Pelvic Pain After Birth: Causes and Treatment 

You’ve just had your 6-week postpartum check-up with your OB. Everything looks great! You are given the green light to resume all activities. Prior to getting pregnant, you used to be an avid runner, so you decide to go for a “short” 3-mile run. After about 5 minutes in, you begin to experience sharp, shooting pain in your groin. You wait a few weeks, try again, and the same pain returns, worse than before. 

This scenario is common for many women after childbirth. While it’s normal to expect some discomfort after pregnancy and birth, persistent or worsening postnatal pelvic pain is not something to ignore. Understanding the causes, symptoms, and available treatment options can help you recover, protect your pelvic floor, and return to the activities you love with confidence. 

Pelvic pain during pregnancy 

Understanding the causes of aches and pains during pregnancy is crucial for recognizing postpartum pelvic girdle pain. Throughout various stages of pregnancy, hormonal changes occur that increase the elasticity of the pelvic girdle ligaments. This is the body’s natural way of preparing for childbirth. However, increased laxity and stress on the joints of the pelvic girdle can result in pain and inflammation. 

Muscle imbalances also begin to occur as the baby grows and the mother’s body changes. A growing belly can lead to increased curvature of the lower back, a tilted pelvis, and increased tension in the upper back. This may result in muscle spasms, groin or hip pain, nerve compression, and sciatica. 

Another common culprit of persistent pelvic pain during pregnancy is increased pressure on the pelvic floor musculature. As the pelvic girdle prepares for childbirth, changes in pelvic floor musculature also occur. There is growing intra-abdominal pressure that increases stress on the pelvic floor muscle. This can present as persistent pelvic pain, lower abdominal pressure, vaginal pain, and even fecal incontinence or urinary incontinence/leakage. 

What causes pelvic pain after delivery? 

Every woman experiences some degree of pain and discomfort after vaginal or cesarean delivery, but how long does postpartum pain last? And when should you worry about postpartum pelvic pain?  

Pelvic pain after pregnancy and delivery can be linked to several overlapping factors. Below are the most common causes of postnatal pelvic pain. 

Perineal tear 

In general, women are advised to wait 6 weeks to allow for the healing of tearing from vaginal delivery or episiotomy. However, every woman heals at her own rate, and 6 weeks is only a guideline. It’s very common for this area to have perineal pain or tenderness and reduced mobility. The larger and deeper the perineal tear, the more time and possibly additional treatment one may need prior to resuming full activity. 

Muscle weakness/imbalance 

The pelvic floor muscles stretch significantly during childbirth. In some patients, this can lead to weakness, dysfunction, or injury to both the pelvic and abdominal muscles. These issues often result in joint pain, bladder or bowel incontinence, and difficulty with daily activities like lifting the baby, standing, or bending at the spine. The imbalance took 9 months to develop and can take just as long or longer to return to the pre-pregnancy state. 

Injury to abdominal or pelvic floor musculature 

Damage to pelvic floor or abdominal muscles during delivery can make it more difficult to lift, bend, carry, use the bathroom, and affect general mobility. Often, additional treatment, including scar massage and gentle strengthening, is required to return to the prior state. 

Separation of pubic bones 

This is a normal part of pregnancy and delivery, allowing for the baby to pass through the birthing canal. However, excessive separation can lead to increased movement of the pubic bone and inflammation or pain in the pubic area. 

Pelvic organ prolapse 

This occurs when pelvic floor musculature is not working efficiently enough to support internal organs, such as the bladder, uterus, or rectum. Prolapse of pelvic organs may lead to feelings of heaviness, pain, or bulging in the pelvis or vagina. 

Symptoms and Diagnosis 

Postnatal pelvic pain can show up in many ways. Common symptoms include: 

• Sharp or aching pain in the pelvic bones, hips, or lower abdomen. 
• Vaginal pain, pressure, or bulging sensations. 
• Incontinence involving the bladder or bowel. 
• Difficulty walking, lifting the baby, or returning to normal exercise. 
• Heaviness or pulling sensations in the pelvis after standing or sitting. 

For diagnosis, a doctor will review your symptoms and medical history, conduct a physical examination, and may recommend imaging or additional tests to identify underlying problems. A clear diagnosis helps guide the right treatment path. 

How to relieve pelvic pain during and after pregnancy 

To mitigate pain, there are a variety of tactics that may help both during and after your pregnancy. 

