Many women experience some discomfort as their body continues to change and adapt to the growing baby inside them. A woman’s shape can change tremendously during pregnancy and when paired with the effects of pregnancy hormones, it is not uncommon for a woman to experience aches and pains.

Symptoms experienced during pregnancy can include:

• Abdominal muscle separation
• Back pain
• Pelvic pain
• Pubic bone pain
• Rib pain
• Carpal tunnel syndrome
• Pelvic floor muscle dysfunction, such as bladder leakage and urgency

Lower back and pelvic pain, including pubic bone pain

Between 49-90% of pregnant women and around 25% of new mums suffer from pregnancy-related back pain. Despite the pain perhaps being felt in the back, most of the problems occur due to changes in the pelvis and pelvic joints.

Common complaints of the back and pelvic joints in pregnancy include:

• Pain into the buttock, coccyx and pubic bone areas
• Difficulty and pain with activities such as rolling over in bed, stair walking, getting up out of a chair and long periods of sitting, standing and walking.

In pregnancy, the pelvic joints can become painful and irritable. The changing posture and position of the spine and pelvis due to a woman’s growing belly and the actions of the pregnancy related hormones are generally the cause. One of the hormones, Relaxin, softens the soft, connective tissues about the pelvic joints to allow more give and movement to accommodate the growing baby and in preparation for delivery. However these pelvic joints are normally very stiff joints and do not allow for much movement at all.

One major positive associated with this pain is that studies have shown that more than 70% (and up to 95% in some studies) of women with these pregnancy-related back pains will have no lasting effects after 2-3 months of their baby being born.

Physiotherapy management of these pregnancy related pains can be very useful. Treatment can vary from gentle joint re-alignment techniques to core stability exercises for the pelvic muscles. There are many other alternatives to help you get through these times with less pain, including:

• prescription of sacral or pelvic belt to offer support and compression to the pelvis
• simple supportive taping techniques around the pelvis
• prescription of Pregnancy and Recovery shorts
• advice on how to function and complete day to day activities without irritating these pelvic joints

Recent evidence recommends combining physiotherapy treatment with exercise therapy for the best outcomes for women in both pregnancy and postnatal periods. Safe and appropriate pregnancy and postnatal Pilates can do just that!

Rib Pain

In pregnancy, as your baby grows, your other internal organs must move to make way for the baby. Your rib cage and middle back need to spread to allow for this shift. This can cause pain in the following areas:

• Around your ribs
• Your armpits
• In your mid back
• When you breathe
• Sitting for prolonged periods

Physiotherapy management of pregnancy-related rib pain can utilise techniques to address the rib and mid back alignment. Massage and exercise therapy such as in pregnancy and postnatal specific Pilates classes can alleviate pain and discomfort.

Carpal tunnel syndrome

This is a very common hand condition reported in pregnancy. After back pain, it is the most common condition involving the skeleton and muscular system in pregnancy. It is most common in the later trimester and is due to the increase in swelling in the body. This swelling can obstruct or narrow the opening through the wrist, compressing the nerves and the blood vessels to the hand. Tingling and numbness in the hands and fingers are the commonly reported symptoms.

Physiotherapy management aims to assist in minimising swelling in the area with night time resting splints, ice packs and advice.

Like most pregnancy related injuries, carpal tunnel syndrome mostly resolves within a month to year after having your baby. Persistent symptoms may need further help, as some women will continue to experience pins and needles with breastfeeding.

Abdominal separation

Separation of the Rectus Abdominis muscle during pregnancy occurs as a result of the growing baby inside a woman’s abdomen. The two rectus abdominis muscles are connected down the centre by connective tissue which stretches during pregnancy. The degree of stretch will vary from woman to woman and pregnancy to pregnancy. It resets every pregnancy so there is no evidence to suggest that just because it was there for the first baby it will be for the second. An abdominal separation is very normal and occurs in majority of women during pregnancy. If a separation of the belly muscles is left untreated it only becomes significant if there is an adverse effect on the support of your back, pelvis, pelvic organs and pelvic floor control.

A physiotherapist can advise and assist a woman presenting with a clear separation during pregnancy by:

• Providing advice on managing and preventing further separation with respect to safe exercise, postures and movements
• Teaching appropriate strengthening exercises of the lower trunk region, including the pelvic floor and deeper abdominal muscle layers
• Prescribing and fitting an abdominal support during pregnancy and for early post-natal days to encourage healing and good abdominal muscle position

Pelvic floor pain and incontinence

Pelvic floor pain or weakness is very common during both pregnancy and after having your baby. Due to the growing baby and increasing pressure on the pelvic floor muscles, pregnancy is the first time women may experience a loss of good bladder or bowel control. Unfortunately it is often made worse if there has been a previous bladder or bowel problem such as constipation or irritable bowel syndrome. Coughing and obesity can also make these symptoms worse.

Most bladder and bowel control problems will resolve themselves six months after childbirth if you perform regular pelvic floor exercises. This is also the case for other pelvic floor problems such as episiotomy and scar healing, sexual pain, sensitivity and pain in the pelvic region.

However, this may not be the case for all new mums. If there is ongoing pain and bladder and bowel control does not start to improve after four to six months of having a baby, call our women’s health physiotherapist Amy. Extra help is at hand.