Pelvic Pain during Pregnancy

A common complaint from women during pregnancy is pain around the pelvis. Many different terms have been used to describe this condition including symphysis pubic dysfunction and more recently pregnancy related pelvic girdle pain (PGP).

Around 1 in 5 women experience discomfort in the front or back of the pelvis during pregnancy. Different women will experience different symptoms and these are more severe in some women than others.

The term pelvic girdle pain (PGP) describes pain in the joints that make up your pelvic girdle. The discomfort is often felt over the pubic bone at the front, below your tummy or across one or both sides of your lower back, the pain can sometimes also be felt at the front or the back of your thighs.


The symptoms commonly associated with PGP during pregnancy include:

• Pain around the pelvic area
• Difficulty walking
• Pain when standing on one leg, e.g. climbing stairs, getting dressed
• Pain and/or difficulty moving your legs apart, e.g. getting in/out of a car
• Clicking or grinding in the pelvic area - you may hear or feel this
• Painful or limited hip movements e.g. rolling or turning in bed
• Pain during normal activities of daily life

Having one or more of these symptoms may indicate the need for a physiotherapy assessment followed by advice and appropriate management.

Sometimes there is no obvious explanation for the cause of PGP. Usually there is a combination of factors which may include:

• The pelvic joints moving unevenly
• A change in the activity of the muscles around your pelvis which can lead to the pelvic girdle becoming less stable and therefore painful
• A previous accident or fall that has damaged your pelvis
• Some women may have pain due to the hormones during pregnancy
• Occasionally the position of the baby may produce symptoms related to PGP

Management of PGP should include early assessment of your condition by a physiotherapist. This assessment should include a careful examination of your pelvic, back and hip joints and the muscles around them, looking at how the joints are moving and whether the muscles are strong enough to support your pelvis and spine.

Physiotherapy treatment aims to improve your spinal and pelvic joint position and stability, relieve pain and improve muscle function. Treatment may include:

• Manual therapy to make sure your spinal, pelvic and hip joints are moving normally or to correct their movement
• Exercises to retrain and strengthen your stomach, back, pelvic floor and hip muscles
• Advice including back care, lifting, suggested positions for labour
• Advice regarding equipment such as crutches and support belts

General advice:

• Be as active as possible within pain limits and avoid activities that make the pain worse
• Ask for and accept help with household chores
• Rest when you can - you may need to sit down more often
• Try sitting down to do tasks such as ironing
• Avoid standing or sitting for long periods
• After your baby is born continue to follow the advice until you are symptom free

References
Damen L, Buyruk HM, Guler-Uysal F, Lotgering FK, Snijders CJ, Stam HJ. Pelvic pain during pregnancy is associated with asymmetric laxity of the sacroiliac joints. Acta Obstetric & Gynaecology of Scandinavia 2001; 80(11): 1019-1024

Wu WH, Meijer OG, Uegaki K, Mens JM, Van Dieen JH, Wuisman PL et al. Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation and prevalence. European Spinal Journal 2004

Mogren IM, Pohjanen Al. Low back pain and pelvic pain during pregnancy: prevalence and risk factors. Spine 2005; 30(8): 983-991

Coldron Y. “Mind the Gap” - Symphysis pubis dysfunction revisited. Journal of the association of Chartered Physiotherapists in Women's Health 2005; 96: 3-15

Young G, Jewell D. Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Systematic Review 2002; (1): CD001139

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