Pelvic girdle pain and pregnancy (2022)

This information is for you if you are pregnant and want to know what might be causing the pain in your pelvic girdle joints during pregnancy and what you can do about it.

If you are a partner, relative or friend of someone with pelvic girdle pain (PGP), you may also find it helpful.

The information here aims to help you better understand your health and your options for treatment and care. Your healthcare team is there to support you in making decisions that are right for you. They can help by discussing your situation with you and answering your questions.

This information covers:

  • What pelvic girdle pain is and what causes it
  • Symptoms of PGP
  • What to do to help symptoms
  • Treatment options and choices around birth
  • What to expect after birth

You can see a full glossary of allmedical terms.

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What is pelvic girdle pain?

The pelvic girdle is a ring of bones around your body at the base of your spine. PGP is pain in the front and/or the back of your pelvis that can also affect other areas such as the hips or thighs. It can affect the sacroiliac joints at the back and/or the symphysis pubis joint at the front. PGP used to be known as symphysis pubis dysfunction (SPD).

Pelvic girdle pain and pregnancy (1)

PGP is common, affecting 1 in 5 pregnant women, and can affect your mobility and quality of life. Pain when you are walking, climbing stairs and turning over in bed are common symptoms of PGP. However, early diagnosis and treatment can relieve your pain. Treatment is safe at any stage during or after pregnancy.

What causes PGP?

The three joints in the pelvis work together and normally move slightly. PGP is usually caused by the joints moving unevenly, which can lead to the pelvic girdle becoming less stable and therefore painful. As your baby grows in the womb, the extra weight and the change in the way you sit or stand will put more strain on your pelvis.

You are more likely to have PGP if you have had a back problem or have injured your pelvis in the past or have hypermobility syndrome, a condition in which your joints stretch more than normal.

(Video) Pregnancy Related Pelvic Girdle Pain | Physiotherapy | Mater Mothers

Can PGP harm my baby?

No. Although PGP can be very painful for you, it will not harm your baby.

What are the symptoms of PGP?

PGP can be mild to severe but is treatable at any stage in pregnancy and the sooner it is treated, the more likely you are to feel better. It is more common later in pregnancy. Symptoms include:

  • pain in the pubic region, lower back, hips, groin, thighs or knees
  • clicking or grinding in the pelvic area
  • pain made worse by movement, for example:
    • walking on uneven surfaces/rough ground or for long distances
    • moving your knees apart, like getting in and out of the car
    • standing on one leg, like climbing the stairs, dressing or getting in or out of the bath
    • rolling over in bed
    • during sexual intercourse.

How is PGP diagnosed?

Tell your midwife or doctor about your pain. You should be offered an appointment with a physiotherapist who will make an assessment to diagnose PGP. This will involve looking at your posture and your back and hip movements and ruling out other causes of pelvic pain.

(Video) Pelvic Girdle Pain Advice Class

What can I do to help my symptoms?

The following simple measures may help:

  • keeping active but also getting plenty of rest
  • 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.

You should avoid anything that may make your symptoms worse, such as:

  • lifting anything heavy, for example heavy shopping
  • going up and down the stairs too often
  • stooping, bending or twisting to lift or carry a toddler or baby on one hip
  • sitting on the floor, sitting twisted, or sitting or standing for long periods
  • standing on one leg or crossing your legs.

What are my treatment options?

Your physiotherapist will suggest the right treatment for you. This may include:

  • advice on avoiding movements that may be aggravating the pain. You will be given advice on the best positions for movement and rest and how to pace your activities to lessen your pain.
  • exercises that should help relieve your pain and allow you to move around more easily. They should also strengthen your abdominal and pelvic floor muscles to improve your balance and posture and make your spine more stable.
  • manual therapy (hands-on treatment) to the muscles and joints by a physiotherapist, osteopath or chiropractor who specialises in PGP in pregnancy. They will give you hands-on treatment to gently mobilise or move the joints to get them back into position, and help them move normally again. This should not be painful.
  • warm baths, or heat or ice packs
  • hydrotherapy
  • acupuncture
  • a support belt or crutches.