Breathing 

Seems simple, right? Often, the pelvic floor muscle is holding increased tension and stress. Find a comfortable position, either lying on your back or slightly reclined. Rest your hands on your belly. Inhale and fill your belly up with air, imagining a balloon expanding in your lower abdomen. Exhale and allow the abdomen to return to its neutral position. Throughout this breathing exercise, there should be a developing awareness of the pelvic muscles lengthening and relaxing. 

Body Mechanics 

There are so many new things to lift and carry after having a baby! The baby itself, a car seat, a stroller, etc. Here are some tips for the unavoidable heavy lifting that will ensue: 

• Tighten deep abdominal muscles by drawing the belly button in toward the spine. This will help protect the lower back and engage the pelvic floor musculature. 
• Keep objects close to your body. Whether you are reaching for the diaper bag or trying to lift the baby out of the crib, getting as low and as close to the object as possible will reduce strain on your lower back. 
• Bend your knees. Although it will become increasingly challenging with a growing baby (during pregnancy and postpartum), using leg muscles to squat, push, and lift will help minimize strain on the lower back and pelvic region. 

Gentle Strengthening 

Just as pelvic floor exercises for men can help their own pelvic floor dysfunction, the same is true for women. Begin to activate muscles that will help stabilize the pelvic area during pregnancy and after delivery. 

1. Engage each pelvic floor muscle by squeezing and lifting muscles around the vagina as if you were trying to stop the flow of urine. 
2. Contract glute muscles simply by squeezing your buttocks together. 
3. Activate deep abdominal muscles by exhaling and pulling your belly button in toward your spine. 

External Support 

Sometimes, our own muscles need a boost. Wearing an SI support belt during pregnancy or after delivery can provide the pain relief we need until our own muscles are strong enough to stabilize the pelvic girdle. 

Posture 

As your body changes during and after pregnancy, posture is key to minimizing tension in the lower and upper back. Neck and shoulders should be relaxed. Utilize back support when able, especially while breastfeeding. Engage glute and deep abdominal muscles with prolonged standing to help reduce excessive curvature of the lower back and support the pelvis. 

Combat pelvic pain with physical therapy 

In many cases, pain relief can be achieved through gentle pelvic floor exercises, education on the causes of pain, and improved body mechanics. When conservative methods aren’t enough, pelvic floor physical therapy is often the most effective approach. Specialized therapists assess your pelvic floor, core muscles, and surrounding joints to create a plan tailored to your condition. 

Therapy may include guided pelvic floor exercise, manual techniques to relieve tight muscles, and strategies to correct posture and movement.  

If you’re experiencing chronic pain, don’t hesitate to find a pelvic floor physical therapist to help relieve your abdominal pain.  

At Ivy Rehab, our team of compassionate pelvic health specialists is trained in women health and dedicated to helping patients heal from pregnancy and birth-related pelvic issues. We have over 400 physical therapy clinics dedicated to providing exceptional care and personalized pelvic floor treatment to get you feeling better, faster. Contact us today to learn more. 

---

Article by Stephanie Calefati Guerra, PT, DPT

Stephanie Calefati Guerra, PT, DPT Ivy Rehab Downtown Hoboken, NJ

Stephanie graduated from Northeastern University with a Doctorate in Physical Therapy in 2010. Her interest in physical therapy, anatomy, and working with athletes developed over the course of many years as a gymnast. She has always had a special interest in rehabilitation for returning young athletes to prior level of performance. As a Pose Certified Running Technique Specialist, she has helped countless runners complete races, recover from injuries, and improve technique. More recently, after giving birth to her 2 babies, her interest in pelvic floor rehabilitation developed. She completed training through Herman and Wallace Pelvic Rehabilitation Institute and looks forward to helping women treat all ranges of pelvic floor related issues. She combines her previous experience with athletes with current pelvic floor training, to help women return to full prior level of fitness and athletic function. She strives to spread awareness and education on pelvic floor rehabilitation and to raise the standard of care for pregnant and postpartum women.

Education:

• Bachelor of Science in Rehabilitation Science
• Doctorate of Physical Therapy
• Herman and Wallace Pelvic Rehabilitation Institute
• Pose Certified Running Technique Specialist

The medical information contained herein is provided as an information resource only, and does not substitute professional medical advice or consultation with healthcare professionals. This information is not intended to be patient education, does not create any patient-provider relationship, and should not be used as a substitute for professional diagnosis, treatment or medical advice. Please consult with your healthcare provider before making any healthcare decisions or for guidance about a specific medical condition. If you think you have a medical emergency, call your doctor or 911 immediately. IvyRehab Network, Inc. disclaims any and all responsibility, and shall have no liability, for any damages, loss, injury or liability whatsoever suffered as a result of your reliance on the information contained herein.