Back pain after childbirth - causes, treatment, prevention

Quite often, girls and women with pain in the lower back or other parts of the back turn to gynecologists or therapists. Soreness can be observed even a month after birth and is accompanied by characteristic symptoms. In some females, the unpleasant sensations are less pronounced and almost unnoticeable, while others have a strong, aching or nagging pain that radiates to the legs.

If such symptoms have been observed for a long time, then it is better for the patient to contact the attending physician or gynecologist-obstetrician, who will carry out a series of diagnostic procedures and find out the cause of the pain. You should not put off visiting a specialist, as these symptoms indicate the presence of a pathological process.

Causes

When very severe, prolonged pain occurs, women begin to worry about why their back hurts after childbirth and what complications there may be. A qualified consultation with a specialist will help you understand the reason. It is not recommended to independently analyze your health status based on symptoms and the process of delivery.

The main causes in the lumbar region and other parts of the spine include the following factors:

• A sharp increase in weight during pregnancy. Weight gain causes a shift in the center of gravity, which can cause some vertebrae to shift or become movable under pressure.
• Consequences of epidural anesthesia. This anesthetic procedure is widespread in all hospitals and private clinics. Conducting epidural anesthesia helps the expectant mother to endure childbirth more easily and reduces pain to a minimum. A special substance is injected into the spinal space, after which the woman’s sensitivity decreases.
• Lifting heavy objects or a baby after childbirth. The weight of a baby or prolonged wearing of large weights affects the lumbar spine, so a woman may experience severe aching pain after walking or before bed.
• Stretching the muscle tissue of the abdomen and back. During the period of bearing a child, the abdominal muscles are greatly stretched, and in the lower back, the muscle tissue, on the contrary, contracts. As a result, the lumbar muscles are in constant tension. This phenomenon explains why the lower back hurts after childbirth.
• Displacement of the hip joints due to difficult childbirth. During delivery, injury to the hip joints or tailbone may occur. This phenomenon occurs rarely due to strong anesthesia or the large weight of the fetus.
• Displacement of internal organs due to enlargement of the uterine cavity. This phenomenon provokes strong pressure on the diaphragm, which can cause pain to radiate to the area of ​​the shoulder blades.
• Inflammatory processes in the abdominal organs. Childbirth can cause inflammation of the uterine cavity and adjacent organs, so after delivery of the fetus, the woman needs to be under the supervision of a doctor for some time.

The cause of unpleasant and painful sensations may be postpartum depression. This symptom is purely psychological in nature, so treatment involves a large number of positive emotions

Features of lumbar pain

Episodic non-pathological pain conditions can most often be managed independently, with the help of painkillers. If the pain is seriously bothering you, is not relieved by anabolic steroids, occurs frequently and interferes with normal life activities, you need to go to the doctor, establish a reliable cause and look for pathology. There can be many causes of low back pain syndrome, and not all of them are safe for the overall health of the body.

1. It can be caused by a whole group of diseases or pathologies of the spine.
2. The syndrome can occur after injury.

   
   Pain after injury

3. The source is often painful conditions of the gastrointestinal tract and appendicitis in exacerbation.
4. Cystitis, urolithiasis and similar kidney diseases also cause pain.

   
   Urolithiasis disease

5. The cause may be an infection called herpes zoster.

By the way. Any pain is a symptom. Lumbar is no exception. It is necessary to react to it, stop it, finding out why it arose. In order for a symptom to go away, it is necessary to get rid of the condition that gave rise to it.

The state of pregnancy and childbirth is not a pathological, but a natural process. However, it is this that becomes the most common cause of lumbar pain in women.

During pregnancy, the female body undergoes a complete restructuring. Concentrates on the task of bearing and giving birth to a child, adapting his functions and needs to it.