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. PGP is not something you just have to ‘put up with’ until your baby is born.

I’ve tried these measures but I’m still in pain. What are my options?

Being in severe pain and not being able to move around easily can be extremely distressing. Ask for help and support during your pregnancy and after the birth. Talk to your midwife and doctor if you feel you are struggling. If you continue to have severe pain or limited mobility, it is worth considering:

  • regular pain relief. Paracetamol is safe in pregnancy and may help if taken in regular doses. If you need stronger pain relief, your doctor will discuss this with you.
  • aids such as crutches or a wheelchair for you to use on a short-term basis. Your physiotherapist will be able to advise you about this. Equipment such as bath boards, shower chairs, bed levers and raised toilet seats may be available.
  • changes to your lifestyle such as getting help with regular household jobs or doing the shopping.
  • if you work, talking to your employer about ways to help manage your pain. You shouldn’t be sitting for too long or lifting heavy weights. You may want to consider shortening your hours or stopping work earlier than you had planned if your symptoms are severe.

If you are in extreme pain or have very limited mobility, you may be offered admission to the antenatal ward where you will receive regular physiotherapy and pain relief. Being admitted to hospital every now and then may help you to manage your pain.

(Video) Pelvic Girdle Pain - Explained by FORMI

Can I have a vaginal birth?

Yes. Most women with pelvic pain in pregnancy can have a normal vaginal birth.

Make sure the team looking after you in labour know you have PGP. They will ensure your legs are supported, help you to change position and help you to move around.

You may find a birthing pool helps to take the weight off your joints and allows you to move more easily. All types of pain relief are possible, including an epidural.

Do I need to have a caesarean section?

A caesarean section will not normally be needed for PGP. There is no evidence that a caesarean section helps women with PGP and it may actually slow down your recovery.

Will I need to have labour started off (be induced) early?

Going into labour naturally is better for you and your baby. Most women with PGP do not need to have labour started off. Being induced carries risks to you and your baby, particularly if this is before your due date. Your midwife or obstetrician will talk to you about the risks and your options.

What happens after the birth of my baby?

(Video) Pelvic Girdle Pain in Pregnancy - expert Physio advice for mild pelvic girdle pain symptoms

PGP usually improves after birth although around 1 in 10 women will have ongoing pain. If this is the case, it is important that you continue to receive treatment and take regular pain relief. If you have been given aids to help you get around, keep using them until the pain settles down.

If you have had severe PGP, you should take extra care when you move about. Ask for a room where you are near to toilet facilities, or an en-suite room if available. Aim to become gradually more mobile. You should continue treatment and take painkillers until your symptoms are better.

If your pain persists, seek advice from your GP, who may refer you to another specialist to exclude other causes such as hip problems or hypermobility syndrome.

Will it happen in my next pregnancy?

If you have had PGP, you are more likely to have it in a future pregnancy. Making sure that you are as fit and healthy as possible before you get pregnant again may help or even prevent it recurring. Strengthening abdominal and pelvic floor muscles makes it less likely that you will get PGP in the next pregnancy.

If you get it again, treating it early should control or relieve your symptoms.

Is there anything else I need to know?

Pregnant women have a higher risk of developing blood clots in the veins of their legs compared with women who are not pregnant. If you have very limited mobility, the risk of developing blood clots is increased. You will be advised to wear special stockings (graduated elastic compression stockings) and may need to have injections of heparin to reduce your risk of blood clots. For more information, see RCOG patient informationReducing the Risk of Venous Thrombosis in Pregnancy and after Birth.

