Common Causes of Postpartum Abdominal Pain

You certainly expect to be sore and exhausted right after childbirth, but maybe you did not expect to experience postpartum abdominal pain. The postpartum period encompasses the first six weeks after delivery, a unique and somewhat fragile period of time in which the body returns to its pre-pregnant state.

Usually, postpartum lower abdominal pain is due to afterpains, constipation, or C-section healing. While uncomfortable, it is typically not dangerous (see below for symptoms that do raise a red flag). Find out what's behind your abdominal pain and how to ease it quickly so you can get back to caring for your newborn and yourself.

After delivery, the uterus contracts and shrinks back to its normal size. This may cause some lower abdominal cramps, called afterpains. These often feel like menstrual cramps. Most women will experience the most intense of these pains in the first two to three days after giving birth, although the uterus can take as long as six weeks to return to its pre-pregnancy size.

These pains will be stronger when your baby is breastfeeding. Nursing stimulates the release of oxytocin, a hormone that triggers the uterus to contract.

What to Do: You can't prevent afterpains, because it's important that your uterus contract. Treat afterpains by applying a warm heating pad or hot water bottle. Or take a pain reliever like an NSAID, as long as you get the OK from your doctor first.

Another contributing factor for abdominal discomfort in the postpartum period is constipation. Potential causes of constipation in the postpartum period include:

• High progesterone levels in a woman's body (leftover from pregnancy)
• Hemorrhoids (common during pregnancy and the postpartum period)
• Pain at an episiotomy site
• Vaginal tears or a bruised perineum (the area between the anus and the vagina) from labor
• Reduced physical activity after delivery
• A low-fiber diet

Medications are another potential culprit in constipation after delivery. For example, anesthesia, opioids used for post-labor pain, or magnesium sulfate (sometimes given to women with preeclampsia) can cause or worsen constipation.

The good news is that while constipation usually improves in the postpartum period—as compared 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. These two steps may be all you need to ease your bowels.

Exercise can also help. Confirm with your doctor when it is medically safe for you to begin exercising; this can vary depending on the type of delivery you had and how active you were before and during pregnancy. Short walks with your baby in a stroller or carrier often feel good for both of you.

If you have hemorrhoids, taking warm sitz baths may be helpful. In addition, 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, talk to your healthcare provider—it may be time to take a stool softener or laxative.

Following a Cesarean birth (a C-section), most women experience some mild cramping as the incision and internal wounds heal. It is also common to feel 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. In addition, be sure to take pain relievers as directed by your doctor.

To allow time for your incision to heal, ask friends and family members to help out with meals, housework, and other tasks, but make sure they don't hinder your need for rest. If possible, hire professionals to take care of tasks like yard work, shopping, and cleaning so you can focus on your healing and your new baby.

If your pain is intense, persistent, or not alleviated by the suggestions above, call your doctor. If you experience any of the below symptoms, seek medical attention right away to rule out complications such as infection and hemorrhage.

• Redness around a C-section incision
• Fever
• Excessive or bright red vaginal bleeding
• Tender areas on your sides
• Nausea and/or vomiting
• Severe pain
• Pain that is worsening

The postpartum adjustment period is not always easy, physically or emotionally. Try to be proactive in treating your symptoms and resting as best as you can.

Be sure to follow up with your obstetrician for your six-week postpartum appointment. This is an important time to discuss your recovery, mental health, contraception, and any other questions or concerns you have.