Spine in pregnant women

In this regard, the hormonal background changes, the uterus increases in size, and internal organs shift under its pressure. The skeletal system is adjusted for childbirth, softening and moving apart as much as possible (bones in the pelvis). The condition of the spinal muscles and the entire lower tier of the spine does not remain the same as before pregnancy.

Important! Almost any kind of pain that occurs in the lower back during pregnancy, during the birth process and after it (natural, with the exception of pathological ones), is rather a discomfort than a full-fledged syndrome. Restorative exercises, regimen, and time help to cope with them in most episodes. But some postpartum conditions accompanied by persistent pain require immediate, thorough treatment.

If you have back pain after pregnancy, it is better to consult a doctor for diagnostics.

Further actions

The question often arises of what to do if your back hurts badly for a long time. As soon as the pain becomes more pronounced or does not go away after 3-4 days, you should consult a doctor or follow general recommendations to reduce the severity of pain.

Such recommendations include:

• limit lifting heavy objects or children - a woman should avoid sudden lifting or bending so as not to strain her back muscles;
• change the sleeping position to one in which the mother feels comfortable and the pain is less pronounced;
• if your back does not stop hurting for too long, and the pain syndrome becomes more and more pronounced, it is recommended to take a painkiller (this can be either a local ointment or oral tablets);
• contact your doctor or therapist for diagnosis and determination of etiology.

Prevention and treatment of back pain

1. About a week after giving birth, a woman should visit an antenatal clinic. And if she is very worried about back pain, she should tell the doctor about it. Clinic specialists will find the reasons.
2. When bones diverge, you may need high-quality manual therapy to help get rid of the pain itself. Regular massage in such a situation can be not only useless, but also dangerous.
3. often prescribed to young women. Exercise therapy may also be prescribed.

General recommendations

1. Strong physical exertion should be avoided. Only a doctor can resolve them. Any type of gymnastics for postpartum recovery of the body, as well as other exercises to eliminate pain - all this can only be done with the permission of a doctor.
2. All child care activities must be very careful and careful. The crib, bath, changing table, etc. should be of such dimensions and position that it will be as easy as possible for a woman to do everything that needs to be done during this period. It is better not to lift bags with groceries, strollers and other heavy objects at all. If you still have to do this, then you should definitely use a sling.
3. It is better not to bend. Instead, if possible, you should squat while keeping your back straight. If you still have to bend over, you can’t straighten up abruptly, you need to do this smoothly and slowly.

And under no circumstances should you lift weights on an incline!!!

1. For feeding, you need to find more comfortable and less painful positions. It is advisable to use pillows, ottomans, and special footrests.
2. In the absence of contraindications, doctors may recommend wearing a bandage or corset.
3. For sleeping, it is better to choose a hard orthopedic mattress.
4. If a woman has gained too much excess weight during pregnancy, she will need to start gradually losing it. It is necessary to adhere to a diet, but only after consulting a doctor.

Diagnosis

Diagnostic methods allow you to find out exactly why your back hurts after childbirth and what was the cause. These methods of analysis include: examination by the attending physician or gynecologist - palpation of the lower back and abdomen is carried out in order to determine tumors or tissue deformations; instrumental diagnostics - the patient is referred to one of the methods of instrumental diagnostics (CT, MRI or radiography).

Computed tomography and radiography are based on the use of x-rays, which are recorded by a special device in the tissues of the subject. The doctor may additionally prescribe the administration of a contrast agent, which will enhance the visualization of the body structures being studied. The main contraindication to the administration of a contrast agent is the period of lactation.

A woman must refrain from breastfeeding for several days until the contrast agent has completely left the body.

Magnetic resonance imaging uses electromagnetic radiation to diagnose structural changes in tissue or neoplasms of various etiologies. Unlike CT, this technique is safe and suitable for girls who suffer from claustrophobia, since diagnostic devices are of the open type.

Magnetic resonance imaging is prescribed when the doctor suspects diffuse degenerative pathologies of the back

Diagnosis for back pain

Neuralgic pain in pregnant women is conventionally divided into:

• gestational;
• non-gestational.

