Back and Pelvic Pain During and After Pregnancy

It's common to feel a pain in the butt, ahem, during pregnancy and after birth, but the cause can vary considerably. Here's a run down of what might be going on.

Back and Pelvic Pain During and After Pregnancy wavebreakmedia/Shutterstock

I've heard it said so many times: Pregnancy is a pain in the butt. It's a lot of things: miraculous, joyous, nauseating, blotchy, exhausting, itchy and fun. Sometimes, however, that pain in the butt is really painful and you can't help but wonder, really – is it worth it?

Two readers wrote with just this problem. Deirdre delivered her baby several months ago but has had continuing pelvic pain, especially right in the front. Nadia is five months along and has shooting pain from her back through her hip and down her leg. They're miserable and wonder what's going on. Is this normal and what the heck do they do about it? It's not exactly normal but it's not freaky weird either. Unfortunately, it's part of the pregnancy package for some women.

Deirdre had a normal vaginal delivery of a great big boy—well over 8 pounds. He also had a massive head—14 inches. She had no trouble with labor and delivery itself but after delivery, had sharp pain in her pubic bone area. The pubic bone is the bony space right under your pubic hair. It's actually a jointed area where the two halves of your pelvis come together at the symphysis pubis. Cartilage holds the two bones together. During pregnancy, hormones (relaxin) cause this cartilage to soften, allowing the pelvis to be more flexible. It makes sense. Your baby's head settles down and eventually passes through your pelvis; you're going to want a little give.

Unfortunately, as in Deirdre's case, sometimes the symphysis pubis "gives" too much and creates a gap between the bones. This is called symphysis pubis disruption (SPD). It can happen any time during pregnancy. It's not a terribly common occurrence but boy-oh-boy, when it happens, you know it. It hurts like heck. Poor Deirdre made it through pregnancy with flying colors but delivering that big boy of hers was a little too much for her pubic bone and it separated, became inflamed and has been really painful for months until her midwife/doctor figured out the problem and set about helping her heal.

Some women need physical therapy, stabilization belts and pain medication to recover from SPD but most heal well within days to weeks with rest, heat, ice and maybe some Tylenol or ibuprofen (after delivery only). As the hormones that originally caused the cartilage to soften recede, the bones fuse together again.

Deirdre's worried SPD might happen again with her next pregnancy and while that's a possibility, it's not an automatic deal. Many women who've had SPD with one baby go on to have others with no problem at all. It's a temporary, though painful condition and while there's no quick cure (we wish), you will heal. It's amazing how resilient we are after birth.

Nadia's pain is a little different and a little more common. That shooting pain down her butt sure sounds like sciatic nerve pain to me. Nadia should talk to her doctor/midwife about it, to be certain, but what she's describing is really similar to what lots of women experience in pregnancy. You describe a twinge that hurts but isn't crazy painful. The sciatic nerve branches off the spinal cord and runs right down the middle of your buttock (there's a sciatic nerve branch in each hip) and down into your leg. As your baby gets bigger and your uterus presses more weight on your back, the nerve gets irritated. Some women say it's like hitting your funny bone in your hip. Others describe it as a shock-like feeling. Still others just say it hurts. Plain and simple, it's a pain in the butt.

I wonder if you've tried prenatal yoga yet or gone for a swim? Five months is the perfect time to get started with these if you haven't already. A lot of women get their best relief through yoga. Gentle, guided movements help strengthen the muscles in your back and pelvis while easing that "baby weight" off your sensitive bones and nerves. Cat/cow pose is perfect for displacing the baby, at least temporarily off the sciatic nerve. Try a hands-and-knees position and gently rock your pelvis back and forth.

If it hurts most when you're sleeping, roll over on the side opposite the pain. Avoid heavy-lifting and standing for long stretches of time. Heat, ice and Tylenol are OK. If you need an excuse for a warm (but not too hot) bath—this is a good one.

Deirdre and Nadia, I hope you're feeling better soon. It may be hard to see the up side of this pain in the butt but take it from millions of mothers before us, babies are worth it—a little tough on the tush, but totally worth it.