Birth Injuries and Postpartum Pain: Having an Undiagnosed Childbirth Injury

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Within weeks of giving birth most women have recovered from the physical effects of pregnancy and delivery, yet a significant percentage may experience lingering pain and complications. Months, even years, later some women continue to suffer from ongoing pelvic, perineal or lower back pain. Some may experience painful sex, or urinary or fecal incontinence due to an undiagnosed birth injury.

It’s not unusual to have pelvic pain or discomfort  during sex for up to six weeks after childbirth. Depending on the type of delivery they had most women can expect vaginal bleeding, some discomfort, and possibly a burning sensation when they urinate for two to three weeks following childbirth. Women who deliver via a C-section may have some abdominal pain or discomfort at the site of the incision.

But if pain lingers or symptoms extend beyond the first few postpartum weeks, it’s important to let your doctor know, so the cause can be diagnosed and treated. If a woman does not discuss the discomfort she experiences, the reasons behind the discomfort may not always be obvious to her healthcare provider.

A study by the University of Michigan examined women seven weeks after childbirth and found that 29 percent had undiagnosed pubic bone fractures while another 41 percent had undiagnosed tears in their pelvic floor muscles. A superficial tear in the perineum is common but some tears are more serious and a few don’t heal well, creating scar tissue.

The hormonal changes that take place during pregnancy prepare the body to give birth, but in some cases those changes can lead to postpartum problems. During pregnancy  a woman’s body releases the hormone relaxin, which loosens joints and tells the pelvic bones to expand to prepare for the delivery.

When the pressure of the baby’s head descending during childbirth meets those extra flexible joints, it can promote a gap between the bones, which in turn affects stability in the pelvic area and can cause postpartum pain while walking, running or moving. While the bones may eventually return to their former position, the instability and pain caused by their new position can last for a long time.

Ligaments and joints also become more flexible to facilitate birth, but sometimes that temporary flexibility can also cause problems. During childbirth the joints can tear, causing lasting pain and stiffness.

Pubic symphysis diastasis (PSD), a rare but debilitating condition that can happen after a vaginal delivery, affects the cartilaginous joint, which expands across the pelvic floor. A University of Pennsylvania School of Medicine study reported cases of PSD in one in 569 deliveries over the course of two years, but reasoned that many such injuries go undiagnosed.

Sometimes ongoing pelvic pain is caused by a fracture  so small that it initially goes undetected. As the baby’s head moves through the birth canal the movement can bruise or fracture a woman’s tailbone or coccyx, which sits at the very base of the spine, resulting in short to long term back pain.

Because of the pressure created by the baby’s descent in preparation for childbirth, back pain during pregnancy is common, but bruising or fractures that take place during delivery can cause pain long after. A 2016 cohort study, found that up to 40 percent of the women surveyed experienced chronic lower back pain for up to six months after having a baby.

Some of the changes a woman’s body experiences in preparation for birth can result in a pelvic organ prolapse, a condition in which the uterus, bladder or small bowel or all of these organs together, drop from their normal position and down into the vagina. It happens because hormonal changes have caused the muscles and tissues that normally support the pelvic organs to become too lax. A vaginal prolapse can cause pelvic or lower back pain, urinary and fecal incontinence, as well as painful sex. Surgery may be needed to correct a prolapse.

New mothers may also experience nerve damage as a result of the baby’s head pressing on the femoral nerve during childbirth. It’s a nerve that figures in leg and hip movement.

Be sure to let your doctor know if you experience pain or discomfort that lasts beyond the first few weeks. That includes:

  • Pain in your hips and pelvic area
  • Pain in your lower back
  • Pain on your pelvic floor
  • The sensation that your organs are slipping out
  • Fecal or urinary incontinence
  • Pain during sex.

Some of these problems may be temporary but discussing them with your doctor can help determine if they would benefit from medical intervention.

Joan MacDonald
Joan Vos MacDonald has written about health and fitness for newspapers, magazines and websites. She is a member of the National Association of Science Writers and the author of two books on health-related topics, "Tobacco and Nicotine Dangers," for young adults, and "High Fit Home," a design book about fitness and architecture. She lives in upstate New York near her children and grandchildren.

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