Gestational pain is caused by natural (physiological) reasons and will go away on its own after childbirth. Non-gestational pathologies are caused by various pathologies and they need to be diagnosed in a timely manner. The doctor does the following step by step:

• interviews the patient;
• analyzes the anamnesis;
• conducts physical examinations - examination, measurements, palpation, checking tendon reflexes, determining pain and temperature sensitivity;
• examines the range of movements, posture, gait.

Rice. 2. Methods for diagnosing neuralgic syndrome during pregnancy

To exclude gestational pain, the following studies are prescribed:

• clinical blood and urine tests;
• hormonal levels;
• pathology markers;
• biochemical examination of vaginal smears.

For acute and chronic pain, the listed methods are sufficient to make a diagnosis. If there are neurological and somatic signs, the doctor prescribes instrumental studies:

• Ultrasound;
• MRI;
• CT.

X-rays are not performed for pregnant women.

When your back hurts badly after childbirth , the doctor prescribes the tests listed above and may refer you for a consultation to specialists - a neurologist, endocrinologist, gastroenterologist, etc.

Treatment

Depending on the etiology, the treatment of painful sensations and the factor that caused them is selected. In case of weakened back and abdominal muscles, the doctor recommends therapeutic exercises, the purpose of which is to strengthen the muscular corset of the back and reduce the load on the spine.

Back cushion for the spine

This gymnastics consists of a number of exercises:

• It is necessary to find a vertical, flat surface, and then lean on it so that the shoulder blades, heels, gluteal and calf muscles are in contact with the surface. Next you need to lift one bent leg in turn, then the other. The leg should be fixed for 15–20 seconds. Number of repetitions: 15 times on each leg.
• Bend and twist your torso in different directions. All actions should be slow so as not to damage weakened back muscles. Number of repetitions: 10–20 times on each side.
• Standing on all fours, bend your back first up, then down. The torso should be parallel to the floor. The number of approaches is 15 times with fixation for 10 seconds.

In addition to exercise, your doctor may recommend medications such as Paracetamol, Diclofenac or Ibuprofen. Self-prescription of drugs is not recommended, since it is necessary to take into account the lactation period and general contraindications.

Additional therapy for pain and discomfort is therapeutic massage and wearing a bandage after childbirth. The bandage supports the muscles of the back and abdomen, making it easier for a woman to bear heavy loads and long walks.

Ibuprofen is a non-steroidal anti-inflammatory drug whose action is aimed directly at the site of inflammation. It effectively relieves severe pain, inflammation, swelling and discomfort in the back area

Why do women in labor suffer back pain?

Cushions and armchairs for mothers

So, a complete physiological restructuring, preparing the body for childbirth, the process of getting rid of pregnancy, restoration and return of the body to its previous indicators - all these are stresses at the physiological level that a woman experiences for almost one year, while the pregnancy, the birth process and the postpartum period last.

By the way. It is with the restructuring of physiology that pain is associated, especially following labor, which is felt in the lower back. However, their strength cannot but be affected by their lifestyle and the presence of diseases. The second reason is precisely the various pathologies that the mother already has.

Table. Physiological reasons.

Advice. Recovery of the female body can occur one month after childbirth, or it can take a couple of months. The joints should return to their place, the ligaments and muscles should return to working condition. It is important not to overstrain your lower back, maintain good posture, and rest.

Prevention

To prevent back pain after childbirth, experts and doctors recommend adhering to the following preventive measures. Maintain an even posture. If there is curvature of the spinal column in different directions (kyphosis, lordosis or scoliosis), the girl should monitor her posture during pregnancy and perform gymnastic exercises that will help strengthen the back muscles.

