Pelvic pain during pregnancy: causes, diagnosis and treatment

2024 Author: Priscilla Miln | [email protected]. Last modified: 2023-12-16 00:21

The load on the female body during the period of gestation increases significantly. Cardinal changes take place literally in all organs and systems, which from the moment of conception are concentrated around the uterus. The reproductive organ itself to some extent depends on the pelvic bones and supporting muscles.

Physiological characteristics

The uterus is located inside the pelvic ring, attached by certain ligaments in a circle. In the cavity of the organ, the muscles are transformed into uterine spirals, which can hurt with increased tone. This can occur in those of the fair sex who had an anatomically twisted pelvis before pregnancy. The ligaments are not tensed equally. As a result, one side is relaxed, while the other is experiencing unnecessary tension, which causes discomfort. Constant pulling pains are a reason to see a doctor.

The pubic joint, or symphysis, is normally in a certain position and does not move. In some cases, the pubisbecomes mobile and may swell, which is a pathology. With the onset of pregnancy, and especially as childbirth approaches, the cartilage tissue connecting the pubic bones softens under the action of the hormone relaxin. This is necessary to ensure the free passage of the baby's head. Halfway through childbirth, these changes return to normal: the cartilage thickens, the width of the joint space decreases, and the ligaments acquire their former elasticity.

Causes of pelvic pain during pregnancy

Pain in the pelvis during childbearing can normally be experienced by more than half of expectant mothers. Usually, discomfort appears from the middle of pregnancy, which is facilitated by completely natural causes. In some cases, the divergence of the pelvic bones during pregnancy is pathological and is accompanied by many unpleasant symptoms that significantly worsen the quality of life of a woman, do not allow her to move normally and have a good rest.

According to most doctors, pelvic pain during pregnancy appears due to calcium deficiency in the body of the expectant mother. Inflammatory processes in the bladder and urethra (cystitis, urethritis), chronic infection in the urogenital tract, magnesium deficiency in vitamin D hypovitaminosis can lead to the development of symphysitis. It is believed that unfavorable heredity and certain problems with the musculoskeletal system affect the appearance of pathology (for example, curvature of the spine or osteochondrosis) before pregnancy.

Starting from the middle of pregnancy, the load onback muscles. The abdomen increases, as does weight gain, which can cause constant tension and pain in the pelvic girdle. It becomes difficult for a woman to walk during pregnancy. The growing uterus itself contributes to the stretching of all ligaments, which can cause pain in the sacrum and pelvis. In this case, to avoid pain, it is enough to reduce the load and rest more in a horizontal position.

Risk factors for symphysitis

Contribute to the development of a pathological condition (divergence of the bones of the pubic joint more than the physiological norm) a sedentary lifestyle and a large weight gain during pregnancy, pelvic injuries in the past, large weight and size of the fetal head (more than 4 kg), numerous births, symphysitis during past pregnancies, significant stress on the body of the expectant mother (work associated with physical stress, intense exercise in certain sports), hereditary diseases of the joints and bones, for example, a collagen defect that leads to excessive joint mobility.

Pathological divergence of bones

Symphysitis (in ICD-10 pathology belongs to class 000-099, block 020-029, group 026.7) in half of pregnant women appears as a variant of the norm and is manifested by minor discomfort. But if this condition significantly worsens the quality of life of the expectant mother, then we can talk about a pathological divergence of the pubic joint. The physiological norm is the divergence of bones up to 5-6 mm. Symphysitis of the first degree is diagnosed withdiscrepancy by 6-8 mm, the second degree - by 8-10 mm, the third degree - more than 10 mm.

Main symptoms of symphysitis

Most often, pelvic pain during pregnancy appears closer to the third trimester, when the effect of the hormone relaxin reaches its maximum, the child's weight is already more than 2 kg, in the total weight gain of a woman during the period of gestation approaches or exceeds 10 kg, which is significantly increases the load on the musculoskeletal system of the expectant mother. Symphysitis is characterized by swelling in the pubic area, pain when pressed, independent pain in the groin, coccyx, perineum at rest and during movement, a characteristic waddling gait.

With a slight divergence of the pubic bones, the pain is periodic, does not differ in intensity and can change localization. Such a symptom can be mistaken for manifestations of osteochondrosis or the threat of miscarriage. The pain appears with a long stay in one position, aggravated by walking or climbing stairs. With a significant degree of bone separation, pelvic pain during pregnancy may occur at rest. Usually there is severe pain with slight pressure on the pubic joint, both from the side of the vagina and in front.

Obvious divergence of the bones becomes if a fingertip (more than 2 cm) is placed in it. Pain usually occurs in the second and third trimesters of pregnancy. In some cases, the bones diverge, and there is no pain until the very birth. After childbirth, the abdominal muscles become flabby and the pubic bones may separate 2 cm or more. In this casea woman simply cannot walk and intuitively assumes a certain position, namely the “frog pose”. The pressure on the symphysis is reduced, which relieves pain.

Necessary diagnostics

The diagnosis of symphysitis (in ICD-10 this pathology belongs to the class “Pregnancy, childbirth and the postpartum period, code 000-099) is usually made only on the basis of complaints from the expectant mother. The doctor will definitely prescribe an ultrasound and tests to determine, respectively, the width of the divergence of the pubic joint and the deficiency of substances in the blood. Biochemical analysis will confirm or refute micronutrient deficiencies, primarily calcium.

