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Many pregnant women know that any sudden movement can lead to pain. How to figure out if this is normal or a reason to see a doctor?

Photo: Alexander Oshchepkov

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Many women during pregnancy recall Sharik's complaints from their favorite cartoon "Three from Prostokvashino": "The paws ache, then the tail falls off." It would seem that you are enjoying the expectation of the baby, but life always makes its own adjustments: it will pull the lower abdomen, then it will shoot in the lower back, then it will start to prick in the side. An interesting situation exacerbates suspiciousness even more, so I want to put the gynecologist's phone and an ambulance on the speed dial.

Let's find out together with doctors why something hurts all the time during pregnancy and what sensations can be considered relatively normal, and what symptoms should promptly see a doctor.

“Pain and discomfort can occur during almost any pregnancy,” says Yulia Sergeeva, an obstetrician-gynecologist at the Vitromed clinic. - Very often in the first trimester there are minor pains in the lower abdomen. They usually pass at rest. In any case, the doctor who observes the pregnancy should assess the danger of the condition.

Starting from the very first days of pregnancy, the body prepares for future childbirth. The hormonal background changes: progesterone is actively produced, which relaxes the muscles and ligamentous apparatus in order to prepare the uterus and birth canal. It is because of the preparation of the muscular pelvic floor that there are pulling pains in the lower abdomen. They can appear with sudden movements and rises.

— I always tell women: we start behaving like a graceful doe. We do not get out of bed abruptly, we rise like this: we turn on our side and smoothly begin to get up. The uterus relaxes, and any sudden movement can lead to short-term cramping pain. As a rule, such pain very quickly subsides almost to nothing. You don’t need to be afraid of such pain, it’s just a restructuring of the body,” advises Olesya Vedernikova, obstetrician-gynecologist of the Ultrasound Studio network of medical centers.

In the second trimester pain in the lower abdomen may be accompanied by lower back pain. This is due to the increasing load on the spine and muscular frame. Obstetrician-gynecologist Olesya Vedernikova advises to discuss such pains at a scheduled appointment with her gynecologist, and to relieve discomfort, do special exercises and do water aerobics, if there are no contraindications.

Also in the second trimester, the tone of the uterus may increase: the stomach “hardens”. If such a sensation occurs rarely, lasts no more than 10-15 seconds and there is no pain, then this is regarded as the norm. But when pains in the lower abdomen or in the lower back join the increase in tone, it is better to contact a doctor or call an ambulance and go to the hospital to exclude miscarriage or premature birth.

At the end of pregnancy, a new misfortune overtakes a woman: training contractions, which are also called false Braxton-Hicks contractions. They do not happen to everyone, but usually occur from the 34th to the 36th week of pregnancy.

If you feel pulling pains, then you need to watch what interval passes between contractions. As a rule, they are not very painful and occur rarely, for example, once every two days. During them, you can do breathing exercises, which are discussed in childbirth preparation courses - consolidate knowledge in practice and relieve discomfort.

But if the contractions become regular, more painful and prolonged, then you need to go to the maternity hospital - perhaps the birth is already beginning.

All pain during pregnancy can be divided into two types: obstetric and non-obstetric. If a woman has chronic diseases, then they can worsen, so be sure to tell your gynecologist about all diseases.

- Of course, more pain occurs in women who have had gynecological operations, especially ovarian ruptures or ovarian cysts, ectopic pregnancy. This often leads to adhesions that cause discomfort during pregnancy. Also, pain can occur if the patient has uterine fibroids or congenital malformations of the uterus, lists doctor Yulia Sergeeva.

During pregnancy, the uterus enlarges, begins to put pressure on all internal organs, especially the load on the kidneys increases, so pyelonephritis, urolithiasis, cholelithiasis can become aggravated. Very often during pregnancy, women are concerned about the intestines - pain and constipation occur. The danger of these pains is that it is difficult to determine whether there are problems with gynecology or intestines, sometimes even observation in a hospital is required to figure it out.

- There may also be headaches. In this case, it is necessary to control blood pressure. If more than 140 by 90 or you have flies in your eyes, confusion, it’s difficult for you to speak, you need to urgently call an ambulance and contact your obstetrician-gynecologist to determine the tactics of treatment, warns Olesya Vedernikova.

If you feel a sudden sharp pain in the lower abdomen, in the uterus or appendages, stabbing, cutting or cramping, you should immediately see a doctor. It is also necessary to consult a specialist if the pain gradually increases, even if you have started treatment in accordance with the doctor's prescription.

Another dangerous signal is abundant discharge from the genital tract. Scarlet discharge may indicate a miscarriage, ectopic pregnancy, missed pregnancy, or placental abruption. And transparent discharge can be a leak of amniotic fluid, which is dangerous for the occurrence of oxygen starvation and infections in a child.

In any case, if you have any pain and something worries, do not engage in self-diagnosis, it is better to consult a doctor who will help you figure out how normal your condition is.

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Pain in the pubic region during pregnancy

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The pubic bone is one of the three bones that make up the pelvic bone. Two pubic bones, forming the pubic articulation (symphysis), form the anterior wall of the pelvis. The pubic bone in women with a regular physique has the form of a roller approximately the thickness of the thumb, which is curved and forms a pubic eminence. This bone hangs in a kind of arch over the entrance to the vagina.

