Introduction
Abdominal pain is a common symptom after giving birth. In most cases, they are caused by the body’s transition from pregnancy to postpartum, disappear on their own after a few days and are not considered worrying. During childbirth, the afterbirth, i.e. the detachment of the placenta from the wall of the uterus, results in a large wound area in the uterus, which heals within about six weeks.
This results in the so-called postpartum flow, which is to be considered as wound secretion during this healing process. . As with any other wound, this internal wound in the uterus can lead to abdominal pain, but this should disappear after the end of the lochia.
If the birth was performed by means of a caesarean section, the scar from the caesarean section is also a possible cause of pain, as the structures separated by the incision, such as muscles, must first grow together again. This healing process takes about four to six weeks. In addition, a bladder catheter is inserted during a birth by Caesarean section.
The resulting mechanical irritation of the urinary tract can also lead to abdominal pain similar to that of a bladder infection. Pain within a few days after a birth can also be caused by afterpains. These have the function of returning the uterus, which was approximately the size of a pear before the pregnancy, to its original size.
The afterpains are triggered by the same hormone that caused the strong contractions in the expulsion phase of birth: oxytocin. This hormone is also released in smaller quantities during breastfeeding, which means that the afterpains and associated abdominal pain can occur especially during or after breastfeeding. Another cause of abdominal pain after childbirth can be the repositioning of internal organs to their pre-pregnancy position.
In addition, giving birth means an enormous hormonal change for a woman’s body, which can also manifest itself in the form of constipation. This, and the accompanying flatulence, can also cause abdominal pain. In contrast to the above-mentioned pain with physiological causes, pathologies can also occur after childbirth that cause abdominal pain and require treatment.
For example, the outflow of the lochia may be disturbed, causing it to accumulate in the uterus. This is called lochial congestion. This is caused, for example, by a blood clot blocking the cervix.
The symptoms usually appear within the first week after delivery and are localised in the lower abdomen. Another leading symptom of lochial congestion is a reduced amount or even a lack of menstrual flow. The retained lochia can be colonised by bacteria and smells unpleasant due to bacterial decomposition.
In addition, an inflammation in the body can occur, which can spread to the uterus (endometritis) or to the fallopian tubes and ovaries (pelvic inflammatory disease). A possible accompanying symptom is fever. Even without a congestion of the puerperium, an inflammation of the uterus can quickly occur during the so-called postpartum period due to bacteria rising from the vagina. This is promoted by frequent vaginal examinations during birth or generally also by a long period of childbirth.
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