Many women experience joint pain during the postpartum period. This symptom causes them significant discomfort, preventing them from fully caring for the child. The quality of life also decreases. But the situation is aggravated by the fact that a woman during breastfeeding cannot take many medications to alleviate her condition and does not have the opportunity to undergo a comprehensive medical examination. Therefore, it is important to know for what reasons all bones and joints hurt after childbirth in order to reduce the influence of provoking factors.
The effect of pregnancy on joints
During pregnancy, changes begin to occur in the female body that affect bone and joint tissue. This is considered normal. But if during such a period the diet becomes unbalanced, a significant loss of calcium and many nutrients occurs. All of them are aimed at the formation of bone and connective tissue of the baby, but the expectant mother is faced with the development of pathological processes in her bone structures.
The deficiency of essential microelements that occurs over nine months leads to metabolic processes in the joints being disrupted. Uncomfortable sensations begin to appear. At the same time, an increased load is placed on the entire musculoskeletal system. Body weight is constantly increasing, because of this the joints of the lower extremities, as well as the vertebral column, suffer.
It is also necessary to take into account the fact that during the period of waiting for a child, the production of a hormone called relaxin is activated in the body. Its task is to facilitate labor by relaxing the ligamentous apparatus. Therefore, those ligaments that should support the joints under increased load are in a relaxed state during gestation. This explains why the hands, knees and other joints hurt.
Many joint diseases do not manifest themselves in any way during pregnancy. But after childbirth they begin to worsen. Sometimes a woman may not be aware of the presence of such disorders occurring in her body. She may encounter the following ailments that cause joint pain after childbirth:
- rheumatoid arthritis;
- reactive and psoriatic arthritis;
- ankylosing spondylitis;
- infectious arthritis.
The course of rheumatoid arthritis during nine months of pregnancy is completely invisible. This disease begins to manifest itself after the birth of the baby. As a result, the joints hurt very much, causing the woman significant discomfort.
ATTENTION! Reactive arthritis begins to develop when expecting a child. This is facilitated by infectious processes occurring inside the body. At first, this disease is in a passive stage, and after the birth of the baby it sharply worsens.
If a woman has already experienced psoriatic arthritis before pregnancy, then subsequently, due to hormonal changes in the body, its symptoms may appear immediately after childbirth. Ankylosing spondylitis often occurs during pregnancy. At some point your back just starts to hurt. If a woman mistakes such a symptom simply for temporary fatigue resulting from increased workload, then after childbirth the disease develops with renewed vigor.
As a result, pain begins to be felt in the hip and lumbar joints. In this case, the shoulder joint, lower jaw, and hands may hurt. Therefore, it is important to pay attention to such symptoms even during the period of bearing a baby, so as not to encounter unpleasant signs of a serious illness later.
While expecting a child, a woman's immune system becomes more weakened and vulnerable. There is a risk of any infection entering the body. The most vulnerable areas are the joints of the arms and legs. This can lead to the formation of infectious arthritis.
Pregnancy and joint pain - prevention or treatment?
Constantly increasing pain that causes discomfort is not normal, so you need to contact a specialist for an examination and a treatment plan. To establish a diagnosis, the doctor identifies the cause of discomfort caused by one of the many existing pathologies. And during pregnancy, any of them may manifest.
Three reasons for pain
The first category is physiological reasons. They are often associated with incredible changes in a woman’s body - hormonal fluctuations, weight gain, the appearance of swelling and, as a result, a shift in the center of gravity. Which in turn inevitably leads to excessive stress on all groups of joints. This is especially true for those suffering from osteochondrosis.
An increase in body weight leads to pain in the back, accompanied by discomfort in the feet, knees and even hips. Joints simply cannot adapt as quickly to changing conditions and loads.
Here are a few more factors that lead to joint pain:
- lack of vitamin D;
- poor nutrition;
- traumas from the past;
- lack of calcium;
- the active influence of the hormone relaxin, it prepares the woman’s body for the upcoming birth.
The second category is pathological causes. They represent factors unrelated to the period of pregnancy, but simply coincide with it. In this case, it is necessary to start therapeutic treatment selected specifically for you in a timely manner in order to avoid the development of serious complications.
In this category, experts separately highlight autoimmune pathologies caused by an imbalance in a woman’s immunity. As a result, the likelihood of developing serious diseases such as lupus erythematosus, rheumatoid arthritis and various forms of vasculitis increases.
In most cases, at the initial stage of such pathological changes, pain is the only symptom of the disease. In the future, the symptoms become more obvious - redness, swelling and deformation of the joints appear. If constant rest or even bed rest prescribed by a doctor does not bring results, then you should definitely contact a rheumatologist.
And the last category is psychological reasons. Depression and stress can also be a great factor in the development of joint pain. And the initial reasons here are:
- change of rhythm of life;
- moving away from your beloved circle of friends and colleagues;
- dissatisfaction with your changed figure;
- fear of childbirth.
How to diagnose and who to go to?
The most effective treatment for joints is carried out by an arthrologist. However, there are quite a few such specialists today. Therefore, first of all, you should contact a therapist who will conduct an examination and, based on its results, refer you to a specialist: an orthopedist, surgeon, osteopath and others.