Further information

Pelvic, Obstetric and Gynaecological Physiotherapy (POGP):pogp.csp.org.uk

Pelvic Partnership:www.pelvicpartnership.org.uk

Sources and acknowledgements

This information has been developed by the RCOG Patient Information Committee. It is based on the article ‘Symphysis pubis dysfunction: a practical approach to management’ published inThe Obstetrician & Gynaecologist(2006;8:153–8), which is available at:onlinelibrary.wiley.com/doi/10.1576/toag.8.3.153.27250/pdf, and on information from Pelvic, Obstetric and Gynaecological Physiotherapy (POGP) and Pelvic Partnership.

This leaflet was reviewed before publication by women attending clinics in Poole, Newcastle upon Tyne and Portsmouth, by the RCOG Women’s network and by the RCOG Women’s Voices Involvement Panel.

FAQs

What does pelvic girdle pain feel like in pregnancy? ›

Symptoms of pelvic girdle pain (PGP)

Pain when putting weight on one leg, such as climbing stairs. Pain and/or difficulty in straddle movements, such as getting in and out of the bath. Clicking or grinding in the pelvic area. Limited and painful hip abduction.

Does pelvic girdle pain affect baby? ›

PGP 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 PGP is worse than in others. Symptoms can include: pain over the pubic bone at the front in the centre.

How early can PGP start in pregnancy? ›

PGP can begin as early as the first trimester but it's more common later in pregnancy (RCOG 2015, Verstraete et al 2013). If the pain comes on at the end of your pregnancy, it may be because your baby's head is engaging, or moving down into your pelvis.

Can PGP cause early labour? ›

If you're prepared, and get good advice and support, PGP shouldn't cause you problems during labour. It's unlikely your obstetrician or midwife will recommend an induction or a caesarean section purely because you have PGP.

How do I get rid of pelvic girdle pain during pregnancy? ›

How can I reduce PGP?
  1. Sit on a firm chair with a rolled towel or cushion to support the lower back.
  2. Do not cross your legs when sitting.
  3. Directly face your computer screen (avoid sitting in a twisted posture)
  4. Place a pillow between your knees and ankles when lying on your side at night.

What week does pelvic girdle pain start? ›

It can start as early as the 1st trimester but typically presents towards the 2nd and 3rd trimester. Women will complain that the following tasks aggravate their symptoms: Turning over in bed.

What makes pelvic girdle pain worse? ›

What makes pelvic pain worse? The pain is often made worse by activities that you previously took for granted, such as lying on your back and turning over in bed. Having sex can be painful, lifting, walking round too much, sitting or standing for long periods can make the problem worse too.

How do you give birth with pelvic girdle pain? ›

Kneeling on all fours or in a forward lean position can be comfortable for birth. The back of the bed can be positioned upright to allow you to lean against it. You might also find lying on your side comfortable. Support your least painful leg with pillows, a foot rest or peanut ball.

Can I give birth naturally with SPD? ›

SPD isn't medically harmful to your baby, and most women with the condition are still able to deliver vaginally. However, chronic pain can lead to sadness or even depression, which is sometimes thought to negatively affect your baby.

When should I be concerned about pelvic pressure during pregnancy? ›

You should be concerned about pelvic pain during pregnancy if you also experience fever or chills, vaginal bleeding, fainting or lightheadedness, severe pain, trouble moving around, fluid leaking from the vagina, the baby moving less, blood in bowel movements, nausea or vomiting, or repeated diarrhea.

Can barely walk during pregnancy? ›

Trouble walking during pregnancy is nothing new. It's a symptom of pelvic girdle pain or PGP, a pregnancy discomfort that physicians have been treating since the time of Hippocrates. During pregnancy, the growing baby causes a woman's center of gravity and posture to change.

Can PGP come on suddenly? ›

PGP may come on suddenly, or start gradually. It usually starts during pregnancy, but it can occur during birth – usually this happens if you have a difficult birth or are in an awkward position for labor or birth. It may also start after giving birth, sometimes weeks or months later.

