Postpartum Pelvic Pain

Postpartum pelvic pain is one of those things you usually don’t give much thought until, well, you’re in pain. 

And if you’re a new mom and you notice pain in the pelvic region, uncomfortable symptoms such as leaking when you laugh or jump, a sensation of “fullness” down there, or just general discomfort, you’re certainly not alone. 

Pelvic pain in pregnancy and postpartum is common, with the American College of Obstetricians and Gynecologists (ACOG) noting that if it goes on for six months or longer, it becomes chronic. 

Postpartum pelvic pain, specifically, has many causes, ranging from pregnancy’s impact on the body to birth and postpartum recovery. It can also show up in different ways for different people, which sometimes makes it hard to diagnose. Lingering tailbone pain, for example, is a sign of pelvic floor dysfunction, which is when the muscles of the pelvic floor don’t function properly. 

Fortunately, with the right support and treatment, postpartum pelvic pain is treatable. Therapies including pelvic floor physical therapy can help tremendously.

Here, a bit more about what postpartum pelvic pain is, what causes it and — most importantly — how to feel better.

What is postpartum pelvic girdle pain?

Postpartum pelvic pain is uncomfortable. It can be felt in many different ways and in many different areas. But if you have pelvic girdle pain, you likely feel it around three different pelvic joints. One place is your pubic symphysis (the joint that sits right in the middle of your pelvis). If you have it, pubic symphysis pain may radiate to your back, hips and legs, and may worsen with weight-bearing activities such as running.

Another joint that tends to be a hotspot for postpartum pelvic pain is your sacroiliac joints (often called the “SI” joints, which sit on either side of the base of the spine). This type of pain occurs in your lower back. You might feel pain on both sides or just one, and pain can radiate to your thighs, worsening with weight-bearing activities.

Of course, pelvic pain postpartum can be experienced in a number of different places too. A few unsuspecting places you might notice pelvic pain, for example, are your tailbone (aka coccyx), inside your vagina or in your groin area.

You might also feel pain right at a C-section scar or an episiotomy or tear scar. Pain can range from sharp, shooting pain to deep, achy pain. You may feel it when you’re sitting, during sex or when inserting a tampon.

Common causes of postpartum pelvic pain

So what’s behind the aches and pains in your pelvic area? Well, just as postpartum pelvic pain can be felt in many different places, there are also many different causes of postpartum pelvic pain, including: 

Pregnancy

During pregnancy, your body releases a hormone called relaxin to loosen your ligaments and joints and relax the muscles for delivery. While this is natural, it can contribute to instability in some joints, including those in the pelvic region. This could cause joint pain.

Obesity (more weight to carry) and an increasing number of pregnancies (you tend to notice the physical signs of pregnancy faster with subsequent pregnancies) also increase the risk for pelvic girdle pain.

Healing from delivery, a perineal tear or an episiotomy

During a vaginal delivery, the pelvic floor muscles can stretch up to three times their length. The trauma from labor and delivery can sometimes lead to pelvic pain, particularly if your muscles go into spasm from the trauma of the baby passing through.

Sometimes, pelvic muscles and tissues are also damaged or torn, leading to perineal pain (in that area between your anus and vagina) or pelvic pain. Complications in healing such as poor healing or infection can cause worsening pain.

Pelvic organ prolapse

Pelvic organ prolapse occurs when the muscles and tissues that support your pelvic organs become weak and your pelvic organs prolapse or droop, pressing into or out of your vagina.

A vaginal delivery is a risk factor for pelvic organ prolapse because of the great demand on the pelvic floor muscles. If this occurs, you might have a sensation of pressure or fullness in the vagina, even without pain.

Pelvic floor dysfunction

Pelvic dysfunction in the postpartum period has to do with the pelvic floor muscles. These muscles carry excess weight and stress during pregnancy.

If you’re experiencing pelvic floor dysfunction, you might notice urinary incontinence or incontinence of gas or stool, constipation, pain with sex, hemorrhoids, vaginal pressure, pelvic pressure, a sensation of "no support" and other symptoms.

