Pain in the pelvis 4 months after childbirth. Why does the pubic bone hurt and swell after childbirth

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

Causes of pain

There are several reasons for the occurrence of discomfort 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.

Pulling or sharp pain in the pelvic area with lumbago is a reason to consult a doctor for an 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 - the symphysis. Under the influence of hormones and fetal pressure, the symphysis is stretched by 5–6 mm or more. As this discrepancy increases and inflammation joins, symphysitis is diagnosed.

Symphysite are peculiar pain when walking, changing body position, physical activity. The gait changes (becomes similar to a duck), there is discomfort during urination and defecation.

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

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

Postpartum recovery includes a number of measures that allow you to connect the dispersed parts of the pubic joint and limit their movement:

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

The course of treatment is compiled individually after examination and consultation of the therapist, gynecologist, osteopath and surgeon. In some cases, an operation is prescribed with the introduction of steel supporting structures.

How to relieve pain

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

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

Preventive measures

Prevention of symphysitis during pregnancy avoids postpartum complications.

Recommended to do special gymnastics stretching and strengthening muscles pelvic floor.
With an uncomplicated pregnancy, you need to walk a lot, walk on fresh air. Walking helps to 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 good health and functioning of the body systems that will be involved in childbirth.

Many pregnant women and women who have given birth have pain in the pelvic bones. This is due to the changed hormonal background, increased load and is a variant of the norm. Attention to yourself, observation of sensations, regular examinations and following the doctor's recommendations will help to avoid injuries and quickly recover after the birth of a child.

Sometimes after childbirth there are complaints of pain or discomfort"Crunching" in the pubic joint, which increases with a change in position, walking up the stairs. The diagnosis is made: symphysitis. As a rule, a woman associates the pathology that has arisen with the genus. Is it fair?