Regardless of the presence of spinal pathologies, perform physical exercises that strengthen the muscular corset (in particular, the lumbar region). This could be swimming, gymnastics, yoga or gym classes. To prevent back pain due to heavy loads on the body and weight gain, a girl should monitor her body weight. You should not eat large amounts of fatty foods. It is important to remember that the more weight, the more pressure placed on the spinal column.

Choose the right orthopedic mattresses and other bedding items. Improper sleeping posture can cause discomfort and discomfort throughout the day. You should lead an active lifestyle and sit as little as possible. Staying in a sitting position for a long time causes discomfort and nagging pain in the lower back, which is something a pregnant woman needs to remember.

After childbirth, you should stop lifting heavy objects and carry your baby with care. Holding a baby for a long time can affect weakened back muscles. You should also take care of the surrounding space and objects. After giving birth, a girl is not recommended to bend over too low, so it’s worth adjusting the diaper changing table, baby’s crib and other necessary items in advance.

Spine restoration after childbirth

According to statistics, more than 50% of women in labor suffer from back pain, and quite often they are accompanied by unpleasant sensations in the neck, shoulders, and pelvis. This condition can last from several weeks after birth to 1 year or longer.

There are a large number of reasons that cause back pain for a mother who has given birth:

• Shifting the center of gravity of the body during pregnancy and redistributing the load.
• Excess weight, which increases the load on the spine.
• Overstretching of the back and abdominal muscles during pregnancy and pushing.
• Carrying a child in your arms for a long time and often, often with a skew to one side.
• The appearance or exacerbation of chronic diseases of the musculoskeletal system.

back pain after childbirth

The appearance of lower back pain is largely influenced by the condition of the abdominal muscles, which stretch and lengthen during pregnancy, diverging to the sides, which shortens the lumbar muscles. Changes in the lumbar muscles, in turn, lead to the formation of a noticeable depression in the lumbar spine, due to which the stomach is able to protrude.

After such adjustments, pain occurs in the lumbar region, which is especially severe when bending forward, squatting and lifting heavy objects.

Stretching of the pelvic muscles during the birth process also leads to pain in the back. The passage of a fetus large enough for it through the narrow birth canal causes stretching. Changes in the structure of muscles and ligaments against the background of hormonal changes in the body of a pregnant woman also have an equally traumatic effect.

Most often, women in labor suffer from strained pelvic muscles, whose physical fitness at the time of the birth of the baby left much to be desired. Those women who actively participated in permitted sports or special gymnastics before and during pregnancy experience much less back pain after childbirth.

Birth injuries are also a common cause of back pain. This term refers to the displacement of the hip joints and vertebrae of the sacrolumbar region. Most often, they affect women with excess body weight, as well as those giving birth who did not prepare for childbirth (did not master proper breathing, did not take gentle positions during contractions, etc.).

Many experts believe that spinal anesthesia during childbirth does not give a woman the opportunity to concentrate on her sensations and take the most comfortable and correct position for herself. For this reason, it is recommended not to use strong painkillers during labor unless directed by your doctor.

Birth injuries in the form of joint displacements bother a woman for a long time in the form of pain in the lower back and hips, which can even radiate along the back surface of one or the other leg. If the injury was very serious, surgical intervention may be necessary, although doctors try to use gentle traditional therapy methods: treatment sessions with a chiropractor or osteopath, physiotherapeutic procedures, exercise therapy.

Drug therapy is used very rarely to treat these injuries, since most anti-inflammatory and painkillers are strictly contraindicated for a nursing mother.

Prevention of back pain after childbirth

For six months after childbirth, the muscles of the back and abdomen remain very sensitive to changes in the motor activity of the young mother. Therefore, physical activity and sports activities should be strictly dosed and not exceed a woman’s capabilities. Training begins gradually, in a gentle manner, otherwise you can very easily break your back and get even bigger problems.

