Pregnancy and post pregnancy

Musculoskeletal Complications of Pregnancy

Virtually all women experience some degree of musculoskeletal discomfort during pregnancy and 25% have symptoms that interfere with their ability to perform daily activities. The most common musculoskeletal disorders relating to the abdomen and pelvis during pregnancy are discussed below.

Pelvic girdle pain and low back pain

  • Up to 50% of women experience pregnancy related pelvic girdle pain (PGP) or low back pain (LBP) during pregnancy
  • Half of these women suffer from pain that’s bad enough to seek medical care
  • Athletes are not immune to PGP and LBP with studies showing similar rates of pain in both elite athletes and non-athletic women
  • Risk factors for PGP and LBP are previous LBP prior to pregnancy, LBP or PGP during or after previous pregnancies, strenuous job and previous trauma to the pelvis
  • Most women recover from LBP and PGP after delivery but 20% can report persistent pain for years
  • Women with LBP or PGP persisting after 6 weeks post partum should see their health care provider if they haven’t already seen them earlier

Diastasis Recti abdominis (abdominal separation)

  • The rectus abdominus is the most superficial of the 4 abdominal muscles and is the one that creates the so called 6 pack
  • The muscle consists of 2 separate muscle bellies that are “wrapped” in connective tissue (fascia) called the rectus sheath that joins in the midline to create the linea alba (the “white line” of connective tissue that runs down the centre of the abdomen between the sternum and ribs and the pubic bones)
  • DRA occurs during pregnancy when the 2 muscle bellies move further apart because the connective tissue of the linea alba gets thinner and stretches more under the pressure of the expanding pregnant belly (similar to dough the size of a small pizza being rolled out with a rolling pin to make it into a medium or large pizza)
  • This expansion of the connective tissue is a natural process to allow the woman’s belly to expand as the baby grows but if the abdominal muscles get far enough apart as the connective tissue stretches then it is called DRA
  • DRA can occur only above or below the umbilicus (belly button) or along the whole length
  • DRA during pregnancy is common and depending on the size of the gap used to report DRA, it is present in 60 to 100% of women by full term
  • Some studies have shown that physical activity prior to and during pregnancy can reduce the chance of developing DRA during pregnancy
  • Post partum rates of DRA vary in the general population between 30 -68%
  • The separation reduces spontaneously from day 1 to 8 weeks post partum as the connective tissue gets firmer again
  • If separation persists beyond 8 weeks post partum it’s likely to still be there at 1 year unless specific exercise or physiotherapy is performed
  • Many women with DRA also have at least one form of pelvic floor dysfunction so it is worth getting it checked with a physiotherapist who specialises in this area if it persists beyond 8 weeks

Pelvic Floor Dysfunction

  • Pelvic floor disorders include urinary incontinence, foecal incontinence and pelvic organ prolapse
  • Urinary incontinence is common during pregnancy with 48% of women experiencing symptoms in their first pregnancy and 85% in their second or later pregnancies
  • 15 – 30% of women experience urinary incontinence in the first year after having their baby
  • Although urinary incontinence is common in this population, it is not normal and should be investigated and treated with pelvic floor muscle retraining under the guidance of an experienced physiotherapist
  • Pelvic floor muscle training before, during and after pregnancy can reduce the rate of urinary incontinence during and after pregnancy
  • A study on foecal incontinence found that up to 20% of women had experienced at least one episode in the first year after having their baby and the biggest predictor for that was having foecal incontinence in late pregnancy
  • Operative vaginal delivery (forceps) and sphincter injury also increased the risk post partum
  • 50% of women who have a vaginal delivery experience stretching or weakening of the pelvic connective tissues and fascia leading to less support of the pelvic organs which can cause symptoms or they may be asymptomatic (they are unaware of the problem)
  • Vaginal delivery is 4 times more likely to lead to pelvic organ prolapse for the first delivery and 8 times more likely after 2 or more deliveries
  • The highest risk vaginal deliveries for pelvic organ prolapse involve the use of forceps
  • Women with any sense of bulging in the vagina persisting 6 weeks after delivery should be seen by an experienced physiotherapist specializing in women’s health for a pelvic floor assessment and consideration of the use of a pessary if indicated

These musculoskeletal problems occurring after pregnancy may be common but that does not mean that they are normal. If you have any concerns about the way your body is functioning after childbirth then it is wise to see your health care professional.

Shire Sports Medicine has specific post partum consultations for individualised advice and assessment regarding any musculoskeletal concerns after childbirth.