Can you be induced because of pelvic girdle pain? ›

For women with severe PGP with a significant impact on the quality of life, early induction of labour is offered sometimes. Very rarely the PGP is so severe that a comfortable position at birth cannot be achieved or maintained. Elective (planned) Caesarean Section is necessary in such cases.

Can you give birth naturally with PGP? ›

Yes. Most women with pelvic pain in pregnancy can have a normal vaginal birth. Make sure the team looking after you in labour know you have PGP. They will ensure your legs are supported, help you to change position and help you to move around.

Can I be induced because of SPD? ›

If you're prepared, and get good advice and support, symphysis pubis dysfunction (SPD) shouldn't cause you problems during labour. You're unlikely to be offered an induction or a caesarean section purely because you have SPD.

Does walking make PGP worse? ›

Walking is often a provocative activity for women with PGP. Many women will find that walking causes their joints to become sore, either at the time they are walking, or some time later. Remember walking around a shopping centre is the same as going for the equivalent walk for exercise.

Why is my pelvic girdle pain worse at night? ›

You may find your pelvic pain is worse at night due to the fact that your buttock muscles are less active at night-time as they are in a resting position. Also, depending on how you are sleeping, the joints may be in a more vulnerable position.

Why do I feel a lot of pressure in my pelvic area during pregnancy? ›

The extra weight of pregnancy often becomes more noticeable in the second trimester. As pregnancy progresses, the uterus puts more and more pressure on the lower body. As the pelvic floor weakens, this pressure can cause a feeling of fullness in the vagina or generalized pain and pressure in the hips and pelvis.

Where is pelvic girdle pain located? ›

Pelvic girdle pain (PGP) is pain which is felt around the pelvic joints, lower back, hips and thighs. Around 1 in 4 pregnant women experience PGP. It can vary from mild to severe. The symptoms can be different for each woman.

Can PGP go away on its own? ›

In most cases, the PGP/SPD goes away after your little one is born, although in rare cases it can continue even after giving birth. Having pelvic pain during pregnancy does not harm your baby and doesn't usually prevent you from having a vaginal birth if that's your preference.

Does pelvic pain mean labor is near? ›

Many women notice more pelvis pressure as the baby's head descends in her pelvis. Some call this “lightening” and it can happen weeks before or just as labor is starting. Some women start to have more nausea and loose stools or even diarrhea as the body is preparing for labor.

What helps pelvic girdle pain at night? ›

To summarize tips for sleeping when you have PGP during pregnancy:
  1. Try to keep some space between your knees.
  2. Ditch the soft pillow between your knees and try a yoga bolster or rolled up quilt instead.
  3. If that doesn't work, try adapting how you stack your legs.
1 Mar 2021

Can you be put on bed rest for SPD? ›

The symptoms:

This is called symphyseal separation or diastasis of the symphysis pubis and can be acutely painful. Bed rest and heat are usually prescribed to manage this, with orthopaedic and physiotherapy assessments required.

How do you massage pelvic girdle pain? ›

Pressure point release and massage
  1. Place the tennis ball against your buttock or lower back area (not over the spine).
  2. Try to find a tender point in the muscle using the ball.
  3. Use your body to push the tennis ball against a wall. ...
  4. Keep the pressure on until the pain eases - it can sometimes take 30 seconds or so.

Does labour hurt more with SPD? ›

Basically SPD is of itself not a reason to fear a longer or a more difficult labour in fact some midwives feel that the SPD indicates a flexible pelvis which assists the labour to be shorter and easier. The main difficulty with SPD in labour is that it can be quite painful to open your legs wide.

Is pelvic girdle pain permanent? ›

Post-partum pelvic girdle pain (PPGP) (which may include the SI joint(s)) will resolve in most women within 4 months after giving birth,45 but 20% of women who experience this pain during and immediately after pregnancy report continuing pain two and three years postpartum.

Does SPD cause preterm labor? ›

SPD doesn't directly impact your baby and whilst it may cause your labour to be a little more difficult, specifically if you're having a vaginal delivery, it isn't known to cause early labour.

