Pregnancy and baby

Pelvic pain in pregnancy

Some women develop pelvic pain in pregnancy. This is sometimes called pregnancy-related pelvic girdle pain (PRGP) or symphysis pubis dysfunction (SPD).

Symptoms of pregnancy-related pelvic pain

PPGP is a collection of uncomfortable symptoms caused by a misalignment or stiffness of your pelvic joints at either the back or front of your pelvis. PPGP is not harmful to your baby, but it can cause severe pain around your pelvic area and make it difficult for you to get around. Different women have different symptoms, and in some women PPGP is worse than in others. Symptoms can include:

  • pain over the pubic bone at the front in the centre
  • pain across one or both sides of your lower back
  • pain in the area between your vagina and anus (perineum)

Pain can also radiate to your thighs, and some women feel or hear a clicking or grinding in the pelvic area. The pain can be most noticeable when you are:

  • walking
  • going upstairs
  • standing on one leg (for example when you’re getting dressed or going upstairs)
  • turning over in bed

It can also be difficult to move your legs apart, for example when you get out of a car.

There is treatment to help, and techniques to manage the pain and discomfort. If you get the right advice and treatment early on, PPGP can usually be managed and the symptoms minimised. Occasionally, the symptoms even clear up completely. Most women with PPGP can have a normal vaginal birth. 

Who gets pelvic pain in pregnancy?

It’s estimated that PPGP, or SPD as it's sometimes known, affects up to one in five pregnant women to some degree. It’s not known exactly why pelvic pain affects some women, but it’s thought to be linked to a number of issues, including previous damage to the pelvis, pelvic joints moving unevenly, and the weight or position of the baby.

Factors that may make a woman more likely to develop PPGP include:

  • a history of lower back or pelvic girdle pain
  • previous injury to the pelvis, for example from a fall or accident
  • having PPGP in a previous pregnancy
  • a hard physical job 

When to get help for pelvic pain in pregnancy

Getting diagnosed as early as possible can help keep pain to a minimum and avoid long-term discomfort. Treatment by a physiotherapist usually involves gently pressing on or moving the affected joint, which helps it work normally again.

If you notice pain around your pelvic area, tell your midwife, GP or obstetrician. Ask a member of your maternity team for a referral to a manual physiotherapist who is experienced in treating pelvic joint problems. These problems tend not to get better completely until the baby is born, but treatment from an experienced practitioner can significantly improve the symptoms during pregnancy. You can contact the Pelvic Partnership for information and support. 

Treatments for pelvic pain in pregnancy

Physiotherapy aims to relieve or ease pain, improve muscle function and improve your pelvic joint position and stability, and may include:

  • manual therapy to make sure the joints of your pelvis, hip and spine move normally
  • exercises to strengthen your pelvic floor, stomach, back and hip muscles
  • exercises in water
  • advice and suggestions including positions for labour and birth, looking after your baby, and positions for sex
  • pain relief, such as TENS
  • equipment if necessary, such as crutches or pelvic support belts 

Coping with pelvic pain in pregnancy

Your physiotherapist may recommend a pelvic support belt to help ease your pain, or crutches to help you get around. It can help to plan your day so that you avoid activities that cause you pain. For example, don’t go up or down stairs more often than you have to.

The Association for Chartered Physiotherapists in Women’s Health (ACPWH) also offers this advice:

  • 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 don’t 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.

ACPWH suggests that you avoid:

  • standing on one leg
  • bending and twisting to lift, or carrying a baby on one 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)

You can get more information on managing everyday activities with PPGP from the Pelvic Partnership.

Labour and birth with pelvic pain

Many women with pelvic pain in pregnancy can have a normal vaginal birth. Plan ahead and talk about your birth plan with your birth partner and midwife. Write in your birth plan that you have PPGP, so the people supporting you during labour and birth will be aware of your condition.

Think about birth positions that are the most comfortable for you, and write them in your birth plan. Being in water can take the weight off your joints and allow you to move more easily, so you might want to think about having a water birth. You can discuss this with your midwife. 

Your 'pain-free range of movement'

If you have pain when you open your legs, find out your pain-free range of movement. To do this, lie on your back or sit on the edge of a chair and open your legs as far as you can without pain – your partner or midwife can measure the distance between your knees with a tape measure. This is your pain-free range.