Quite simple rules of prevention can prevent the occurrence of back pain:

• Before picking up your baby, sit down a little, bend your knees, and straighten your back. Lift the weight, not straining your back muscles into extension, but your leg muscles, gradually straightening your knees. This is standard advice on lifting weights for any person, so as not to hurt their back; it is especially relevant for mothers with newborns, who need to be lifted frequently with increasing weight during the first year of life.
• The height of the changing table, crib, bath while bathing the child must be adjusted so as not to overload the back during daily child care procedures.
• If possible, try to use slings, kangaroos, or special carriers to carry your child, which do not overload the back, but, on the contrary, distribute the load on the shoulders, supporting the back muscles with special belts. At the same time, minimize the time you carry your baby in your arms, especially when he is sleeping or in a calm state. Hand your child over to relatives or caregivers more often.
• To feed your baby, you need to choose a comfortable position using a pregnancy pillow, bolsters or ottomans, choose a suitable armchair, sofa or chair with a comfortable back. Many feeding positions require the mother to lie on her side or back.
• Make it a rule to do several exercises 1-2 times a day to strengthen your back and abdominal muscles. You can start exercising 2-3 days after a natural birth without complications and about a month after a cesarean section (or as recommended by your doctor). As strength returns, you can increase the number of repetitions and intensity of muscle work.
• The most important point for a young mother is normalizing weight after childbirth. Excess body weight significantly increases the stress on the back, especially when combined with the ever-increasing weight of a child who is often picked up. According to the recommendations of experts, the energy value of a breastfeeding woman’s diet should not exceed 2000 kcal/day for weight loss. For the mother of a bottle-fed baby, the value of the diet is calculated based on the degree of her activity, and is approximately 1600 kcal/day, as in normal everyday life.

Exercises to strengthen the muscles of a woman in labor

Not any physical activity is suitable for a woman after childbirth. It is best to perform sets of special exercises designed specifically to restore the body after pregnancy and childbirth: to strengthen the muscles of the chest, shoulders, back, anterior abdominal wall, and pelvic floor. These same exercises will serve as a good prevention of postural disorders.

Complex for chest and shoulder muscles

The load on the muscles of the chest and shoulders, in addition to the main task, indirectly improves lactation and serves as a prevention of mastitis.

1. Take a standing or sitting position on a chair with a straight back and a tucked stomach. Clasp your hands at chest level, and move your elbows as wide as possible to the sides. Make a squeezing movement with your hands, focusing on your palms, as if there is a nut in them that needs to be crushed. Keep your muscles tense for 5-10 seconds, then relax your arms. Perform 2 sets of 10 times.
2. Stand facing the wall, resting your hands on it, bent for push-ups on a plane, place your feet shoulder-width apart. The elbows should not be spread to the sides, but located along the body, the head should not tilt, the stomach and buttocks should be tucked. Wall push-ups are performed slowly, with obvious pressure on the wall. Perform 2 sets of 10-15 times.

Abdominal complex

Exercises for the muscles of the anterior abdominal wall can be performed 1.5-2 months after childbirth, if there are no obvious contraindications, for example, after a cesarean section (at least 2-3 months). During this period, the abdominal muscles, which moved apart during pregnancy, return to their place.

However, before starting classes, you must definitely check the condition of your abdominal muscles. To do this, you need to lie on your back and try to lift your legs a few centimeters off the floor. If, at the moment of tension in the abdomen, a tubercle appears along its midline, then the muscles have not yet returned to their usual position, and the greater the width of the tubercle, the greater the discrepancy. It is not recommended to start classes until the width of the bulge is less than 2.5 cm.