How do you know if you have SPD in pregnancy? ›

What are the symptoms of SPD?
  1. Back pain, pain at the back of your pelvis or hip pain.
  2. Pain, along with a grinding or clicking sensation in your pubic area.
  3. Pain down the inside of your thighs or between your legs.
  4. Pain that's made worse by parting your legs, walking, going up or down stairs or moving around in bed.

Why do I have sharp pains in my private area while pregnant? ›

Baby movement

The movement of a baby stretching, turning, or kicking during pregnancy can put pressure on a nerve. This can cause sudden, sharp pain in the pelvis, vagina, or rectum. As the baby grows, the force behind the movements gets stronger, which may cause an increase in pain.

Can pelvic pain cause miscarriage? ›

It can occur normally as the bones and ligaments shift and stretch to accommodate the fetus. If caused by a disorder, pelvic pain may be accompanied by other symptoms, including vaginal bleeding. In about half of these women, the pregnancy ends in a miscarriage.

What is lightening in pregnancy? ›

At the end of the third trimester, the baby settles, or drops lower, into the mother's pelvis. This is known as dropping or lightening. Dropping is not a good predictor of when labour will begin. In first-time mothers, dropping usually occurs 2 to 4 weeks before delivery, but it can happen earlier.

What is overdoing it when pregnant? ›

You feel exhausted instead of energized after a workout

A healthy workout will leave you feeling a little tired at first, but energized and refreshed overall. If you feel completely drained or increasingly fatigued long after a workout, you're probably overdoing it.

When should you go on maternity leave? ›

Unless specified by your employer, you can continue working right up until your due date if you wanted to. However it's usual to take your leave a week or two before your due date, to avoid the stress of going into labour at work and ensure the safe, planned arrival of your baby.

Are SPD and PGP the same? ›

Pelvic pain in pregnancy was originally called Symphysis Pubis Dysfunction (SPD) but health professionals now call it Pelvic Girdle Pain (PGP) because it affects all the joints of the pelvis not just the one called the Symphysis Pubis.

What exercises can I do with pelvic girdle pain? ›

4 Exercises for Pelvic Girdle Pain (Part 1) - YouTube

How is pelvic girdle pain diagnosis? ›

PGP can be diagnosed by pain provocation tests (P4/thigh thrust, Patrick's Faber, Gaenslen's test, and modified Trendelenburg's test) and pain palpation tests (long dorsal ligament test and palpation of the symphysis). As a functional test, the active straight leg raise (ASLR) test is recommended.

What should you not do with SPD? ›

If you have SPD pain, it may help to avoid:
  1. Putting your weight on one leg. ...
  2. Twisting movements or movements that involve spreading your legs. ...
  3. Lifting and pushing heavy items. ...
  4. Sitting on the floor or in a twisted position (with your legs crossed).
  5. Standing or sitting for long periods.
  6. Vacuuming.
24 Feb 2021

Does SPD go away after birth? ›

If SPD is treated, most people get back to an active lifestyle by three to four months postpartum.

Can I ask to be induced at 37 weeks? ›

This is why it's important to wait until at least 39 weeks to induce labor. If your pregnancy is healthy, it's best to let labor begin on its own. If your provider talks to you about inducing labor, ask if you can wait until at least 39 weeks to be induced.

How long does pubic bone pain last in pregnancy? ›

A separated pubic symphysis can take 3 to 8 months to heal on its own. For most women with this condition, pain or discomfort lingers for about 2 months after childbirth.

Where is pelvic girdle pain located? ›

What is pelvic girdle pain? The pelvic girdle is a ring of bones around your body at the base of your spine. PGP is pain in the front and/or the back of your pelvis that can also affect other areas such as the hips or thighs. It can affect the sacroiliac joints at the back and/or the symphysis pubis joint at the front.

