Everything You Need to Know About Postpartum Cramping

Are you experiencing aches or abdominal discomfort? Read on to learn more about postpartum cramping.

While you certainly expect to be sore and exhausted after childbirth, you might not expect postpartum cramping. You've just completed nine months of hard work, after all. You probably assumed the days and weeks after giving birth would be a welcome respite, at least from most discomfort and pain. But during the postpartum period (the first six weeks after delivery), lower abdominal pain is common. It is usually caused by afterpains, constipation, or C-section healing. It can occur at regular intervals or be sporadic and, while uncomfortable, it is typically not dangerous.

Here is a look at the most common causes of postpartum cramping—plus information on how to handle and ease symptoms while caring for your newborn and yourself.

illustration of person holding cramping stomach

Emily Roberts

What Is Postpartum Cramping?

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 or associated with heavy bleeding or fever, contact a healthcare provider for an evaluation.

For most people, these pains are most intense in the first week after giving birth. However, the uterus can take as long as six weeks to return to its pre-pregnancy size, so you may feel afterpains throughout this period.

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

First Baby vs. Subsequent Pregnancies

If this is your first baby, your afterpains will likely be less severe than they are in people who have had more than one pregnancy. This is because someone who has given birth more than once will have less muscle tone in their uterus.

What Causes Postpartum Cramping?

Constipation 

Postpartum cramping 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.

Reasons for postpartum constipation include:

  • Low-fiber diet
  • Hormonal changes, particularly high levels of progesterone
  • Stress
  • Dehydration
  • 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 or C-section pain can cause constipation or make it worse. Certain vitamins, such as iron, can also contribute to or worsen constipation.

The good news is constipation usually improves in the postpartum period—as opposed to during pregnancy when the uterus is pressing on the colon.

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 for 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. Ask a healthcare provider if it is medically safe for you to do so, however.

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 

Postpartum cramping can also happen following a Cesarean birth (C-section). It's common to experience mild discomfort 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.

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. Non-narcotic pain relievers are preferred.

To allow time for your incision to heal, ask friends and family members to help out with meals, housework, and other tasks (as long as 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.

Infections

While rare, it is possible to develop an infection after birth—and these infections can cause postpartum abdominal pains. However, it's important to note that, unlike other afterpains, these are aches and cramps aren't related to birth at all. Rather, they are coincidental.

Some potential causes include:

  • Urinary tract infections (UTIs)
  • Appendicitis
  • Endometriosis, though this is uncommon during and immediately after childbirth—as flares tend to occur when ovulation and menses return

If you are uncertain about the cause of your abdominal pain, see your healthcare provider. They will be able to provide you with a proper diagnosis and treatment plan.

How to Treat Postpartum Cramping

While 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 to your abdomen. If your doctor gives 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).

When to Call a Doctor 

If your postpartum cramps are intense, persistent, or not alleviated by the suggestions above, call a doctor. If you experience any of the "red flag" symptoms below, 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

Regardless, make sure to 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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Sources
Parents uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Analgesia for relief of pain due to uterine cramping/involution after birthCochrane Database Syst Rev. 2011.

  2. Pregnancy and postpartum bowel changes: Constipation and fecal incontinenceAm J Gastroenterol. 2015.

  3. Interventions for preventing postpartum constipation. Cochrane Library. 2015.

  4.  Interventions for preventing postpartum constipationCochrane Database Syst Rev. 2015.

  5. Exercise after pregnancy. American College of Obstetricians and Gynecologists. 

  6. Cesarean birth. American College of Obstetricians and Gynecologists. 

  7. ACOG Committee Opinion No. 742: Postpartum pain managementObstet Gynecol. 2018.

  8. ACOG Committee Opinion No. 736: Optimizing postpartum careObstet Gynecol. 2018

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