A bit of anatomy in order to find out why do pelvic bones hurt after childbirth?
During childbirth, the fetus passes through the woman's bone 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 a pubic joint - a symphysis, and behind - by two sacroiliac joints.
The pubic symphysis is a pubic fusion of both pubic pelvic bones by means of a fibrocartilaginous disk, in the center of which there is an articular cavity in the form of a gap filled with joint fluid. Front and back, top and bottom, the symphysis is reinforced with ligaments that give strength to this joint. The pubic articulation is a semi-joint, i.e. has a very limited range of motion. 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 ligament that raises the clitoris. Nerves and blood vessels pass below the symphysis. Behind the pubic symphysis are the urethra and bladder.Symphysite- this is common name changes and damage to the pubic joint, under which up to 16 components are hidden: loosening, softening, edematous impregnation, stretching, expansion, divergence, rupture, inflammation, special form hypovitaminosis, symphysiopathy, symphysitis itself, etc. Most often, these changes occur and manifest themselves during pregnancy, childbirth and in postpartum period. This article will discuss the consequences to which they can lead. Divergence of the pubic joint.
It arises as a result of physiological changes as an adaptive process to facilitate childbirth; those. these are normal changes.
At physiological pregnancy in the ovaries and placenta, the substance relaxin is released, which has a specific relaxing (relaxing) effect. Under the joint action of relaxin and female sex hormones articular cartilage and the ligaments swell, loosen, additional gaps filled with fluid appear in the joints, as a result of which there is 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 pubic joint, 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, slight movements (up to 10 mm) of the articular ends of the pubic bones up and down are possible, like piano keys. 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, the width of the joint space decreases. Symphysiopathy. So called excessive relaxation of the pubic joint as a manifestation of toxicosis of pregnant women with a predominant lesion musculoskeletal system woman's body. Some women said changes in the structure of the joints go beyond physiological processes, acquire pathological character and lead to excessive divergence of the joints of the pelvis. Symphysiopathy is characterized by the appearance of complaints and symptoms in the presence of a discrepancy in the pubic joint. Distinguish the discrepancy of the symphysis of three degrees (in excess of the physiological discrepancy by 5-6 mm):
I degree - a discrepancy of 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 a violation of phosphorus-calcium metabolism and a lack of vitamin D. Calcium is the main structural component skeletal bones and teeth. The exchange 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. If the phosphorus-calcium balance is disturbed in the direction of decreasing calcium, these elements come to the fetus from the "repositories" of the mother's body - bones and teeth.
With a lack of vitamin D, bone mineralization is disturbed due to impaired absorption of calcium and phosphorus from the intestine, as well as their mobilization from bone tissue. Decreased calcium levels in the blood can also be seen with concomitant pathology: diseases gastrointestinal tract, chronic enteritis, dysfunction of the parathyroid gland, kidney failure, diabetes, as well as with a diet with insufficient calcium, vomiting of pregnant women and other conditions. Against such a painful background, pregnancy and breastfeeding can exacerbate 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 a change in skin sensitivity), twitching and contraction of individual muscles are characteristic, especially night cramps in calf muscles. With minor discrepancies of the symphysis, the appearance of "flying" pains in the bones of the pelvis, lower back is regarded as sciatica, osteochondrosis, the threat of abortion. In the second and third trimesters of pregnancy, symphysiopathy is characterized by pain and discomfort in the pelvic bones when walking and standing.
The disease occurs frequently. Symphysiopathy may not make itself felt before childbirth and be latent. In the second half of pregnancy, the ratio of the pubic bones is restrained by the tension of the abdominal muscles due to the increase in the uterus. Immediately after childbirth, flabbiness of the abdominal muscles occurs and the divergence of the pubic bones can increase to 20 mm or more. For the divergence of the pubic articulation II and especially III degree during pregnancy and childbirth, the diagnosis is not difficult: there is a change in the nature of pain in the symphysis area, which increases when turning in bed, with active movement legs, often a woman cannot walk. In bed, the patient assumes a certain position - the “frog pose”: she lies on her back with her hips turned outward and deployed with her knees slightly bent.
When pressing on the pubic joint, both in front and from the side of the vagina, severe pain is determined. In addition, the discrepancy itself can be determined - a fingertip is placed in it. A significant divergence of the pubic articulation (more than 2 cm) is also indicated by the appearance of a waddling gait "duck".
The diagnosis is specified by X-ray and by ultrasound diagnostics. Preference during pregnancy ultrasound diagnostics, Considering bad influence x-rays to the fruit. Usually, a discrepancy of the pubic articulation of one degree or another is found on a pelvic radiograph, but there are no pathological changes in the bones.
When determining the concentration of calcium and magnesium in the blood and urine, there is a decrease in their amount in the blood by almost half, and their content in the urine is slightly increased. Only when determining the content of calcium and magnesium in the blood and urine of a pregnant woman in the absence of complaints, it is possible to predict the divergence of the pubic articulation.
The course of symphysiopathy is usually favorable. In itself, this disease during pregnancy is not an indication for delivery by surgery. caesarean section- neither planned nor urgent order. For determining obstetric tactics in the choice of the method of delivery, the magnitude of the divergence of the pubic articulation matters.
With a pronounced divergence of the symphysis during pregnancy and the risk of injury to the bone pelvis during childbirth, delivery is performed by caesarean 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, most often associated with childbirth and occurs when the pubic articulation of the III degree diverges more than 2 cm. with operative delivery obstetric forceps) or with a combination of a narrowed pelvis with violent labor activity.
By itself, mechanical trauma does not have a dominant value: the rupture 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 a slight mechanical impact is an impetus to break the weak adhesion of the ligamentous apparatus.
In most cases, during childbirth, there is a slow spreading of the tissues of the pubic joint, so complaints of pain in the pubic region, aggravated by the movement of the legs, appear a few hours or 2-3 days after childbirth. Only in rare cases the woman in labor feels a sharp pain in the womb, sometimes heard characteristic sound torn ligaments, after which a rapid lowering of even a large fetal head occurs through the expanded bone ring.
The rupture of the pubic symphysis is sometimes accompanied by an injury to the bladder and urethra, the formation of hematomas in the pubis 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 takes a forced position ("frog posture"). On palpation, both in front and from the side of the vagina, pronounced soreness is determined, and, in addition, the mobility of the pubic bones and retraction due to their wide separation from each other.
The nature of the damage is determined by x-ray examination. The rupture of the pubic joint 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 perform rocking movements, a “duck gait” appears, constant complaints of lumbosacral pain, regarded as sciatica.
In severe cases of damage to the pubic joint (rupture, severe sprain), as well as in the absence of the effect of conservative treatment, usually applied surgical treatment with the use of metal structures, the imposition of lavsan and wire seams. Ability to work is restored in 3-4 months after the operation.
Symphysite. This term means changes in the pubic symphysis due to 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 appears, impaired movements in the limbs, swelling and redness in the pubic area, and a feverish state. The radiograph shows the divergence of the pubic symphysis with the phenomena of osteoporosis (rarefaction) in the bone tissue.
Chronic inflammatory processes in the bladder (cystitis) and urethra(urethritis) may be accompanied by focal changes in the pubic joint. The disease develops when chronic infection in the urogenital tract (ureaplasma, mycoplasma, herpetic infection, staphylococcal) in pregnant women and puerperas against the background of calcium and magnesium deficiency, with hypovitaminosis D. The use of antibiotic therapy in combination with calcium and magnesium preparations, UV irradiation gives an excellent and quick therapeutic effect even when severe course symphysitis with a pronounced divergence of the pubic articulation.
For the prevention of symphysiopathy and other damage to the pubic joint, the following matters:

