All around the world approximately 350,000 babies are born every day. That is more than a quarter of million women around the world experiencing the wonder of pregnancy at the same time. If you know me well you would have heard me say that pregnancy was the best time of my life. I loved every kick, every baby hiccup and I loved watching my belly grow. I even felt wonder and awe when I had pelvic pain, nausea and when I began to waddle, because: how amazing are women’s bodies?! We are creating human beings simply by using our own cells and nutrients (The boys also made a small contribution :P).

 

Not everyone feels so wondrous about the whole pregnancy experience. Nausea, fatigue, heartburn, swollen ankles and stretch marks take their toll.  Pregnancy related pelvic pain is one “side effect” of pregnancy that certainly hits it’s fair share of victims. The research would suggest that around 20%-25% of women suffer from pregnancy related pelvic pain, but if you ask me, I would imagine the stats are much higher. Perhaps many cases go unreported or are not classified as “serious” and therefore are left out of the literature. I do however agree that while most women recover from these pains within the first 3 months post-natally (if not immediately after the baby is born), around 5-7% of women do not recover, and this is when you need to seek help.

 

Why does pregnancy hurt?

 

There are a myriad of changes that happen to the body during pregnancy, from posture change, to weight fluctuations, blood pressure to changing fluid levels. This can affect the way we move during pregnancy and make us susceptible to pregnancy related pelvic pain. Week 20 gestation appears to be the magic number. Why? Because around 4 months gestation the hormones kick in big time. The hormones encourage the ligaments of the pelvis to relax, in preparation for the baby to be allowed to pass through the bony outlet that is your pelvis. This will often manifest as lower back, sacrum or pelvic pain. Because the pelvis is also a ring shape, movement at the back of the pelvis can also affect movement at the front, and this is called pubic symphisis dysfunction. Women often describe this pain as a sharp, shearing pain in their pubic bone when they weight bear, attempt to move up and down steps or turn over in bed. I won’t lie… this is one of the nastier ones, and can be hard to get rid of once it hits, because it in actual fact, it is a combination of mechanical type pain, and inflammation type pain.

 

How do we fix it?

 

Like a well trained football team trying to win the grand final, we can hit pregnancy related pelvic pain and pubic symphisis dysfunction will a multi-faceted approach. Here is the game plan:

 

1. Play some defence!

Avoiding activities which will irritate the joints of the pelvis and spark pelvic pain will help you big time in the long run. Each time the joints are irritated, they can cause excess movement or shearing forces, and cause inflammation. With anti-inflammatories being a ‘pregnancy no-no’, time and aqua aerobics with the oldies is what it’s going to take to settle an inflammatory reaction. Activities that you should be on the defensive for include impact exercise, jumping, excessive crossing of the legs or separating of the legs, taking steps 2 at a time and multi-directional movements (like bending, twisting, reaching and lifting, or pivoting).

2. Have your outside players make a move!

The players on the outside are your gluteals, piriformis, lumbar multifidus and hip rotators. They hang out on your lower back, the outside of your pelvis and the side of your hips. By strengthening these muscles and maintaining their strength throughout the pregnancy, it will help to support the pelvis and the ligaments, and hence prevent any  excessive shearing forces, and in turn, prevent inflammation. My fav exercise is called “the clam”. I tell all my lovely ‘mama’s to be’ to do this exercise every single day of your pregnancy and it will help you get started to creating a strong and stable pelvis. Check out this you-tube clip of “the clam”! And just to be sure, it is always a good idea to get your physiotherapist or pilates instructor to have a look at the way you are doing this exercise, to make sure you are nailing your technique!

 

 

 

3. While the big girls are working the outside, get the secret game-play moving on the inside! AKA: Pelvic floor muscles.

The pelvic floor muscles are a hammock of muscles that extend from the pubic bone at the front, to the tailbone at the back, and extends left to right between the 2 sit-bones. When they activate, they squeeze around the urethra (where the urine flows from), the vagina and the back passage. They also lift up inside, creating an upward support for our precious pelvic organs (bladder, bowels, uterus etc), and of course, for the precious cargo you are carrying during pregnancy. If you are imagining theses muscles correctly, you can also imagine that when they contract they might be able to support our bony pelvis from the inside. They essentially create a force that would draw the walls of the pelvis together, and combined with the outside players, we essentially have a stabilizing, compressive force that could be a game changer in the world of pelvic pain. Helpful tip! Check out The Continence Foundation of Australia website or our blog “The pelvic floor 101” to check out how to do your pelvic floor muscle exercises correctly. They will also help prevent urine leakage 😉

4. Smash the fluids and the oranges at half-time!


OK, all the time for you pregnant ladies! Hydration and a balanced diet plays an important role in maintaining the integrity of our muscles and ligaments, with the right fuel you can give your body, your pregnancy and your baby a good shot at having a healthy and strong experience. The rest of the population needs around 1.5-2.5 litres of fluid per day. As you progress through pregnancy, and especially if you intend to breastfeed, you should aim for 3.5 litres of fluid per day.

5. Avoid constipation! (I don’t seem to have a sport analogy for this one. Don’t block the goal posts? Sorry I have nothing).

Anyway, constipation is one of those ones that seems to affect most pregnant mothers. But we never talk about it. If you allow constipation to continue and go unmanaged, it can create pressure from the bowels that can cause pain, make the pelvic floor muscles difficult to contract and affect the way your pelvis wants to move. It is can be a catalyst for pregnancy related pelvic pain that will most likely go unnoticed and unaddressed in medical land. My advice? Get on it early. Take a supplement and combine it with enough fluid for the day, ensure you have good posture on the toilet and never strain. This will also help you in the long run for bladder and bowel function, keeping you strong and preventing damage to the muscles that can lead to things like urinary incontinence. For more advice on preventing and managing constipation download our free e-book: the pelvic floor top 10, available from our website: Calmandconnection.com.au.

 

Outside of this game plan, Physiotherapists also have tips, tricks, equipment and their magic hands that can help you treat pregnancy related pelvic pain. Pregnancy support belts, taping and stretches often give relief, and help you continue your day to day activities. This can be especially valuable if you are still working, have home commitments or are caring for cutie bootie toddlers.

 

In conclusion, I apologise for offending football players everywhere by using my primitive knowledge of the game to explain pregnancy related pelvic pain. Second apology: This blog is in no way comprehensive of the experience of pain during pregnancy. I will continue to try leak that out slowly throughout my blogging career!

 

Coming up…

Heard about the “mesh” drama? We are going to hit our blogs with some valuable resources and references that will help guide you in making evidence based and informed decisions (not just horror stories!) regarding mesh and it’s use in treating pelvic organ prolapse.

Until then…

 

Be kind to yourself,

Julia Berger
Physiotherapist