Pelvic girdle pain in pregnancy: symptoms, treatment and birth

The pelvic girdle is a ring of bones around the base of the spine, and the RCOG explains that its three joints normally move slightly and work together. PGP is usually caused by the joints moving unevenly, which can make the pelvic girdle less stable and painful. The NHS describes it as a collection of uncomfortable symptoms caused by stiffness of the pelvic joints or the joints moving unevenly at the back or front of the pelvis.

It was formerly called symphysis pubis dysfunction (SPD), which refers to the joint at the front. The RCOG says it can involve the sacroiliac joints at the back and the symphysis pubis joint at the front. It is more common later in pregnancy, as the baby grows and the extra weight and changes in the way you sit or stand put more strain on the pelvis.

The NHS says women with PGP may feel pain over the pubic bone at the front, across one or both sides of the lower back, in the area between the vagina and anus (perineum), and spreading to the thighs. The RCOG adds the hips, groin and knees. Some women feel or hear a clicking or grinding in the pelvic area.

• Pain when walking, particularly on uneven ground or for long distances.

• Pain going up or down stairs.

• Pain standing on one leg, for example when dressing or climbing into the bath.

• Pain turning over in bed.

• Pain moving the legs apart, as when getting out of a car.

• Pain during sex.

The NHS says it is not known exactly why pelvic pain affects some women but it is thought to be linked to previous damage to the pelvis, joints moving unevenly, and the weight or position of the baby. Factors that may make it more likely include a history of lower back or pelvic girdle pain, previous injury to the pelvis such as from a fall or accident, having PGP in a previous pregnancy, a physically demanding job and being overweight. The RCOG also lists hypermobility syndrome, in which the joints stretch more than normal.

The NHS advises calling your midwife or GP if you have pelvic pain and it is hard to move around, it hurts to get out of a car or turn over in bed, or it is painful going up or down stairs. It says getting diagnosed as early as possible can help keep pain to a minimum and avoid long-term discomfort. The RCOG says you should be offered an appointment with a physiotherapist who will look at your posture and your back and hip movements and rule out other causes of pelvic pain.

Treatment is individual. The RCOG says it may include advice on avoiding movements that aggravate the pain, exercises that relieve pain and strengthen the abdominal and pelvic floor muscles, and manual therapy by a physiotherapist, osteopath or chiropractor who specialises in PGP in pregnancy. The RCOG also mentions warm baths, heat or ice packs, hydrotherapy, acupuncture, and a support belt or crutches. The NHS says these problems tend not to get completely better until the baby is born, but treatment from an experienced practitioner can improve symptoms during pregnancy.

The NHS and RCOG give very similar practical advice, and small changes to how you move often make a noticeable difference.

• Keep active but avoid things that make the pain worse, and rest when you can.

• Wear supportive shoes and put equal weight on each leg when standing.

• Sit down to get dressed and undressed.

• Keep your knees together when getting in and out of the car and when turning over in bed.

• Put a pillow between your legs in bed and one under your bump for extra support.

• Avoid sitting or standing for long periods, going up and down stairs too often, lifting heavy objects and carrying a toddler on one hip.

• The RCOG notes paracetamol is safe in pregnancy and may help if taken in regular doses, and that if you need stronger pain relief your doctor will discuss this with you.

The NHS says many women with pelvic pain in pregnancy can have a normal vaginal birth, and suggests writing in your birth plan that you have PGP so the people supporting you know, thinking about comfortable birth positions and considering a water birth, which can take the weight off the joints. The RCOG says the team in labour will ensure your legs are supported and help you to change position, that all types of pain relief are possible including an epidural, and that a caesarean section will not normally be needed because there is no evidence it helps and it may slow recovery. It also says most women with PGP do not need labour started off early.

The RCOG says PGP usually improves after birth although around 1 in 10 women will have ongoing pain. If that is you, continue to receive treatment and take regular pain relief, and keep using any walking aids until the pain settles. If pain persists, seek advice from your GP, who may refer you to another specialist to exclude other causes such as hip problems or hypermobility.

If you have had PGP, you are more likely to have it in a future pregnancy, and the RCOG says strengthening abdominal and pelvic floor muscles and being as fit and healthy as possible before pregnancy may help.