What is my pelvic girdle?

The pelvic girdle is the circle of bones sitting around your body at the base of the spine. Pelvic Girdle Pain (PGP) (previously known as Symphysis Pubis Dysfunction (SPD) can affect the symphysis pubis joint at the front of the pelvis, or the sacroiliac joints at the back. Normally these joints have hardly any movement, but due to increased pressure in the pelvis and the effects of pregnancy hormones, they become looser and cause the bones to move. This can result in pain in the symphysis pubis joint, sacroiliac joints and hips and thighs. If you have suffered back injuries in the past or have hypermobility, you are more likely to suffer with PGP. However, although it is painful, it is not harmful to your baby.

PGP can affect up to 1 in 5 pregnant women. It is a common condition and one that has an impact on both quality of life and the ability to move around easily. Despite this, with early diagnosis and management, most sufferers achieve at least some relief.

Treatment and diagnosis

The symptoms of PGP vary in all women and can develop at any stage, although it is much more common later in pregnancy. Indeed, symptoms can range from minimal to more severe pain. The sooner it is diagnosed and treated, the more benefit you will get. Typical symptoms include pain when rolling over in bed, pain when climbing stairs and getting dressed (standing on one leg) or pain when getting out of bed (moving knees apart), pain during sexual intercourse or pain when walking on uneven surfaces.

To ensure early diagnosis, report symptoms to your midwife or GP. Treatment involves an appointment with a physiotherapist who will assess you by testing your back and hip movements, and they will then confirm the diagnosis.

Prior to your physiotherapist assessment there are a few things you can try to reduce your pain. These include:

• sitting to get dressed/undressed
• improving your posture by tucking in your bottom and bump and dropping your shoulders
• moving around often so that you are not in the same position for more than 30 minutes
• wearing flat, supportive shoes
• trying to get plenty of rest and lying on the less painful side to sleep with a pillow between your knees can help. Keeping your knees together when turning over in bed also reduces pain.
• trying to minimise any movements that make the pain worse such as stooping or using the stairs
• avoiding the carrying of heavy loads

Your physiotherapist should recommend exercises and tips to reduce pain. These will help relieve your pain by strengthening your abdominal and pelvic floor muscles and will help to improve your balance and posture (see some exercises listed at the bottom of the article). Your physiotherapist may also offer manual therapy and manipulation to the muscles and joints, and they may also offer you a support belt or crutches. This is something that a chiropractor or osteopath could also help with. Heat and ice packs, warm baths, hydrotherapy and acupuncture can also help. If you remain in pain despite these measures, discuss taking regular pain relief (paracetamol) with your midwife or doctor.

It is important to remember that being pregnant puts you at higher risk of developing blood clots in the legs or the lungs and that this risk is heightened if you are less mobile. You may be advised to wear compression stockings and may even need blood thinning injections if your mobility is severely impacted.

PGP and delivery

Most women with PGP go on to have a normal vaginal delivery and the team looking after you during your labour should know you have PGP. This means they can make sure your legs are supported and give you advice on positions that are less painful. All types of pain relief are available including an epidural. Often women find that a birthing pool helps them move around more easily. There is no evidence that a caesarean section is needed for women with PGP. In addition, the longer recovery required following a C-section may actually slow speed of recovery from PGP.

After labour and delivery, the majority of women find that their PGP improves. However, 1 in 10 will have lasting symptoms. You should continue taking regular painkillers and use any aids given to you during pregnancy. Ideally, you should increase your mobility gradually, rather than trying to do too much at once. If your symptoms continue, speak to your GP who may recommend a referral to exclude any other cause for your hip pain.

After having PGP once, you are more likely to have it in following pregnancies. Ensuring you are as fit as possible before you get pregnant may help prevent symptoms. Indeed, pelvic floor exercises and building abdominal strength will make it less likely you will get symptoms again.

Pelvic floor and abdominal strength exercises

Exercises to help increase pelvic floor and abdominal core strength (taken from University of Southampton NHS Foundation Trust Patient Information factsheet):
Practice this exercise when you are lying on your side, sitting or standing.

1. Breathe gently, letting your tummy relax.
2. Gently squeeze your pelvic floor as if you are stopping a flow of urine, thereby creating a lifting sensation from back to front.
3. Draw in your lower tummy at the same time.
4. If your hand is resting on your lower tummy you should feel the bottom of your baby’s bump lift and your lower tummy move in towards your spine.
5. Count how long you are able to stay in this position for, up to ten seconds then relax.
6. Repeat this up to ten times. Aim to hold for ten seconds and complete this exercise two to three times a day. Throughout this exercise you should be able to breathe and talk. Your back should not move.

Pelvic tilting exercises

• Sit up tall on a firm chair or birthing ball, with your feet square on the floor.
• Tighten your pelvic floor/deep tummy muscles as described above.
• Gently squeeze your bottom and curl your bottom under you, thereby sinking onto your tailbone.
• Hold for five seconds. Release gently. Repeat ten times.

Arm raises/heel raise exercises

• Sit up tall on a firm chair or gym ball, with your feet square on the floor.
• Tighten your pelvic floor/deep tummy muscles as described above.
• Raise and lower one arm above your head or one heel from the floor while keeping your pelvis still.
• Relax your muscles once your arms or heels are lowered.
• Repeat and alternate your arms and heels ten times.

Pelvic floor awareness

In addition to the basic pelvic exercise, it is important that you also use your pelvic floor and deep tummy muscles in everyday activity to reduce the strain on your back. Try to remember to tighten them during activities such as sitting, standing and walking.

Main points

• Pelvic Girdle Pain (PGP) is pain in the front and/or back of your pelvis but can also affect your hips and thighs.
• PGP is caused by increased mobility in joints that do not normally move.
• Hormonal changes together with the extra weight caused by the baby are the main causes of PGP.
• PGP affects around 1 in 5 pregnant women.
• PGP symptoms include pain rolling over in bed, pain climbing stairs and getting dressed, pain getting out of bed and pain during sex.
• PGP is most common during the later stages of pregnancy although it can develop at any stage.
• A physiotherapist can help treat your PGP.
• Heat and ice packs, warm baths, hydrotherapy and acupuncture can relieve symptoms, as can a support belt or crutches.
• Paracetamol may be useful in relieving regular pain.
• Compression stockings and even blood thinning injections may be necessary to reduce the risk of developing a DVT if PGP is severely restricting your mobility.
• Pelvic floor exercises and strengthening abdominal muscles can help reduce your chances of getting PGP in subsequent pregnancies.

References

‘Symphysis pubis dysfunction: a practical approach to management’ The Obstetrician & Gynaecologist 2006;8:153–8
Pelvic Girdle Pain and pregnancy- Patient Information Leaflet; The Royal College of Obstetricians and Gynaecologists (RCOG), June 2015
University Hospital Southampton NHS Foundation Trust Patient Information Factsheet: ‘Pelvic and Back Pain during Pregnancy’ http://www.uhs.nhs.uk/Media/Controlleddocuments/Patientinformation/Pregnancyandbirth/Pelvic-and-back-pain-during-pregnancy-patient-information.pdf