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, yogurt, 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, attendance at schools for expectant mothers where physiotherapy to strengthen the muscles of the back, abdomen, buttocks and stretch the ligaments of the pelvic floor.
Prolonged exposure to 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.
With poor absorption of calcium associated with a disease of the gastrointestinal tract, digestive enzymes, the fight against dysbacteriosis.

Treatment of symphysiopathy
With the divergence of the pubic symphysis during pregnancy and childbirth, as a rule, it is possible to avoid surgery.
In case of development of symphysiopathy with a slight discrepancy of the pubic articulation during pregnancy or after childbirth, restriction is recommended physical activity, wearing a bandage, sleeping on an orthopedic mattress, taking calcium supplements in a well-absorbed form (CALCIUM CARBONATE, CALCIUM L ACT AT), CaDs NIKOMED, FISH OIL (preferably in capsules), MAGNE Be, B vitamins, UV irradiation. In the presence of a urogenital infection, it is prescribed antibiotic therapy 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 discrepancies of the pubic bones in the postpartum period, the main thing is to achieve convergence of the ends of the pubic bones and keep the pelvic bones in a certain position. This is achieved by bed rest (for 2 to 6 weeks after birth, you can not get up and walk), as well as using a bandage or tight bandage. On the first day after childbirth, cold is used, in the future - physiotherapy procedures on the area of the pubic joint. Calcium preparations, painkillers are used, when inflammation (symphysitis) is attached, antibiotic therapy is prescribed, a diet with high 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 keep the pelvic bones in a certain position, which allows you to expand bed rest. Usually, after 3-5 days of bed rest in a corset, a woman can already get up and take care of 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 a narrowing of the pelvis, from ancient times to the present in some countries of Africa and Latin America use a pelvic expansion operation - symphysiotomy (dissection of the symphysis).

Orthopedist-traumatologist, surgeon of the first category, 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 ordeal.

According to statistics, more than half of newly-made mothers complain that their pelvic bones hurt after childbirth. This syndrome may indicate serious problems in the body of a woman, and therefore it is not worth delaying a visit to the doctor. These issues are dealt with 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 prone to diseases of the pelvis and spine. Even quite healthy ladies who lead passive image life, move little, eat malnourished and work in a sedentary job, may complain of hip pain after childbirth. The lack of movement significantly weakens the body of the expectant mother, this also applies to 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 intensifying during movements or even during sleep;
Feeling of tightness in the muscles;
Limited movement;
muscle spasm, which long time does not pass.

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

Features and diagnostic needs

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

After the required examination it is possible to make a diagnosis and establish the cause of the arising painful sensations. 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, then the doctor can make another diagnosis - “rupture of the pubic joint”.

Causes of pain syndrome

If after childbirth the leg hurts in the thigh and pelvic area, an examination will be required. It can reveal the displacement of the pelvic bones during childbirth. In some cases, the coccyx and pelvic bones may also be displaced. This is necessary to free the fetus to pass through the birth canal. Nature intended this process to be practically painless, since the woman's body has been preparing for this for a long time. And if a woman may not notice the displacement itself, then the process of return is quite tangible, 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, in the process of delivery, calcium is simply washed out of the body, and therefore the body does not have enough resources, which is reported by pain syndromes.
Tissue softening has occurred natural process, which is due to the increase 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.
Stretching of the ligaments and muscles is a condition that can also cause discomfort.
Birth trauma - it is she who most often explains why the hip joint hurts after childbirth. Dislocation, fracture of bones, tissue rupture - all this can cause severe pain. An untimely appeal to the doctor can lead to the fact that the bones will grow together incorrectly. And this will already entail a change in gait.

