Pregnancy related pelvic pain, or pain in the pelvis during pregnancy is common.
In fact, it is estimated to affect about 50% of women who are pregnant, and it may linger postpartum.
The cause has historically been blamed on Relaxin, a pregnancy hormone that peaks in the first trimester.
This theory is frighteningly old, dating back over 2000 years ago to Hippocrates, who presumed that pelvic pain during pregnancy is the result of irreversible widening of the pelvis with a woman's first pregnancy.
Cue my eyes rolling wayyyyyyy back into my head! Did cavewoman have an irreversibly unstable pelvis after giving birth? Do Chimpanzees? Uhm, no.
But what is even more shocking, is that we are only now starting to bust this myth and understand the true reasons why this is occurring.
What Relaxin Actually Does
Relaxin is not the cause for all of the ligament relaxation during pregnancy, albeit it does some.
The role of relaxin is to inhibit uterus activity, soften cervical connective tissue, relax the pelvic joints and plays a role in cardiac and immune function.
It is not, however, the primary cause of pelvic pain in pregnancy.
What About A Weak Pelvic Floor?
Another tip women have been arbitrarily provided with over the years to help address pelvic pain in pregnancy is to kegel away!
"You can't do too many kegels during pregnancy!"
This well-intended advice considers the fact that as the pelvis widens during pregnancy, the pelvic floor becomes more stressed and therefore needs more strength. The uterus and increased blood volume levels also place increased stressors on the pelvic floor.
Therefore, won't all women need kegels? Especially those experiencing pain (from a loosy goosy pelvis no less?)
The answer is no. So what is causing the pain? Let's dive in now.
Pelvic Muscle Tension
Research has found that pelvic pain during pregnancy is typically the result of tenderness in the pelvic floor, not weakness. And more kegels means more tension, so no kegels during pregnancy if you are having pain until you get evaluated by a pelvic floor physical therapist!
Tenderness in the pelvic floor is often from trigger points, just like you would get in your shoulders, which means the muscles are tight, overworking, or working in a way that is not functional.
I often see this in conjunction with asymmetrical pelvic floor and hip firing.
Stress, Anxiety, and Depression
Another cause for pelvic pain in pregnancy, but especially lingering pelvic pain postpartum is stress, anxiety, and depression.
These are considered strong prognostic indicators of ongoing pain following childbirth.
And, considering how little support moms are provided within the demands of motherhood, this is a common problem.
Factors that fall into this framework and that can cause ongoing inflammation include gut microbiome, sleep quantity and quality, stress coping mechanisms.
Conclusion
Pelvic pain during pregnancy is strongly connected to pelvic floor muscle tenderness, not weakness or the hormone relaxin as previously thought.
We are also beginning to understand that pelvic pain in pregnancy may not just disappear postpartum for a couple of reasons. Inflammation in the body can play a role in ongoing pain as it relates to sleep quality, quantity, gut microbiome, and stress coping mechanisms.
It can also linger due to asymmetries within the pelvis, hip problems, and core dysfunction.
If you are struggling with pelvic pain, reach out to us to book an appointment here today!
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