To protect your joints, try not to open your legs wider than this during labour and birth. This is particularly important if you have an epidural for pain relief in labour, as this will take away any pain that warns you that you are separating your legs too far. If you have an epidural, make sure your midwife and birth partner are aware of your pain-free range of movement of your legs.

When pushing in the second stage of labour, you may find it beneficial to lie on one side. This prevents your legs from being separated too much. You can stay in this position for the birth of your baby, if you wish.

Sometimes, it might be necessary to open your legs wider than your pain-free range to deliver your baby safely, particularly if you have an assisted delivery (for example with the vacuum or ventouse). Even in this case, it is possible to limit the separation of your legs. Make sure your midwife and doctor are aware that you have PPGP. If this happens, your physiotherapist should assess you after the birth. Take extra care until they have assessed and advised you.

Healthtalkonline has interviews with women talking about their experiences of pelvic pain in pregnancy and how they coped.

 

 

 


Page last reviewed: 22/03/2012

Next review due: 22/03/2014

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Comments

The 14 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Jas1992 said on 04 April 2014

I suffered the complete agony of pelvic pain in my sacroiliac joints and pubic joint PGP SPD in my first two pregnancies. Both times I was messed about by the NHS and saw physiotherapists who were a complete waste of time. In my third pregnancy I went straight to a chiropractor in west London at 24weeks when the pain was unbearable agony, supported in by two friends and walked out 60 minutes later - it's so simple - they really know what they're doing and unlock the sacroiliac joints which realign the twisted and separated joint at the pubic joint and used muscle trigger points and rehab exercises. It's so easily cured and unbelievably nobody else seems to know how to do it. Just go to a chiropractor - pay £100 for a couple of sessions and get it sorted. They have special adjustable manipulating couches for pregnant women and are incredibly specific, gentle and effective. They should be on the NHS and are the best advice for anybody reading this.

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Swizzlerock77 said on 21 March 2014

I am so glad to have found this page and the comments below! I was beginning to feel like because my Dr wasn't taking me seriously about the pain, that maybe there was something wrong with me. I am 37 weeks pregnant - have had pelvic pain on alternating sides radiating down my buttocks to my knees, and my joints feels so stiff- they actually lock up when I try to walk sometimes. I am seeing a chiropractor and a physical therapist, but the pain is still pretty severe. I take warm baths, apply heat patches, and take acetaminophen (the equivalent of paracetamol here in the United States) - but nothing helps that much. I work on my feet for 13 hour shifts every other day and by the time I come home I am in tears and then I can't sleep because of the pain when I lie down. I can't take off work early because here in the US we only get 6 weeks of job- protected maternity leave per year, and I want to spend all that time with my baby. So I asked my OBGYN if she could prescribe me anything at all for the pain (codeine is not available over the counter here) and she said "no - pelvic pain is normal in pregnancy- it will get better after the baby is born". I have been in pain for over 2 months, and at this point I just don't believe her. I don't know if I'm going to be able to push past the pain to keep working for the next 3 weeks, and I'm scared that if I'm not getting any sleep now, how am I going to be able to keep up with a newborn afterwards. I'm also terrified of giving birth because I'm afraid of doing more damage to my pelvis. It's so frustrating that people just expect pregnant women to cope with such debilitating pain. I'm glad I'm not alone though - because when she told me it was "normal" and that I should just get on with it, I began to feel like maybe I was just being a big cry-baby or something.

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RachelE83 said on 11 March 2014

After reading all the comments, it's good to know that I am not alone in my gripes with the way I've been treated. I'm 23 weeks pregnant with my 3rd baby and am feeling really annoyed with constantly being ignored. My first pregnancy was easy but during my 2nd I was in constant pain when walking, standing or moving about. The pain started a few inches below my belly button from the time my bump started to show, and gradually spread further until it was right down the inside of both of my legs. I mentioned it to my midwife but was fobbed off each time and nothing was done. I put it down to having two children so close together and so I never kicked up a fuss but just got on with things instead. This was hard considering I had toddler to run around after. One day it got too much, after getting off the sofa time and time again running around after my other son, I phoned my sister in tears telling her that I couldn't do it anymore, I just couldn't get up again. Luckily, she lived local and offered to come and get my son to look after him for a few hours so I could rest. I'd never heard of Pelvic Girdle Pain until months after giving birth when I was talking about my experience with others. I've been worried that it would happen this time around and sure enough, it has just started again. Today I decided to try self diagnoses on the NHS site which resulted in their recommendation of a call from a nurse. The nurse told me that I should get an appointment with a midwife today but when I phoned them, I got fobbed off again. The only reason I've ended up with the number for the physio is because I carried on pushing. She didn't listen to where the pain was and wasn't going to give me an appointment.. Once I pushed her to listen to what I was saying she mentioned PGP, gave me a few what-not-to-do's and tried to send me on my way. I had to ask about bump support and told her I was worried about the pain spreading like it did last time, and she finally recommended physio!