The role of calcium in the state of the woman in labor

Already at 30–34 weeks, you can notice that the pregnant woman begins to involuntarily tilt her body back, trying to transfer weight. Nature has laid down another thing - a change in gait to a “duck”, when a woman rolls from foot to foot. But by this point future mommy already has time to get used to unpleasant sipping in the lumbar region, even to pain. They may be provoked not enough calcium. This causes the development of symphysiopathy, so the doctor who observes the pregnant woman must prescribe calcium.

Medicines strengthen bones and also reduce pain. However, you should not be zealous in taking it - the dosage is strictly observed in order to avoid negative consequences including the formation of kidney stones. The right approach to solve this problem eliminates pain 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 \u200b\u200bthe pubis and pelvic bone. Divergence of bone tissue after childbirth is no longer a rarity, and such a condition can lead to the appearance of sharp and severe pains, which often do not go away, but only increase. Painful condition may be so strong that it will be difficult for a woman to walk or stand normally.

Symphysis treatment

What to do if the pelvis hurts after childbirth? Contact a vertebrologist or another doctor who will examine the patient and take rational decision on 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 on the need:

Quite often, the doctor advises to combine bed rest with gymnastics. You should not choose exercises on your own, an osteopath should work with the patient. He also evaluates the state and decides on the possibility / impossibility of performing a group of exercises.

Preventive measures

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

Pregnancy is a difficult process for a woman. The body goes through the row various changes that take time to recover. Pain in the hip joint after childbirth frequent complaint. Learning why body changes happen can help prepare moms to spend 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 half or a whole day is spent standing on their 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 separation of the pelvic bone and coccyx to free the way for the child. The pelvic bones after childbirth converge to the original position, which causes pain.
Increased weight during pregnancy also has a negative effect. Women carry a growing baby in the womb during pregnancy and the weight gradually increases. The body shows some visible changes in increased stress, including discomfort in the hip and pubis after the birth of the baby.
Another reason is the original chronic disease or arthritis.
In mothers who previously suffered from pain in the coccyx, the pelvic bones after childbirth may hurt even more.
Relaxin is a hormone that causes the bones to soften. The main action of this hormone is to relax the ligaments of the body, which helps women carry the extra weight of the child. But the ligaments of the body take a long time to restore their actual position. It 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 the hip joint hurt? The time of recovery and recovery of the body depends on the health of the woman. This process can take anywhere from a few weeks to six months. Those moms who had a healthy pregnancy who follow healthy diet and carry out correct mode, will be restored soon.

Other factors such as rest, care, previous injury or joint complaints and general state health, including affect the process of recovery of the hip part in the postpartum period.

Some reasons that prolong the recovery period:

Inappropriate posture of the mother when she is breastfeeding or rocking the baby in her arms.
All the daily duties of a mother, which involve other strenuous activities, can have a negative impact on physical health.

Treatment at home

If they hurt hip bones, it can be easily treated without neglecting proper rest after the pregnancy period. It is necessary to have enough time for rest, because mommy has to perform many duties. A doctor's consultation will provide proper 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 in this:

Alternating hot and cold. Take a bath with hot water or use heating pads to relax your muscles. After that, place an ice pack on the part of the body where there is discomfort. But remember that you should not apply ice directly, it must be wrapped in a towel, and only then used.
Many mothers feel better with good massage, with oil or any other healing lotion, which acts like a lubricant and helps control correct location bones.
One can find relief from acupuncture, which also helps to relax.
Healthy diet and relaxation techniques (eg meditation) excellent tool. Nutritional supplements are possible after medical consultations to secure recovery.
Maintaining water balance.
Stabilization bands in the hips and pelvis, including support normal condition this area.

Exercises

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

Types of Kegel 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 in shape.
Biking if the seat is comfortable.
Swimming that doesn't cause high pressure on the bones, but at the same time trains the muscles.

