Pelvic girdle pain during pregnancy

Pregnancy-related pelvic girdle pain happens for approximately 20% of pregnant women and can happen at any stage of pregnancy.¹

Pregnancy hormones cause the ligaments around your pelvis and lumbar spine to become softer and stretchier to allow the baby to grow. However, this, combined with the weight of the baby, postural changes and joint instability, can cause discomfort and stiffness in the pelvis and the lower back. 

We take a look at the symptoms and how to manage them, as well as possible treatments.

Symptoms of pelvic girdle pain

Pelvic girdle pain is not harmful to your baby, but women can experience a variety of symptoms including:

• Pain over the pubic bone at the front in the centre, roughly level with your hips.
• Pain across 1 or both sides of your lower back.
• Pain in the area between your vagina and anus (perineum).
• Pain spreading to your thighs.
• Some women feel or hear a clicking or grinding in the pelvic area.²

The pain can be worse when undertaking everyday tasks or movements, for example rolling over in bed or going up and down the stairs.

Pelvic girdle pain can start during any stage of pregnancy, although it varies from person-to-person, but it’s a good idea to speak to your midwife or doctor as soon as you start to feel pain; as they can help refer you to a physiotherapist for assessment.

It can also be accompanied by lower back pain, symphysis pubis dysfunction and sciatica. It can also be exacerbated by pre-existing and pregnancy-related injuries to the lower back and pelvic area.

Self-management

There are some self-help tips that can help with easing the pain in the pelvis and lower back. The Royal College of Obstetricians and Gynaecologists suggest:

• keeping active but also getting plenty of rest
• pain management – for example massage, heat/ice packs, TENS machine
• pelvic floor and abdominal exercises
• standing tall with your bump and bottom tucked in a little
• changing your position frequently – try not to sit for more than 30 minutes at a time
• sitting to get dressed and undressed
• putting equal weight on each leg when you stand
• trying to keep your legs together when getting in and out of the car
• lying on the less painful side while sleeping
• keeping your knees together when turning over in bed
• using a pillow under your bump and between your legs for extra support in bed.³

Treatment for pelvic girdle pain

Pelvic girdle pain can be treated by physiotherapy with a physiotherapist that specialises in pelvic joint problems. They would aim to:

• correct the alignment of your pelvis,
• strengthen the muscles around your pelvis,
• improve muscle stability of the pelvic area, back and abdomen,

in order to help ease the pain. A support belt or crutches may also be offered to help with the pain.

Hydrotherapy and acupuncture may also be offered alongside strengthening exercises such as pelvic floor muscle exercises⁴, given by a physiotherapist.

Many hospitals have classes for women with pelvic girdle pain so make sure you ask at your antenatal appointments. Most women find that their symptoms resolve after they give birth however sometimes it can take longer.

For most women, early diagnosis and treatment should stop symptoms from getting worse, relieve your pain and help you continue with your normal everyday activities. It is therefore very important that you are referred for treatment early.⁵

Labour and birth

Most women with pelvic girdle pain can have an active labour and a vaginal delivery. However, it is important that the midwives and doctors involved in your labour care are aware of the pelvic girdle pain, as they can help support you by:

• Ensuring your legs are supported.
• Helping you change positions.
• Suggesting a birthing pool to help take the weight off your joints.

After the birth

It is a good idea to be mindful that some pain relief given to you after the birth may mask your pelvic girdle pain symptoms, so still try to be careful of your positioning. 

It is also a good idea to be mindful of your posture and position when:

• feeding your baby,
• changing nappies / bathing the baby,
• carrying your baby / lifting equipment such as car seats or prams,
• pushing the pram.

It is also important to remember to do regular pelvic floor exercises and any recovery exercises given to you by your physiotherapist. It is sensible to take advice from your physiotherapist or doctor before recommencing sport and exercise too. 

References

1. Pregnancy related Pelvic girdle pain and low back pain during pregnancy and after having a baby – Pelvic, Obstetric and Gynaecological Physiotherapy
2. Symptoms of PGP - NHS
3. What can I do to help my symptoms? – The Royal College of Obstetricians and Gynaecologists
4. Pelvic girdle pain – NHS
5. What are my treatment options? – The Royal College of Obstetricians and Gynaecologists