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IdleStarfish said on 11 February 2014

I am 30wks pregnant and I have been diagnosed with PGP complicated by arthritis in my left hip. I was referred for physio 4 weeks ago, but have heard nothing. All I have for pain relief is paracetamol and cocodamol which was given to me by my GP, but the leaflet inside says it is not for use in pregnancy! Two weeks ago I took a slight miss-step when coming downstairs, not enough to normally bother me, but I twisted my left hip slighlty and then spent 2 days with pretty much no mobility in my left hip at all. It's driving me nuts now, it keeps me awake at night and I'm so tired I don't feel like I'm being a proper mum to my 3 year old. Roll on due day, but I have no idea how I will cope with delivery as I really don't want pethidine or an epidural like I had last time. At least after delivery I can go back on proper anti-inflamatories!

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lady lancia said on 05 December 2013

I had a minor fall at 17 weeks and twisted my pelvis.
Thankfully the baby is fine, but I have pelvic pain that has increased as my bump has grown. I'm now 36 weeks.

The following has helped me:

Seeing the GP and getting painkillers (Dihydrocodeine) so I can get some sleep. I only take them when I really have to, but even getting 1 or 2 decent night's sleep a week makes a huge difference. I use paracetamol in the day if I need to, but as others have found, they take the edge off but don't relieve severe pain.

Getting referred to a physio who was sympathetic and took me seriously helped a great deal. She is slowly straightening my pelvis and at least preventing it from moving further out of alignment.

Follow the movement advice, it has helped reduce the strain.

The belt support does help spread the weight of my bump more evenly if I'm standing/walking.

Aqua natal exercise classes make me feel less of an invalid and allow me to move the bits that don't hurt. Even just going to the pool and bobbing about with a big float relieves the stress on my joints so the muscles can rest and I'm more relaxed afterwards.

It is good to know I'm not the only one who has had to really fight to get any help to cope with this amount of pain.

I would be very grateful if anyone has any thoughts about how best to manage the birth with this condition.
I am very worried that I may be put in positions that permanently damage my pelvis, that I simply won't be able to cope with any more pain, and that my PGP won't be taken seriously.

I agree that just being pregnant is not a reason to leave anyone in agony for weeks or months in this day and age.





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Gorganite said on 13 November 2013

I have experienced both hip and back pain during my pregnancy, and was able to self refer to a physiotherapist.

If you are pregnanat you can self refer by calling your local hospital and booking an appointment with the physio yourself and don't have to wait for a doctor to do it for you.
(Unless it's different in other parts of the UK)

It's always best to speak to your midwife first but it's really helped me.

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Miss Boo said on 14 October 2013

It's all very well saying that "If you get the right advice and treatment early on, PPGP can usually be managed and the symptoms minimised" but I am on my first pregnancy and this was caught when I was just 8 weeks pregnant.

I am now nearly 22 weeks and still have not had my first physio appointment as I was only referred a couple of weeks back. What's the point in catching it early if no one cares? I can barely move, I haven't been able to work, I am unable to sleep from the pain and I'm frustrated at the lack of support from the NHS. I feel I've been dismissed as just a overly anxious first time mother and maybe I am, but this pain is excruciating and the thought of another 18 weeks of this just fills me with terror. All I've been told to do is take paracetamol which doesn't even touch the pain.

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Caenozoic said on 28 September 2013

Hi Horsemad,
After 3 attempts to reach my midwife, called the maternity centre and asked if I should just go to my GP. Yes. It took about 3 minutes of him observing my "walking" and how leg movements bothered me to get his physio referral started. The referral was faxed to the wrong department, twice, so it took a while to chase that. Beware. My physio was a very nice lady, very understanding - but did very little to help the pain. I was given 2 'exercises', advised to buy a gymnastics ball, told about a resting position, and advised not to walk or exercise. I was offered a zimmer frame, but didn't take it. My physio doesn't believe in the support belts. I saw them and they look exactly like the maternity support belts you can buy over the counter. I bought one myself, and found it is good around the house/when standing. The only real help I have found is in following movement instructions (like on this page), buying a 4" memory foam mattress topper, taking frequent rests, and in seeing a chiropractor which unfortunately is about 32 quid a pop. I am still in a lot of pain (I am so slow when out), but the root of the problem is the pelvic alignment, so I want to address that rather than resting my way into being a disabled person. Don't give up. I was told in 97% of cases it goes away after birth, but pregnancy is not a reason for anyone to have to suffer in this day and age.

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horsemad1981 said on 04 August 2013

I was diagnosed as having spd at 20 weeks by a midwife at maternity assessment after being in so much pain I could hardly walk. My GP and community midwife seem ignorant to the problem and won't refer me for physio. I can never get hold of my community midwife when I need her and always end up going to maternity assessment for help. What's my options?

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User266592 said on 01 July 2013

I am suffering from this condition the second time with my second pregnancy and wanted to share the valuable lessons I have learnt when taking a different approach the second time round - I hope this helps a few women! Both times I started suffering early, at around 12 weeks. The first time round I tried to grit my teeth and get on with things as good as I could, just took some paracetamol. Then I had a very busy week, lots of shopping (walking and carrying) and the week after I got stuck in traffic for two hours, riding the clutch all the time which really made things very bad - my sacroiliac got very inflamed and nothing could help. I was in tears whenever I tried climbing the stairs or getting up from the sofa etc. 1 week of rest at home did not improve things much so I went back to work. Any physio / acupuncture/ chiropractor did not improve much, just temporary relief. Second time round I tried the approach to avoid the inflammation getting bad in the first place. I limit my walking, travelling by car/bus/train (I arranged to work from home every other day so I can get a proper rest in between journeys). My GP wrote me a note recommending I work from home three days a week. And behold, I can feel I got the condition, and it is a numb pain like a bruised coccyx, but not the eye watering pain that radiates out into your buttocks and legs. Simple rule - if it hurts, it is making it worse! This is not tooth ache or a head ache, ignoring it will cause the inflammation to worsen. And yes, keep your knees together, avoid carrying anything slightly heavy over long distances, (above 3kg!), avoid rushed walking, sitting for a long time, driving (I do find that 15 mins at a time every other day does not harm) - and you'll find you are much better! This way, I have so far managed to keep the pain in check for about 4 weeks, whenever it gets worse I rest more and it goes back to a 'just' numb/nagging pain. I hope this helps!

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Beckymmartin said on 28 May 2013

To the ladies struggling with their PGP, if your physiotherapist isn't working for you seek another opinion. It's perfectly fine to receive manual therapy whilst you are pregnant, just crutches is not enough! (i wish i had known this). Please contact the pelvic partnership (link in the article), they can point you in the right direction.

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Lkclarky said on 23 May 2013

Hi,
I am suffering with SPD too. I had it in my first pregnancy a few years ago and had physiotherapy (which, I have to be honest, did offer much relief) I am now pregnant again (30weeks) and I'm suffering terribly, this time it's chronic. I am struggling to get dressed, get in and out of the car and walking is unbearable. It's so bad that I too keep crying. I have a maternity support belt (again offers little or no relief) and I'm feeling incredibly worried about my next 10 weeks as I just don't know how I'm going to be ale to cope, particularly with having another young child! I suppose the only comfort I can offer is that your not alone.....x x

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Lkclarky said on 23 May 2013

Hi,
I am suffering with SPD too. I had it in my first pregnancy a few years ago and had physiotherapy (which, I have to be honest, did offer much relief) I am now pregnant again (30weeks) and I'm suffering terribly, this time it's chronic. I am struggling to get dressed, get in and out of the car and walking is unbearable. It's so bad that I too keep crying. I have a maternity support belt (again offers little or no relief) and I'm feeling incredibly worried about my next 10 weeks as I just don't know how I'm going to be ale to cope, particularly with having another young child! I suppose the only comfort I can offer is that your not alone.....x x

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baker89 said on 20 May 2013

i am in absolute agony with pelvic pain, im 30 + 2 and i can barely move today, getting out of bed is so hard im crying with pain i just dont know what to do. ive been given crutches a support belt but they dont seem to help me. the pain is continuing to get worse. i have physio too which doesnt seem to help!! i just want this pain to go away its that bad i feel like going to hospital. but i know nothing will get done. has anyone else experienced this pain so bad? and if so what did you do or are doing? please help!!!

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