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.
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:
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.
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.
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.
‘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