Pelvic Pain in pregnancy

Pelvic Girdle Pain (PGP) in Pregnancy affects up to one in five women. It is the umbrella name for all pelvic pain, including pubic pain which is called symphysis pubis dysfunction (SPD), or Osteitis Pubis which is inflammation of the pubic symphysis. PGP includes pain anywhere from the lumbar spine, abdomen down to the thigh, either at the front or back.


Symptoms of PGP?

You may feel pain:

  • in your lower back
  • in your symphysis pubis joint
  • in your sacroiliac joints
  • in your groin
  • at the front and the back of your thigh
  • at the back of your lower leg
  • around your hips
  • in your pelvic floor and around the opening to your vagina and your anus (your perineum).

There can also be instability of the joints, which makes day-to-day activities difficult, the main symptom that women report is a pain while walking, climbing stairs and turning over in bed. The pain can radiate into the buttocks and down the legs and is frequently misdiagnosed as a trapped nerve or Sciatica.


What causes PGP?

PGP is usually a mechanical joint problem, caused by number of factors.

Often one joint becomes stiff causing extra strain or irritation in the other joints.

This asymmetrical change of normal movement can cause alignment issues in the low back or pelvis; strain can also be caused by postural changes associated with the growing baby and hormonal changes.

During pregnancy, the body produces a hormone called relaxin which softens the ligaments in the pelvis and other joints to assist the baby passage through the mother’s pelvis during birth.

PGP can develop at any stage of pregnancy although it is more common after 20 weeks. It may start gradually, or suddenly, if the pain comes on at the end of the pregnancy, it may be due to the baby’s head engaging, or moving down into the pelvis. It can also occur during birth, usually with difficult births or birth. It can also start after giving birth, sometimes weeks or months later.


Risk factors for developing PGP

The risk factors for developing PGP during pregnancy include a history of low back pain, previous back or pelvic trauma and higher levels of stress. If you experience PGP in one pregnancy, it is more likely to recur earlier in your subsequent pregnancies and without treatment may be more severe. Health professionals advise letting the symptoms from one pregnancy settle before trying for another baby, it is important to remember that PGP is a common and in most cases a treatable condition.


How is PGP diagnosed?

PGP is not widely understood; sadly women are often told that pelvic pain is a regular part of the aches and pains associated with pregnancy or that it is due to nerve irritation such as sciatica which it is not treatable and will get better on its own.

Most women with PGP are able to have a normal labour and vaginal birth. With the right support, it’s rare for PGP to cause problems, or to be a reason for having labour induced or a caesarean.  If you’re in severe pain, and can’t move much at all, you may be offered a caesarean section. This really would be a last resort, as having a caesarean doesn’t help with PGP. It may slow down your recovery from PGP.


Treatment for PGP

A registered osteopath trained experienced in women’s health can safely treat PGP during pregnancy. Osteopathic assessment involves assessing the position, symmetry, and movement of the pelvis, especially the sacroiliac joints at the back of the pelvis. Treatment typically includes a combination of gentle osteopathic techniques, with lifestyle advice and specific strengthening or release exercises for the low back, abdominal and pelvic floor muscles which can improve the stability of the pelvis and back. Some women benefit from wearing a pelvic support belt in addition to treatment especially if they need to stand for long periods, or carrying other children, these can give immediate relief and can be worn safely during pregnancy.


How soon will PGP go away?

In a few cases, PGP can linger after birth. If it does, you can help yourself to recover by carrying on with your treatment. You’re unlikely to have pain that persists. However, some women experience a mild recurrence just before their period., the hormones released at this time can have a similar effect to relaxin.

Finally, don’t suffer in silence or self-diagnose PGP is a condition which affects large numbers of pregnant women. As a joint problem, it can be safely treated in pregnancy. Prompt assessment and treatment can prevent the condition from worsening and lead to a shorter overall recovery time.

Note; PGP also occurs in sportsmen especially rugby players they are usually treated effectively with the same range of techniques as those used for pregnancy related PGP.


Self-help tips 

  • Wear flat, supportive shoes, sorry no flip flops or ballet pumps
  • Sleep on your side with a pillow (or some of the duvet) between your legs and support underneath your bump.
  • If you do have to lie on your back, place a rolled towel under your knees.
  • Use a pelvic support belt if you need to stand for long periods of time.
  • Keep your knees together when getting in and out of a car.
  • Sit  up straight and use pillows for support
  • Take the stairs one at a time, or try sidestepping.
  • Pushing supermarket trolleys can be particularly painful, shop online or ask for help
  • Doing regular pelvic floor exercises may help to strengthen and balance your pelvis

Try to  avoid

  • Bending and twisting to lift.
  • Sitting with your legs crossed,
  • Standing for long periods.
  • Lifting heavy objects, such as shopping bags.
  • Pushing heavy objects, such as a supermarket trolley or vacuum cleaner
  • Wide leg exercises:  squats, lunges and stretches as these out excessive load on the pelvis squats, lunges and stretches as these out excessive load on the pelvis
  • Sitting with your legs crossed, or slumped in a sofa
  • Standing for long periods.
  • Lifting heavy objects, such as shopping bags.
  • Pushing heavy objects, such as a supermarket trolley or vacuum cleaner