What does perineal pain during pregnancy mean? How can you manage it?

Perineal pain during pregnancy most commonly occurs in the third trimester, just before childbirth. It is associated with the loosening of ligaments due to the hormone relaxin. Women usually experience this pain when walking or sitting for extended periods. It is advisable to report this pain to the gynecologist.

Perineal pain during pregnancy usually occurs when walking, sitting for long periods, standing up, or engaging in physical exertion. The expectant mother may feel discomfort, pulling, or pressure in the pelvic area, which sometimes radiates to the hips and groin. The pain typically goes away on its own after resting or changing positions. If it becomes very distressing, a doctor should be consulted, as there is a risk of pubic symphysis relaxation.

Causes of perineal pain

Perineal pain during pregnancy typically occurs in the last few weeks (most expectant mothers report perineal pain in the 9th month) and is linked to the body’s preparation for childbirth. The hormones produced during pregnancy (such as relaxin) cause the ligaments of the uterus, the sacroiliac joints, and the bone-cartilage tissue of the pelvis to loosen. This process can cause pain in the groin and perineum in some women. During pregnancy, the pressure of the uterus on the pubic bone is also a cause.

Perineal pain before childbirth (i.e., after the 36th week of pregnancy) is caused by the pressure of the baby’s head, meaning the baby is ready to be born, and labor may begin at any time.

Perineal pain in early pregnancy

In some women, perineal pain occurs at the beginning of pregnancy or during the second trimester. This should not be a cause for concern, as it is also related to the effects of pregnancy hormones and the body’s preparation for the gradual growth of the uterus and changes in body shape. Perineal pain in early pregnancy resembles the kind of discomfort experienced before menstruation.

Are perineal pains dangerous?

Perineal pain during pregnancy is a physiological symptom that, although it may be uncomfortable, should not cause concern. However, it is advisable to report it to the treating doctor and request an orthopedic consultation. Sometimes, perineal pain during pregnancy can be a sign of pubic symphysis diastasis.

Pubic symphysis diastasis is a result of excessive loosening of the bone and cartilage tissue of the pelvis, particularly the cartilage connection between the right and left pubic bones. Characteristic symptoms include perineal pain while walking and difficulty moving (known as a “duck walk”). A diastasis of the pubic symphysis makes vaginal delivery difficult and sometimes even impossible. This condition affects 1 in 800 pregnant women.

Perineal pain during pregnancy, if caused by pubic symphysis diastasis, is very intense. To relieve it, physiotherapy exercises are required, along with the use of a special support belt, rest, and avoiding lifting heavy objects. In extreme cases, the doctor may prescribe painkillers and anti-inflammatory drugs. In some cases, surgery may be necessary after delivery.

The woman should also consult a doctor if perineal pain during pregnancy is accompanied by other symptoms:

• Bleeding or spotting from the vagina
• Contractions
• Severe abdominal pain
• Elevated body temperature

In such cases, it is necessary to immediately perform an ultrasound examination (USG) and cardiotocography (CTG).

Stinging pain in the perineum during pregnancy

Sometimes women report a stinging pain in the perineum during pregnancy. This symptom should also not cause concern, as it is related to the loosening and stretching of the uterine ligaments and tissue connections in the pelvic area. Stinging pain in the perineum can occur both early in pregnancy and just before childbirth.