Treatment of symphysitis during pregnancy

Symphysiopathy during pregnancy has no effect on the development of the fetus. After childbirth, the problem usually disappears on its own. Prior to this, the pathology may pose a danger at the time of delivery. There is a risk of significant divergence of the bones of the pubic joint, which in the future will require a long recovery. Natural childbirth is possible in most cases, but the final decision will be made by the obstetrician-gynecologist.

To alleviate the condition of a woman before childbirth in case of symphysiopathy during pregnancy, the doctor will give certain recommendations. As a rule, the intake of special anti-inflammatory drugs, multivitamin complexes with calcium content or individual drugs is indicated. It is necessary to adjust the diet, normalize weight and control gains, reduce physical activity, do gymnastics and be sure towearing a brace.

Physical activity with symphysis

In case of severe pain, restriction of physical activity will be required. The expectant mother should not walk a lot on stairs, sit or lie on a hard surface, in a standing position, you need to distribute the weight on both legs. In the supine position, you can put a hard pillow under the buttocks, lifting the pelvis, and several pillows under the legs. This will reduce the pressure of the fetus on the pelvic area. With minor pain, the knee-elbow position will help. If there is a history of diseases of the musculoskeletal system, a woman should definitely consult a trauma surgeon or osteopath about pain.

Prenatal bandage: how to wear

The bandage supports the stomach and prevents excessive stretching of the ligaments. Wide support belt made of elastic fabric can be worn from 20-24 weeks. In some cases, it is advisable earlier or much later. The bandage is especially relevant for women who lead a fairly active lifestyle during the period of gestation, are on their feet for several hours in a row, have diseases of the musculoskeletal system or experience pain in the pelvis. Wearing a bandage is indicated for the appearance of stretch marks, multiple pregnancy, varicose veins, some obstetric pathologies, the threat of premature birth, osteochondrosis.

How to wear a prenatal bandage? The belt cannot be worn continuously. A break of 30-40 minutes is recommended every three hours of wearing. The bandage should not squeeze the stomach and deliver anyunpleasant sensations. It is advisable to wear a support belt until the very end of pregnancy, if it brings relief to a woman, and there are no contraindications. When used correctly, the bandage does not pose any danger to either the child or the woman herself.

Vitamin-mineral complexes

Calcium preparations are usually forbidden to be taken in the third trimester of pregnancy, when the body is actively preparing for childbirth. This can lead to some complications. Some doctors even recommend eliminating calcium-containing foods from the diet, because strengthening bone tissue will greatly complicate the birth process. The skull of the baby will become stronger and harder, which is highly undesirable before his birth.

What is the best calcium for pregnant women in the second trimester, when is the use of such a mineral acceptable? One of the most common drugs is calcium gluconate, but the body perceives it the worst (due to the lack of vitamin D). The combined remedy is "Calcium D 3" ("Complivit", "Nycomed"). Such vitamins make up for the deficiency of nutrients much more effectively. When choosing a drug, it is important to remember that the best vitamins for pregnant women (in the 1st trimester and throughout the rest of the period) can only be selected by a doctor.

Drug therapy

In some cases, hospital treatment may be required. In a hospital, physiotherapy procedures are carried out, anti-inflammatory drugs and painkillers are administered under the supervision of doctors. usedmedical bandage. Can be applied ultraviolet irradiation of the pubic area, antibiotic therapy.

Natural Birth or COP?

With a significant divergence of the pubic bones during pregnancy, there may be indications for delivery by caesarean section. With a narrowing of the pelvis and a large size of the fetus (more than 3.5 kg), the critical distance of divergence is 10 mm. The issue is resolved individually. Natural childbirth is possible, but only if the bones have expanded no more than 10 mm, the woman's pelvis is of normal size, and the fetus is not very large.

With symphysitis in childbirth, a rupture of the pubic articulation is possible. In this case, the woman in labor suddenly feels intense pain, sometimes a characteristic click is heard when the ligaments are torn. After that, even the large head of the child passes freely between the bones. Sometimes the rupture is accompanied by injury to internal organs (primarily the bladder and canal), the formation of extensive hematomas in the labia and pubis. Recovery requires surgical treatment with the imposition of special metal structures.

Prevention of symphysitis

For the prevention of pelvic pain during pregnancy, a diet enriched with all the necessary microelements and trace elements involved in bone formation, and vitamin D is recommended. These beneficial substances are found in cheese, eggs, meat and fish, milk and lactic acid products, nuts. It is better to avoid foods that contribute to active weight gain, because extra pounds repeatedlyincrease the load on the musculoskeletal system.

Woman recommended walks in the fresh air, sun and air baths, moderate physical activity. Fitness classes or yoga for pregnant women, water aerobics or swimming have a good effect on the body. Additionally, it is desirable to take suitable vitamin and mineral complexes, you need to monitor your posture. You may need to take painkillers. In this case, you need to follow the doctor's recommendations and refuse self-medication, because not all medicines can be taken during pregnancy.