Pelvic pain, not pelvic floor pain

Let's start off with a message of b'sha'a tova to Will & Kate (a.k.a the Duke and Duchess of Cambridge) - and all other expectant mothers out there. I'm reliably informed Kate is a regular reader of these blogs, but in case she misses this one, I have no doubt she's getting this advice from her own physiotherapist (By Royal Appointment).

I will address pelvic floor pain sometime in the near future as most of my pelvic floor blogs are more to do with incontinence. However today I am focusing on pelvic pain, the various causes and what is in the realms of normal-no-need-to-worry pain. 

Pregnancy is a very exciting time in one's life but it can also come with lots of fear and worry. The fear and worry is normal, as long as it's all about ensuring that this new life is safe and healthy and has everything it needs for the best start in there life.

As mentioned in previous blogs, two common causes of pelvic pain are relaxed joints and pressure from the weight of your growing baby. If the pain is constant or there is bleeding, unusual discharge, or strong cramping, it is time to see your doctor rather than visiting your physiotherapist.

With that in mind, it is very common to experience cramp-like pain that feels like your period is coming between weeks 8-12; this is your uterus expanding and as long as there is no bleeding this is within the normal realms of pregnancy.

Functional ovarian cysts, which form due to changes in the way your ovaries make or release eggs are also very common and and normally harmless. They can grow larger during pregnancy and the pressure that your growing uterus puts on your ovaries can cause persistent pain. If the cyst ruptures, the pain may suddenly get worse. It is therefore important to tell your doctor if you have a history of ovarian cysts so he can keep an eye on them or any potential growing ones. On very rare occasions a cyst can twist. This is called torsion, it is serious and needs immediate attention. It sometimes occurs after vigorous activity or having intercourse and is followed by very sharp pain, severe and constant and sometimes nausea, vomiting and sweating. 

As mentioned in a more recent post another common pain is round ligament pain. It is common to the second trimester and the pain is felt from your side, as the ligament that goes from the top of the uterus down to the groin stretches. It is felt more when walking or standing up from a chair. The uterus tilts and pulls on the ligament. Lying on the painful side can often help with this

Especially is the third trimester one can experience pain from the pressure on the baby in your pelvic region, often during movement when walking or in a moving car, because the baby bounces with your movements. Rest can ease this pain.

Braxton Hicks contractions is the pressure or tightening in the pelvis that comes and goes spontaneously. They are often described as practice contractions, often from week 20 onwards and triggered by dehydration (drink lots of water). If however they continue for more than 4 an hour for 2 hours and you are before week 37 it is good to check that it is not preterm labour and go and get checked out.

Relaxed pelvic joints also cause a lot of pain; this is one for the physiotherapist. Caused by the hormone relaxin which relaxes your joints a ligaments, it is common to feel pain over the pubic bone, and down your legs. There are many previous blogs on this.

Constipation is another common complaint and can cause pelvic pain; drink lots of water and eat fibre rich food. It is also important to assume a good position while on the toilet. Ensure your knees are higher than your hips and learn forward. This is the optimum position for the stool to come out with the least obstacles. 

There are many other reasons for pain, some of which are more serious than those mentioned above. For this reason, it is important to get regular check-ups throughout your pregnancy. If you experience any of the below list it is important to go to the doctor immediately

•  
• Pelvic pain that you can't walk or talk through
• Any bleeding
• Fever and/or chills
• Severe headache
• Dizziness
• Sudden swelling of the face, hands, and/or feet
• Persistent nausea and/or vomiting
• Less than 10 fetal kicks in one hour, from 28 weeks until delivery
• More than four contractions in an hour for two hours
• Watery, greenish, or bloody discharge

If you are suffering from pain during your pregnancy and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you privately or through Leumit in Bishvilaych Women's Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.