For some women, pelvic floor dysfunction can make normal activities feel impossible. You may experience pain or pressure in the pelvis or vagina while lifting your baby or have difficulty walking.

Can pelvic floor therapy help my pelvic pain?

Pelvic floor therapy is a specialized form of physical therapy that uses strengthening exercises to relieve and condition pelvic floor muscles. 

For some women prior to therapy, muscles may be tight or spastic, leading to pain. In these cases, pelvic floor physical therapy trains these muscles to relax.

For others, pain may be due to muscle injury or poor muscle function, in which case pelvic floor physical therapy can help by strengthening the muscles to function normally.

All pregnancies affect pelvic muscle function no matter the delivery route, and sometimes the muscles do not return to normal function postpartum. Pelvic floor physical therapy may help.

What should you expect from pelvic floor physical therapy? At your first visit, the pelvic floor therapist will perform an initial evaluation. This can include both an external and an internal (vaginal) exam.

The external assessment may include checking pelvic alignment, looking at your posture and strength, searching for signs of diastasis recti (a bulge due to the separation of your abdominal muscles most noticeable after pregnancy), and assessing your scars, including teaching you how to massage them to help them heal.

The internal assessment is not as invasive as getting a pap smear. The therapist will evaluate your muscle function by checking pain and strength of the external muscles of the vulva and inside the vagina.

Treatment at the visit can include strengthening, relaxation, and possibly massaging of muscles in your pelvis internally and externally to help you function better. If your pelvic floor physical therapist does manual therapy internally, it's to help release any areas of excess tension that may be contributing to your pain. Your therapist will likely give you an at-home exercise plan to follow outside the office.

Here’s more about what else to expect from pelvic floor physical therapy, as well as some of the techniques commonly used during sessions.

Pelvic floor exercises such as Kegels

Kegels refer to an exercise where you contract and relax your pelvic floor muscles. Sometimes after labor and delivery, the pelvic floor muscles are not able to contract or relax properly. A trained pelvic floor physical therapist can help you teach your muscles how to function optimally again. 

In particular, Kegels are helpful for muscle strengthening and endurance. They’re especially important for women with urinary or anal incontinence and pelvic floor weakness.

But Kegels are not a panacea — if you have painful or spastic muscles, Kegels can worsen pain. If you feel pain doing a Kegel or cannot do one, a pelvic floor physical therapist can help you find the proper treatment for your body and pain. 

Pelvic floor relaxation

When you think about strengthening your pelvic floor, it is equally as important to be able to fully relax the muscles as it is to squeeze the muscles. Lengthening and letting go of the pelvic floor muscles allows for improved oxygen and nutrient-rich circulation through the tissue and reduces pain. Relaxation of the pelvic floor muscles is particularly important if you have tight or spastic muscles.

Core function

Did you know that the pelvic floor is part of your core muscles? Therefore, strength and coordination of both your abdominal and pelvic floor muscles is important for normal functioning. Diastasis recti commonly occurs during pregnancy. Working on the proper muscles, including the deep abdominal muscles called the transverse abdominis, to strengthen your core will help improve your posture, reduce pain and improve function.

Pelvic floor biofeedback

Biofeedback is a tool used to help you get a visual representation of how your pelvic floor muscles are functioning. It doesn't replace a physical assessment, but it can be a good adjunctive tool to help your brain connect with this part of your body through visual feedback.

Biofeedback can be particularly helpful if you have a weak pelvic floor or if you’re not able to perform a Kegel. It can help you identify the proper muscles to use when activating or relaxing your pelvic floor.

Remember that pelvic floor physical therapists are specially trained to handle these sensitive issues and work hard to make patients comfortable, even though it might seem a bit strange or awkward at first to those who are new to this type of treatment. Pelvic floor physical therapy can effectively treat many cases of pelvic dysfunction relatively easily over the course of just a few months. You can find a pelvic floor physical therapist by visiting the Academy of Pelvic Health Physical Therapy or Pelvic Rehab.