Skip Squats and Stick to Isometric Strengthening abdominal cavity(Isometric exercises are static exercises where the muscles are tensed in a fixed position, and not through movement).

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

Breathing exercises

Some breathing exercises also help in the restoration of the pelvic floor. Practice diaphragm yoga trick with healthy medical support. Here's how to do it better:

When inhaling, try to expand as much as possible. chest and belly.
Then, as you exhale, pull in your belly and lift your pelvic floor “up.”

This focus breathing method creates stability that 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 rest. 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 sexual intercourse.
Learn the proper ways to hold a baby. Maintain your position large quantity pillows so that your shoulders and back do not get tired.
Proper posture during work and stress management also improve the healing process.

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

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

All these relaxation techniques and exercises after the baby is born are 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 right away if you feel:

loss of sensation 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 urination or bowel movements difficult or cause incontinence.
if the pelvic bones hurt after 4 months.

Pregnancy is special condition woman, which is accompanied by changes hormonal background. All changes are aimed at adapting the body to childbearing and childbirth. However, due to some features of the 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 that occur 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 certain 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 action on the fetus and the body of a pregnant woman 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. Prepare the breast for feeding by increasing the alveolar ducts. Stimulate the growth of the uterus. Reduce arterial pressure pregnant and increase blood clotting. Contribute to increased fat deposition, 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 performs protective function. Stimulates the release of adrenal hormones that protect the fetus from attacks 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 the ligaments in the pelvic area, womb and sacroiliac region. Stimulates the opening of the cervix, lowers 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 baby.	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 the production of milk. The hormone has a very high activity.	0.05 – 1.7 mg/l	0.3 – 6.6 mg/l	2.6 – 11.5 mg/l	-

Let's see why the pelvic bones, lower back and sacrum hurt during pregnancy and after childbirth? Is this 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. Under the influence of relaxin, the cartilaginous disc of the pubic articulation, interosseous, dorsal, ventral sacroiliac ligaments of a similar articulation fall. 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 region of the sacrum, lower back, hip joint. After childbirth, the condition returns to normal within a few weeks, 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 pubic joint, the pelvic bones diverge and symphysitis occurs, and with the defeat of the sacroiliac - sacroileopathy.

These diseases are accompanied by the fact that 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, pain usually disappears and worsens with any physical activity.

Injuries during childbirth

Increased activity of relaxin, large fruit, complications labor activity can lead to rupture of the pubic joint or damage to the coccyx. With a rupture of the pubic joint, the pelvic bones diverge in this area up to 5-7 cm and immediately after childbirth cause pain of medium or high intensity. The pain is exacerbated by any movement, and in bed after childbirth, the puerperal is in a forced position - the “frog position”.

With an injury to the coccyx, the puerperal will feel pain only when she gets on her feet or sits for a very long time, during the act of defecation. The pain is intense, pulling in nature, aggravated by getting up from a sitting position, bending forward, tension of the muscles of the pelvic floor. The injury may be accompanied by a curvature of the posture and spine - antalgic posture.

objective data.

In addition to collecting complaints of pain in the relevant area, studying the anamnesis, the doctor conducts an examination and palpation to find out the distance between the pelvic bones, to assess the function of the joints. Also, with a rupture of the pubic joint or symphysitis, the patient will not be able to raise her legs in an unbent position upwards while lying on a hard couch. There may be difficulty 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 ligamentous apparatus of the pelvis, remains radiography. It is thanks to her that it is possible to make such diagnoses as "symphysitis", "rupture of the joints", "fracture and dislocation of the coccyx", "sacroileitis".

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.

With an increase in the distance of more than 2-3 cm, it is worth thinking about breaking the pubic joint.

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

A good assistant in treatment is a bandage, which provides a quick and effective strengthening ligaments, restoration of function musculoskeletal system while unloading it. Wear a bandage throughout the disease. There are also special corsets that ensure the immobility of the coccyx and contribute to its healing. They also prescribe medications that are aimed at reducing inflammation, relieving pain - paracetamol, ibuprofen, B vitamins.

Timely access to a doctor with complaints, a detailed history and characteristics of pain (where and how it hurts) allows you to early stages diseases to carry out as much as possible effective treatment, is a protection against the development of complications.

Sources:

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