Diagnostics is carried out in several stages:
- external examination, when the doctor examines the external characteristics of the joints: shape, volume and symmetry;
- palpation, in this way the temperature of problem joints is determined and the presence of thrombosis is detected;
- performing the Trendlenburg test to assess the performance of the veins in the lower extremities;
- if the need arises, the woman is referred for additional laboratory tests and more thorough diagnostics.
Therapeutic treatment
The main thing here is to realize that treatment is prescribed only by a specialist. No amateur performances. To begin with, they resort to non-drug treatment to avoid harm to the child. Medicines are prescribed only as a last resort, when the first option does not bring the desired effect.
When treating physiological pain, the fundamental point is weight control and preventing its increase. During the consultation, the doctor will give advice on revising your daily diet, reducing the amount of carbohydrates and the need to introduce fasting days. During the first trimester, doctors recommend resting as much as possible to facilitate the body's process of getting used to the change in center of gravity. Also, in the absence of contraindications, special gymnastics and yoga classes are recommended.
If edema occurs, it is recommended to reduce the amount of fluid consumed. Special herbal preparations may also be prescribed. If the hormone relaxin is to blame, only limiting sudden movements and patience will help, since after pregnancy everything will return to normal on its own.
When pathological pain is detected, therapeutic treatment is inevitable. Here it all starts with wearing special bandages and ends with a carefully selected list of medications, which the rheumatologist must agree with the gynecologist. Medicines are selected with the obligatory condition that they are not harmful to the child.
Prevention of joint pain
In most cases, expectant mothers do not pay attention to joint pain
, although such a problem requires a very serious approach.
To prevent the causes and processes that cause joint pain, it is recommended:
- eat foods containing vitamins and calcium;
- do not give up vitamins;
- be sure to drink the required amount of fluid;
- control the level of weight gain;
- switch to comfortable shoes;
- in the absence of contraindications, attend yoga classes and gymnastics.
And remember, if while you are expecting your baby you have pain in your joints that does not go away, you do not need to endure it - be sure to seek advice from a specialist to avoid the development of chronic diseases.
Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr
Causes of pain
Pain after childbirth that appears in the joints may be associated with the recovery processes of the female body. It may indicate the development of some complications. The most common causes of joint pain are related to the body's reaction to stress such as childbirth. This may also be a consequence of disorders occurring with the musculoskeletal system, which arise against the background of a deficiency of essential microelements.
Unpleasant and painful sensations in the joints often indicate a decrease in the strength of bone or connective tissue. This condition can be caused by a lack of calcium and magnesium in the body. And sometimes this can be a complication after the use of an anesthetic drug during childbirth. Especially if the woman in labor has contraindications to pain medication.
Inactivity during pregnancy causes subsequent knee pain
Knee joints hurt due to weakening of the muscular and bone apparatus, which is associated with passive physical activity during gestation. A discomforting symptom that manifests itself in the area of the pelvic bones is usually associated with difficulty moving the baby through the birth canal. In this case, the risk of dislocation increases.
After the birth of a child, a woman’s body begins to get used to a completely different load. Weight becomes less, and activity increases. With pathological processes that began to develop during pregnancy and were not detected, then the back or lower back may hurt severely. This may be due to a curvature or herniation of the spine.
Sometimes excessive accumulation of fluid in the female body can lead to discomfort in the joints. But all the unpleasant sensations associated with this gradually disappear when breastfeeding ends. Pain syndromes in the shoulder girdle and hands may be associated with the need to frequently carry the baby in your arms.
Often, failure to follow medical recommendations can lead to joint pain. After the birth of the baby, the new mother should give up active training and increased physical activity. The body needs to be given the opportunity to rest from the stress it has experienced. Otherwise, joint problems cannot be avoided.
During childbirth, women stretch the muscle tissues of the spine, pelvis and ligaments of the pubic joint. Because of this, noticeable lumbar pain then appears, which gradually moves to the lower extremities, affecting the feet. Discomfort in the legs may be associated with varicose veins. Typically, the prerequisites for such a disease begin to emerge during pregnancy.
IMPORTANT! The root cause of the pathology itself can sometimes be determined by the location of the pain. The hip joint can cause discomfort due to the separation of the pelvic bones. This occurs when the baby's birth canal is obstructed. In this case, the joints recover spontaneously within two weeks.
Pain in the area of the wrist joints, hands and fingers appears quite rarely. Such discomfort may be due to the fact that during childbirth a woman persistently grabs and squeezes a sheet or other nearby objects. When the baby is born, the mother constantly rocks and carries him in her arms. As a result, the cartilage tissue of the fingers and hands, which has not had time to recover, begins to become inflamed, causing even more injury.
The skeletal system of the legs is affected due to the fact that the female body faces a colossal load. As the fetus develops and the baby's weight increases, the knee and ankle joints begin to suffer from excess body weight. After childbirth, the load decreases, but the woman spends a lot of time on her feet. This causes pain that occurs when squatting, walking, and even while lying down.