1. Lie on your back, bring your legs together and bend your knees slightly, cross your arms on your stomach above or just below your navel. Raise your head and shoulders, while trying to feel the tension in your abdominal muscles, move them to the center, and stay in this position for 4-5 seconds. Perform 2-3 sets per day of 5 repetitions.
2. Take the starting position as in exercise 1, while pressing the sacrum and lower back to the floor as much as possible, placing your hands under your head, and spreading your elbows to the sides. Slowly raise the sacrum above the floor, while the lower back should remain in place, then raise the head and shoulders, fix the position for a few seconds and slowly return to the starting position. Perform 5 times, gradually increasing the number of repetitions.
3. Take the starting position as in exercise 1, arms down along the body. Slowly raise your upper body, stretching your arms forward, then just as slowly return to the starting position. At first, you don’t need to climb high; you can help yourself by grabbing furniture with your hands or asking relatives for help. Over time, the loads increase, as does the lifting height. Repeat 2-5 times per approach.
4. Sit on the floor, bend your legs, stretch your arms in front of you. Slowly lower yourself from a sitting position to a lying position. Perform 2-3 times from the first approaches.
5. Lie on your back, bend your knees so that your heels are as close to your buttocks as possible, place your hands under your head, and elbows apart. Twisting is performed: as you exhale, the head, shoulders and knees rise slightly, the upper part of the body turns to the right, and the lower part to the left, on the next exhalation the direction of movement changes to the opposite. Perform 2-5 times on each side.
6. Lie on your back, bend your legs slightly and place them shoulder-width apart, fold your arms under your head, and spread your elbows to the sides. Raise your head and shoulders, fix them for 3-4 seconds, then raise your legs, fix them for 3-4 seconds, smoothly lower your head and shoulders, keeping your legs suspended for another 3-4 seconds, lower your legs into place. Perform 2-5 times.

Complex for the pelvic floor muscles

This group of exercises is necessary to tidy up the pelvic muscles and normalize the functioning of the female reproductive system. They can be performed already 2-3 days after birth, with the exception of cases with serious ruptures or cesarean section. The complex is performed 3-5 times a day. These are Kegel exercises designed specifically to improve the health of the female genitourinary system, useful both during pregnancy and after it, facilitating natural childbirth.

1. Vaginal muscle training. Squeeze the internal muscles, as if you want to hold urination, hold them for 3-5 seconds, then smoothly release them. To understand which muscles should be tense, you can practice in the toilet, interrupting urination. Perform 20-30 times per set.
2. Anal muscle training. It is performed in the same way as the first exercise, but the muscles of the anus are tensed for 3-5 seconds, then relaxed. Perform 20-30 times per set. This exercise, in addition to training the pelvic floor muscles, serves as a prevention of hemorrhoids, which young mothers often suffer from.
3. After mastering the first two exercises, you can move on to the next stage: perform both at the same time for 20-30 repetitions.

Exercise for the lower back muscles

Performed lying on your side. Lie on your right side, stretch your right leg along your body, and stretch your left leg forward across your body, your right arm stretches along your body. The left arm must be moved behind the back as much as possible, while simultaneously turning the head, neck and left shoulder to the left, the muscles of the back and pelvis should be tense. Perform 5 approaches, change sides and repeat the exercise 5 times.

Fitball exercises

To put their own bodies in order, young mothers will need a fashionable sports equipment - a fitball (a large inflatable ball of various diameters). It is used not only for exercises for adults, but also for performing a number of exercises to improve the health of children almost from birth.

Exercises on the ball will help women overcome compensatory thoracic kyphosis, which appears during pregnancy. To do this, you need to work the rhomboid muscles, located on either side of the spine. They extend from the vertebrae of the cervical and thoracic segments of the spine and are attached to the inner edges of the shoulder blades, pulling them towards the center of the back. Sufficient tone of the rhomboid muscles forms beautiful posture.

To perform an exercise on a fitball, you need to place the ball under your stomach so that you can comfortably maintain your balance, resting on the toes of your straightened legs.
Your arms should be straight and joined above your head. To train the muscle, you need to round your back, then, while inhaling, lift your torso up with your arms, fix your body, bend your elbows and try to bring your shoulder blades together. Then you need to return to the starting position. Repeat 5-10 approaches. Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr