Some women develop a condition called pregnancy-related pelvic girdle pain (PPGP) in pregnancy. This is sometimes called SPD (symphysis pubis dysfunction).
What are the symptoms of PPGP?
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:
- 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 PPGP?
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 joint pain
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.
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 PPGP
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) offers advice on managing PPGP, including:
- 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
- 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
Many women with PPGP 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.