The main cause of pain in the pubic bone is the divergence and increased mobility of the pubic symphysis. To refer to pathological changes in the pubic symphysis of the pelvis during pregnancy and after childbirth, the following terms are used: symphysiopathy, symphysitis, arthropathy of pregnant women, divergence and rupture of the pubic symphysis, dysfunction of the pubic symphysis. The most commonly used terms are "symphysitis" or "symphysiopathy".

So, symphysiopathy is a disease associated with a pronounced softening of the pubic joint under the influence of the hormone relaxin, which is produced during pregnancy. The process of softening the interosseous joints is natural, it helps the child to pass more easily through the bone pelvis during childbirth. The diagnosis of "symphysiopathy" is made when severe pain appears, the pubic joint swells, greatly stretches, becomes mobile, and the pubic bones diverge excessively. One of the striking, characteristic symptoms of this pathology is that it is impossible to raise the leg in the prone position. In addition to acute pain in the pubis, there are difficulties when walking up the stairs, it becomes difficult to turn from side to side on the bed and get up from the sofa, and the gait changes and becomes like a "duck". According to most doctors, the cause of symphysiopathy is a lack of calcium, an increased concentration of the hormone relaxin, and increased physical activity on the bones of the pelvic region. In addition, the development of symphysiopathy can be provoked by a serious sports injury or a fracture of the pelvic bones.

At what stage of pregnancy do they occur?

The disease begins gradually or suddenly during pregnancy, childbirth or after childbirth. Most often, women begin to feel pain in the area of ​​the pubic joint in the third trimester of pregnancy. This is due to the fact that the places of adhesions of the pubic bones, their ligaments and cartilage, soften under the influence of the hormone relaxin. This hormone of pregnancy naturally softens the bony joints, which is necessary to facilitate the passage of the child's bone pelvis and birth canal at the time of childbirth.

Some women begin to complain of pain in the pelvic bones some time after giving birth. This may be the result of traumatic childbirth (imposition of obstetrical forceps, shoulder dystocia, excessive separation of the hips during childbirth, etc.) or physical exertion (lifting a heavy baby stroller up the stairs, prolonged motion sickness in the arms of a well-fed baby, etc.). It is recommended to limit physical activity, wear an orthopedic bandage, consult a traumatologist. Complaints usually recur after the next pregnancy. In a small proportion of patients, pain persists for a long time.

When can this be considered the norm, and when not?

Obstetricians-gynecologists do not consider a slight soreness of the pubic joint to be a pathology, but if the pain is acute, restricting the movements of the pregnant woman, accompanied by edema, then we can talk about pathology. Pain can be quite strong and especially manifest itself while walking, turning the body to the right and left in a sitting position and even lying down. In this case, you need to urgently consult a doctor and undergo an ultrasound diagnosis (ultrasound) to determine the size of the divergence of the pubic bones. Magnetic resonance imaging (MRI) is also used, which allows assessing the state of the symphysis, the state of the bone tissue, as well as soft tissues.

With ultrasound, the degree of divergence (diastasis) of the pubic bones is determined. The severity of the clinical picture largely depends on the degree of divergence of the pubic bones, and therefore there are three degrees of divergence of the pubic branches: in the first degree - by 6-9 mm, in the second - by 10-20 mm, in the third - more than 20 mm. The severity of the symptoms of the disease varies from mild discomfort to unbearable pain.

How can pain be relieved?

There are some recommendations that will help reduce bone pain during pregnancy, if the cause of its occurrence is the divergence of the pubic bones. Be sure to wear a bandage, especially in later pregnancy. The bandage takes on most of the load, thereby releasing pressure from the pubic joint. Limitation of heavy physical exertion is indicated for any manifestations of pain, lying down more often, walking less and being in a sitting position for no longer than 30-40 minutes. In severe cases, before and sometimes after childbirth, a woman may be shown strict bed rest. Moreover, the bed should not be hard and flat.

Since the appearance of symphysiopathy is associated not only with a large production of the hormone relaxin, but also with a lack of calcium in the body, the expectant mother is prescribed calcium preparations and complex vitamins for pregnant women, which contain all the necessary vitamins and trace elements in the right amount and proportions. There is evidence that pain is reduced during acupuncture and physiotherapy.

In especially severe cases of symphysiopathy, the pregnant woman is hospitalized.

What is the danger of this condition?

The occurrence of symphysiopathy is due to several reasons. This is a lack of calcium in the body of the future mother, and an excess amount of the hormone relaxin, and the individual structural features of the woman's body, and possible hereditary or acquired problems of the musculoskeletal system.

With an unexpressed clinical picture of the disease, with an expansion of the pubic fissure up to 10 mm, normal pelvic sizes, a small fetus, childbirth can be carried out through the birth canal, avoiding the use of physical force, such as the Christeller maneuver. With a pronounced stretching of the pubic symphysis, pain syndrome, especially with anatomical narrowing of the pelvis, a large fetus, there is a danger of rupture of the pubic symphysis, and the method of choice in this case is caesarean section. This is due to the fact that during natural delivery, the bones can disperse even more and the woman subsequently will not be able to walk at all.

Prevention

The body of a healthy woman is able to independently cope with all the difficulties of the pregnancy period. First of all, the expectant mother should include enough foods containing calcium in her diet, as well as take vitamins for pregnant women.

For the prevention of symphysiopathy, the use of a prenatal bandage is recommended, which supports the abdomen and prevents excessive stretching of the ligaments and muscles.

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