Typically, such a symptom, not associated with internal pathological processes, goes away on its own a month after birth. Sometimes the full recovery process takes a little longer. But if the unpleasant painful sensations do not go away and the woman feels severe discomfort every time she bends, she should seek help from a specialist.
Arthritis and pregnancy causes, symptoms, treatment and prevention methods
Pregnant women with arthritis need constant monitoring throughout the gestational period; the appearance of signs of disease activation requires a change in the treatment regimen. In the normal course of pregnancy, hospitalization every three months is recommended for the purpose of examination, assessing the effectiveness of treatment, studying the dynamics of the disease, and preventing complications.
Despite the fact that most women experience clinical improvement during pregnancy and the activity of arthritis decreases, they still require drug therapy. The prescription of a medicine, its optimal dosage and course of treatment should be carried out by a doctor on an individual basis, taking into account the characteristics of the course of pregnancy, general health, and the presence of contraindications.
The choice of drug is determined by the severity of the disease. Thus, with low inflammation activity and complaints of morning stiffness in the joints, non-steroidal anti-inflammatory drugs, such as Ibuprofen, are recommended from the moment of conception until the 32nd week of pregnancy. The use of NSAIDs at a later stage can impair renal function in the fetus, provoke an increase in pressure in the pulmonary circulation, and reduce blood clotting.
If the effect of Ibuprofen is insufficient, the choice is made in favor of synthetic hormonal drugs - Prednisolone and Methylprednisolone. With the correct dosage regimen and application regimen, they are absolutely safe for the health of the mother and the unborn child. The average daily dose, sufficient to suppress inflammation and successfully develop pregnancy and childbirth, is 5-15 mg. With persistent remission of arthritis during gestation, it is possible to reduce the drug dosage or completely discontinue the drugs until the end of pregnancy.
In cases where arthritis cannot be treated with anti-inflammatory drugs, the doctor may prescribe immunosuppressive drugs such as Hydroxychloroquine, Salazopyrine, Cyclosporine.
To prevent exacerbations of arthritis during gestation and after childbirth, it is important to follow a diet: limit the consumption of foods with a high degree of allergenicity: red meat, milk, chocolate, citrus fruits, tomatoes, corn. To reduce the load on the organs of the digestive system and improve the functioning of the gastrointestinal tract, it is necessary to adhere to the principles of a healthy diet: exclude fried, fatty, spicy, smoked foods, spices, herbs, sauces, salt. Moderate physical activity, Nordic walking, yoga, swimming are beneficial; according to doctor’s recommendations - physiotherapy, massage.
Since a genetic factor cannot be ruled out in the development of arthritis, the child after birth needs regular examination by a rheumatologist for early detection and prevention of the disease.
Diagnostics
If pain in the joints occurs, a nursing woman should immediately contact a medical specialist. In order to make a reliable diagnosis, a woman will be prescribed the following types of examination:
- General clinical analysis of blood and urine;
- Biochemical blood test;
- X-ray examination of a particular joint (if necessary);
- Laboratory analysis for infectious pathogens.
Perineal pain after childbirth: how to relieve it?
Materials and methods
Randomized controlled trials (RCTs), including cluster RCTs comparing paracetamol and placebo, were considered. Quasi-RCTs and crossover trials were excluded.
All studies looked at pain relief (a single dose of paracetamol (acetaminophen)) used for acute postpartum perineal pain.
The review included 10 studies involving 1,301 women, ranging from the 1970s to the early 1990s.
5 studies (482 women) assessed paracetamol dosages from 500 mg to 650 mg, and 6 studies (797 women) assessed 1000 mg paracetamol. One study evaluated 650 mg and 1000 mg versus placebo and contributed to both comparisons.
results
Paracetamol may reduce the number of women experiencing pain four hours after birth (10 trials, 1279 women) (mean risk ratio (RR) 2.14, 95% confidence interval (CI) 1.59–2.89; 10 trials, 1279 women); fewer women may require additional pain relief with paracetamol (eight trials, 1132 women) (mean RR 0.34, 95% CI 0.21–0.55; eight trials, 1132 women).
Adverse side effects: Nausea may have little or no incidence (median RR 0.18, 95% CI 0.01 to 3.66; 1 trial, 232 women; low-certainty evidence); somnolence (mean RR 0.89, 95% CI 0.18 to 4.30; 1 trial, 232 women; low-certainty evidence).
No other side effects were observed, and none of the studies examined the effect of the drug on infants.
Overall, the evidence was of low quality due to unclear methodology presented and variability in results.
The strength of the evidence was assessed using the GRADE approach.
Conclusion
Perineal injuries and severe perineal pain can reduce a woman's functional abilities and may affect her ability to breastfeed and care for her baby. It can also cause urinary and fecal incontinence and painful intercourse. Pain can persist for weeks, months, and sometimes for a longer period, so adequate pain control in laboring women is very important.
This review found that a single dose of paracetamol may improve perineal pain relief after vaginal delivery and may reduce the need for additional pain relief.
Breastfeeding women should be informed that there is little information available on the effects of paracetamol on breastfed infants.
Source:
cochrane.org/CD008407/PREG_paracetamol-relief-perineal-pain-after-birth