postpartum gymnastics will help the woman regain her shape and the pelvic bones will quickly return to their original position.

Carrying a child involves putting stress on the entire body of the expectant mother, including hip joints.

Sometimes pain syndrome in the pelvis occurs in the last trimester and continues after delivery, and this pathology can affect even completely healthy women.

Effect of pregnancy on bones

Hormones produced during pregnancy have the following effects on the bones of the skeleton:

Soon after fertilization, vasodilation occurs bone joints and the liquid content in them increases. This promotes a gradual expansion of the volume of the pelvic bones, allowing the fetus to develop comfortably.
The increase in hormone levels continues until 35 weeks.
By the time of delivery, sharp changes in hormone levels occur, which contributes to accelerated expansion of the pelvis.

Often, against the background of these processes, women complain of the appearance of pain in the pelvic area.

Main reasons

The pelvic bones hurt after childbirth for the following reasons:

during and after delivery. Bone structures shift, providing better ways to promote the baby during childbirth. The initial change in the position of the bones is practically not felt by the pregnant woman, but their return to their original position after childbirth is associated with severe pain.
Lack of calcium also leads to pain in the pelvic area. This is due to the fact that this microelement is actively washed away both during pregnancy and after childbirth.
Stretching of the muscles or connective tissue formations that connect the bones of the skeleton. This happens during pregnancy, and after delivery, the stretched ligaments lose functionality, so they try to compensate for this bone structures, which are not physiologically designed for this.
Injury received during childbirth. This may be a dislocation or disruption of the integrity of the pelvic bones. And if the woman in labor was under anesthesia, then the presence of a fracture will not be immediately known. Women with such injuries often complain of severe pain after childbirth, and there is also a risk of improper bone healing.

In addition, among the causes of pain in the pelvic area there are also: changes in the hormonal levels of a pregnant woman, overweight, exacerbation hidden diseases.

Symptoms

Treatment

Often women are interested in what to do if their pelvis hurts after childbirth. Before taking any therapeutic measures, it is necessary to find out exact reason the appearance of pain after childbirth. But even before the diagnosis is clarified, it would be correct to limit physical activity.

In addition, the woman in labor must wear a bandage, as well as her sleeping place must be properly organized. To restore calcium balance after childbirth, a woman should take a multivitamin and mineral complex that contains calcium in an easily digestible form.

If, against the background of pain in the hip joints after childbirth, the examination revealed infectious pathology, then the use of antibiotics may be necessary. Oral and parenteral painkillers may also be prescribed to the woman in labor. In addition, if the symptoms are pronounced, manual techniques will relieve pain.

Therapeutic gymnastics

Exercise therapy for symphysitis after childbirth is aimed at strengthening or increasing muscle tone of the pelvis and perineum. If you exercise several times a day, the pain syndrome will become less pronounced over time. However, it should be remembered that physical activity with this pathology must be strictly controlled, and any therapeutic exercises on initial stage must be performed under the supervision of an orthopedist.

Folk remedies

One of the most popular recipes is a decoction of geranium, which is used during bathing.

To prepare the decoction, take 4 g of dry crushed geranium leaves and pour 800 ml of boiling water over them, then keep them on low heat for 10 minutes. After this, the broth is infused for about half an hour, filtered and poured into the bath.

In addition, a woman should reconsider her eating habits. She should drink more fermented milk products and other foods that contain a lot of calcium (dried fruits, bananas). She should also give up fatty, fried, and spicy foods.

Prevention during pregnancy

To some extent avoid pelvic pain after delivery these will help preventive recommendations:

Besides, great value has general condition health, so a pregnant woman should promptly treat everything accompanying pathologies, which can affect calcium metabolism or hormonal levels.