Where is pelvic pain located during pregnancy? ›

About one in four pregnant women have pelvic pain – sharp pain felt most often in the hips or groin. It may start late in the first trimester and can continue for a few months after giving birth, or longer. Treatments such as physical therapy and modifying how you move can help.

What makes pelvic girdle pain worse? ›

What makes pelvic pain worse? The pain is often made worse by activities that you previously took for granted, such as lying on your back and turning over in bed. Having sex can be painful, lifting, walking round too much, sitting or standing for long periods can make the problem worse too.

What does it mean when it hurts to walk while pregnant? ›

During pregnancy, the growing baby causes a woman's center of gravity and posture to change. This, along with pregnancy hormones, can cause the pelvic joints to become unstable leading to a variety of mobility issues ranging from minor discomfort to significant pain and sometimes the inability to walk.

Can you be put on bed rest for SPD? ›

The symptoms:

This is called symphyseal separation or diastasis of the symphysis pubis and can be acutely painful. Bed rest and heat are usually prescribed to manage this, with orthopaedic and physiotherapy assessments required.

Can PGP come on suddenly? ›

PGP may come on suddenly, or start gradually. It usually starts during pregnancy, but it can occur during birth – usually this happens if you have a difficult birth or are in an awkward position for labor or birth. It may also start after giving birth, sometimes weeks or months later.

What week in pregnancy do hips widen? ›

Your hips will start expanding around weeks 10 to 12 of pregnancy when relaxin, a protein that loosens the ligament fibers in the body to accommodate a baby, begins to increase. "Women's hips are already wider than men's to allow the baby to pass through the birth canal,” says Dr. Tran.

Should I go to the hospital for pelvic pain during pregnancy? ›

Head to the hospital if you're experiencing vaginal or pelvic pain in addition to other symptoms, including a fever, chills, or vaginal bleeding. There are serious causes for pelvic pain during pregnancy. These might include miscarriage, ectopic pregnancy, or preterm labor.

Why is pelvic pain worse at night pregnancy? ›

Pelvic Pain at Night in Pregnancy

You may find your pelvic pain is worse at night due to the fact that your buttock muscles are less active at night-time as they are in a resting position. Also, depending on how you are sleeping, the joints may be in a more vulnerable position.

Does walking make PGP worse? ›

Walking is often a provocative activity for women with PGP. Many women will find that walking causes their joints to become sore, either at the time they are walking, or some time later. Remember walking around a shopping centre is the same as going for the equivalent walk for exercise.

When should I be concerned about pelvic pressure during pregnancy? ›

You should be concerned about pelvic pain during pregnancy if you also experience fever or chills, vaginal bleeding, fainting or lightheadedness, severe pain, trouble moving around, fluid leaking from the vagina, the baby moving less, blood in bowel movements, nausea or vomiting, or repeated diarrhea.

How do you massage pelvic girdle pain? ›

Pressure point release and massage
  1. Place the tennis ball against your buttock or lower back area (not over the spine).
  2. Try to find a tender point in the muscle using the ball.
  3. Use your body to push the tennis ball against a wall. ...
  4. Keep the pressure on until the pain eases - it can sometimes take 30 seconds or so.

Videos

1. Managing your symptoms of Pelvic Girdle Pain in Pregnancy
(@AneurinBevanUHB)
2. Pregnancy Related Pelvic Girdle Pain—Easy to Treat, So Do It!
(PAINWeek)
3. 4 Exercises for Pelvic Girdle Pain (Part 1)
(RafflesHospital)
4. Bed mobility with pregnancy related Pelvic Girdle Pain
(Sheffield Teaching Hospitals NHS Foundation Trust)
5. Pelvic Girdle Pain/SPD FULL BODY Workout (FIX PELVIC PAIN!) Pregnancy/Postpartum
(Pregnancy and Postpartum TV)
6. Pregnancy related Pelvic Girdle Pain Video
(Southern Health and Social Care Trust)

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