Did you know 1 in 5 women experience pelvic pain during 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 in the pelvis and the lower back.
Risk factors for pelvic girdle pain
The following are some risk factors associated with pelvic girdle pain according to POGP (2021), however, some affected women may not have any risk factors.
- a history of previous low-back and pelvic girdle pain
- previous injury to the pelvis
- more than one pregnancy
- a hard, physical job or workload/awkward working conditions/poor working postures
- PGP in a previous pregnancy
- increased body weight and body mass index before and/or by the end of pregnancy
- increased mobility of other joints in the body.
Symptoms
Women can experience a variety of symptoms when suffering from pelvic girdle pain 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.
The pain can be worse when you're:
- walking
- going up or down stairs
- standing on 1 leg (for example, when you're getting dressed)
- turning over in bed
- moving your legs apart (for example, when you get out of a car)[2] (NHS Choices, 2021)
Pelvic girdle pain can start during any stage of pregnancy and it can become worse further into the pregnancy, although it varies from person to person, therefore it is beneficial to have it diagnosed as early as possible in the pregnancy. Pelvic girdle pain may be diagnosed by your physiotherapist or GP after they assess your pelvic alignment, movement and history of symptoms.
Pelvic girdle pain can be treated by physiotherapy to correct the alignment of your pelvis and to strengthen the muscles around your pelvis. A support belt may also help with the pain. 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.
Management
Tips to help with pelvic girdle pain from Pelvic, Obstetric and Gynaecological Physiotherapy (2021) include:
- be as active as possible within your pain limits, and avoid activities that make the pain worse
- rest when you can
- get help with household chores from your partner, family and friends
- wear flat, supportive shoes
- sit down to get dressed – for example, do not stand on one leg when putting on jeans
- keep your knees together when getting in and out of the car – a plastic bag on the seat can help you swivel
- sleep in a comfortable position – for example, on your side with a pillow between your legs
- try different ways of turning over in bed – for example, turning over with your knees together and squeezing your buttocks
- take the stairs one at a time, or go upstairs backwards or on your bottom
- if you're using crutches, have a small backpack to carry things in
- if you want to have sex, consider different positions, such as kneeling on all fours.
POGP suggests that you avoid:
- standing on one leg
- bending and twisting to lift, or carrying a baby onone1 hip
- crossing your legs
- sitting on the floor, or sitting twisted
- sitting or standing for long periods
- lifting heavy weights, such as shopping bags, wet washing or a toddler
- vacuuming
- pushing heavy objects, such as a supermarket trolley
- carrying anything in only one hand (try using a small backpack instead).
Treatment for pelvic girdle pain
If you require treatment from a physiotherapist, alongside the above tips, they may also suggest:
- manual therapy
- hydrotherapy
- exercises
- acupuncture
- TENS
- Support belts
- walking aids.
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 situation so they can support you in the best way they can.
Upright positions that make the most of gravity, can make labour and birth more comfortable.
For example:
- all fours
- kneeling up
- standing.
It would be wise to avoid:
- lying in a semi recumbent position because it reduces the pelvic diameter.
- squatting
- using a birthing stool.
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.
For more information on pregnancy take a look at our pregnancy and childcare centre.
Further reading
Getting the birth you want - AXA Health
Exercise and fitness hub - AXA Health
References
[1] POGP - Pelvic girdle pain, 2021
[2] NHS – Pelvic Pain in Pregnancy (2019)
