Connection between pregnancy and pelvic floor changes
Congratulations on your pregnancy. During pregnancy, your body goes through many changes across all systems — hormonal, metabolic, cardiopulmonary, immune, integumentary, gastrointestinal, urinary, musculoskeletal and psychological.
In the musculoskeletal system, pregnant women experience loosening of ligaments and a change in their center of mass, which can result in altered posture and core muscle length tension relationship. Due to these changes, pregnant women can experience pain.
Common pregnancy-related issues includes the following: Pain arising in the low back region may extend into the buttocks, thighs, ankle, and/or foot. Pelvic girdle pain can be anterior, posterior, or in both regions. About 20 percent of pregnant women will experience PGP. Anterior PGP involves pubic symphysis joint and ligaments, adductors and anterior hip/lower abdominal muscles and soft tissues. The normal pubic symphysis gap is 4-5 millimeters; however, during pregnancy, this gap can increase to between 6 and 9 millimeters.
Posterior PGP involves sacroiliac joints, sacroiliac ligaments, and posterior lateral hip soft tissues such as gluts and piriformis.
Round ligament pain is described as “twinge-y” pain along the groin region with position changes. This pain does not typically start until around 20 weeks when the uterus is growing more rapidly, and that ligament has more stress on it. The round ligament attaches from the posterior lateral uterus down through the inguinal region to the labia.
Pelvic floor dysfunction can include over-activation (inability to correctly relax muscles) or under-activation (unable to coordinate muscles). Examples include incontinence, constipation, increased urge or frequency, or pain. This condition affects up to 50 percent of women who have given birth.
Lower leg cramping has an unknown etiology, but some potential causes include rapid weight gain and joint laxity, decreased blood supply to the lower body, or electrolyte, vitamin or mineral imbalance. Research supports iron and magnesium oxide supplementation. Talk to your healthcare provider about supplements.
Lower leg swelling can be caused by extra fluid in your body. There is an increase in total blood volume by 30-50 percent during pregnancy. Swelling can be managed with elevation and compression garments.
Following childbirth, women in the postpartum phase may continue to experience pain. Lower back pain can persist in 25-50 percent of women at three months postpartum and become chronic. They can also have diastasis recti abdominis due to poor regain of core muscle strength. DRA is the widening of the linea alba and rectus abdominis halves (known as the six-pack muscle). There is a gap in the muscle that is considered normal. Widening of this gap is also normal during pregnancy with the growing baby.
However, postpartum, a separation of less than 2cm (two-finger width) at any point along the muscle is positive for DRA, which can get better on its own without physical rehab. If DRA is still present a year postpartum, rehab is needed.
Only 32 percent of women who have pregnancy-related LBP or pelvic girdle pain report it to their care providers. Of those who report pain, only 25 percent will get a treatment recommendation. It is important to contact your doctor if the pain is severe or lasts more than two weeks. The conditions discussed can be helped with physical therapy.
Physical therapy treatment can include: core muscle control retraining; mechanical diagnosis and therapy to determine movement bias for centralization of symptoms (with sciatica); and education on external bracing such as compression garments to provide pelvic girdle support by helping to lift from under the abdomen.
