Common Causes of Postpartum Abdominal Pain

postpartum abdominal pain causes

Verywell / Emily Roberts

The postpartum period encompasses the first six weeks after delivery. It is a unique and somewhat fragile time in which your body returns to its pre-pregnancy state. You certainly expect to be sore and exhausted after childbirth, but you might not expect to experience postpartum abdominal pain. Here's what you need to know about the different types and causes of this pain.

Lower abdominal pain postpartum is usually caused by afterpains, constipation, or C-section healing. While uncomfortable, it is typically not dangerous. Here is a look at the most common possible causes of postpartum abdominal pain as well as some easy tips for handling it while you are caring for your newborn and yourself.

Afterpains 

After delivery, the uterus contracts and shrinks back to its normal size. As this happens, it can cause some lower abdominal cramps that are referred to as afterpains. These pains can feel like menstrual cramps. If they are severe, contact your healthcare provider for an evaluation.

Most women will experience the most intense of these pains in the first week after giving birth. However, the uterus can take as long as six weeks to return to its pre-pregnancy size.

The pains will typically be stronger when your baby is breastfeeding as nursing stimulates the release of oxytocin, a hormone that triggers the uterus to contract.

If you are a first-time mom, your afterpains will likely be less severe than a mom who has had more than one pregnancy. This is because a mom who has given birth more than once will have less muscle tone in her uterus.

What to Do

You can't prevent afterpains, and it's important that your uterus contracts and goes back to its pre-pregnancy size. You can, however, treat afterpains by applying a warm heating pad or hot water bottle. If your doctor gives you the OK, you might want to take an over-the-counter pain reliever such as Motrin (ibuprofen) or another non-steroidal anti-inflammatory drug (NSAID).

Constipation

Abdominal discomfort during the postpartum period can also be caused by constipation. There are several potential causes of constipation after giving birth and figuring out which one is behind your symptoms will help you find the best way to manage it.

Possible reasons you are constipated in the postpartum period include:

  • Low-fiber diet
  • Hormonal changes
  • Stress
  • Reduced physical activity after delivery
  • Vaginal tears or a bruised perineum (the area between the anus and the vagina) from labor
  • Hemorrhoids (which are common during pregnancy as well as during the postpartum period)
  • Pain at an episiotomy site

Medications are another potential culprit of constipation after delivery. Anesthesia and opioids used for post-labor pain can cause constipation or make it worse. Certain vitamins, such as iron, can also contribute to or worsen constipation.

Constipation usually improves in the postpartum period—as opposed to during pregnancy when the uterus is pressing on the colon.

What to Do

Eating lots of fiber (for example, fruits, vegetables, beans, legumes, nuts, and whole grains) and drinking plenty of water during pregnancy and in the postpartum period are critical steps to preventing constipation. Getting enough fiber and staying hydrated might be all you need to ease your postpartum bowel woes. If not, exercise can also help.

Before you start doing any physical activity, make sure you ask your doctor if it is medically safe for you to do so. When you can return to exercising will depend on the type of delivery you had and how active you were before and during pregnancy. Start by taking short walks. You can put your baby in a stroller or carrier and head out for some fresh air (which will be good for both of you).

If you have hemorrhoids, taking warm sitz baths might help. You can also soothe pain in the vaginal or anal area with an over-the-counter pain reliever (again, check with your doctor or pediatrician first—especially if you are breastfeeding) or by using ice packs.

If you haven't had a bowel movement for more than a couple of days, let your doctor or midwife know—they might recommend that you take a fiber supplement, stool softener, and/or laxative.

C-Section Healing

Following a Cesarean birth (C-section), it's common to experience mild cramping as the incision and internal wounds are healing. It's also normal to feel some pain or soreness around the incision—especially in the first few days.

What to Do

The best thing you can do after a C-section is to ensure you get enough rest and avoid putting too much strain on your abdomen. Lift nothing heavier than your baby.

If you had a C-section, be sure to take pain relievers as prescribed and directed by your doctor during your postpartum recovery.

To allow time for your incision to heal, ask friends and family members to help out with meals, housework, and other tasks—just make sure that they don't hinder your need for rest.

If possible, hire professionals to take care of bigger tasks like yard work, shopping, and cleaning. That will give you the time and energy to focus on your healing and your new baby.

When to Call the Doctor About Postpartum Pain

If your pain is intense, persistent, or not alleviated by the suggestions above, call your doctor. If you experience any "red flag" symptoms, seek immediate medical care. These signs and symptoms can indicate complications such as infection and hemorrhage.

Postpartum symptoms that require emergency medical attention include:

  • Excessive or bright red vaginal bleeding
  • Fever
  • Nausea and/or vomiting
  • Pain that is severe, persisting, or worsening
  • Redness, tense skin, drainage or swelling around a C-section or perineal incision
  • Abnormal vaginal or rectal discharge
  • Tender areas on your sides
  • Headache
  • Chest pain or difficulty breathing

A Word From Verywell

The postpartum period is one of adjustment and healing. Even when you have help, it is not always easy—physically or emotionally. Try to be proactive about treating your symptoms and resting as best as you can.

Make sure that you follow up with your obstetrician or midwife for your postpartum appointment, within three weeks of birth (the American College of Obstetricians and Gynecologists recommends a second, comprehensive postpartum visit no later than 12 weeks after birth). This is an important time to discuss your recovery, which should include your mental and physical health, contraception, and any other questions or concerns you have. 

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