Understanding the Causes of Postpartum Abdominal Pain

You certainly expect to be sore and exhausted right after delivery, 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 a woman's body returns back to its pre-pregnant state.

From a shrinking uterus to constipation, 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, your uterus is contracting and shrinking back to its normal size, and this may cause some lower abdominal cramps, called afterpains. 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 normal size. It's important to note that these pains will be stronger when your baby is breastfeeding since this stimulates the release of oxytocin, a hormone that triggers the uterus to contract.

Interestingly, if you are a first-time mom, your afterpains will likely be less 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.

You can remedy these pains by applying a warm heating pad (you can make your own rice sock for this) or taking 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 which can cause painful bowel movements, straining, lumpy or hard and dry stools, and a feeling of incomplete evacuation of stool. 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
• Diets low in fiber

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

The good news is that while constipation may be troublesome in the short-term, it usually improves in the postpartum period, as compared to during pregnancy when your pregnant uterus is pressing on your colon. 

In addition, there are things you can do to prevent constipation in the postpartum period. Eating lots of fiber (for example, fruits, vegetables, beans, legumes, nuts, whole grains) and drinking plenty of water during pregnancy and in the postpartum period are critical and may be all you need to ease your bowels.

Also, exercising after pregnancy will help your constipation. According to the American College of Obstetricians and Gynecologists, a woman should get at least 150 minutes weekly of moderate-intensity aerobic exercise. Be sure to confirm with your doctor when it is medically safe for you to begin exercising, as the time will vary. Examples of moderately-intense exercises include:

• Brisk walking
• Gardening
• Water aerobics
• Playing tennis (doubles)
• Ballroom dancing

Finally, if you have hemorrhoids, taking warm sitz baths may be helpful. In addition, pain in the vaginal or anal area may be soothed with a pain-reliever or by using ice packs.

Even if you are proactive in your bowel health, some women still experience constipation. If you haven't had a bowel movement for more than a couple of days, please talk to your healthcare provider—it may be time to take a laxative.

If you had a cesarean birth (a C-section) you will experience some mild cramping as the incision and internal wounds heal. The best thing you can do after a C-section is to ensure you get enough rest (for example, sleep when your baby sleeps) and don't put too much strain on your stomach.

In addition, be sure to take your pain relievers as directed by your doctor. Remember, if the pain really bothers you, it's better to stay ahead of it by taking your dose as prescribed than to delay a dose.

Finally, 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 necessary, hire professionals to take care of yard work, shopping, and cleaning.

If you experience any of the below symptoms, or if your pain is not alleviated by simple remedies, be sure to seek medical attention right away to rule out anything more serious like an infection. Symptoms include:

• 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 adjustment from pregnancy back to your nonpregnant state is not always an easy one physically or emotionally. Try to be proactive in maximizing your comfort and rest as best as you can.

Be sure to follow up with your obstetrician too for your six-week postpartum appointment—this is an important time to discuss your mental health, contraception, and/or any questions or worries you have.