Pregnancy related pelvic girdle pain (PGP) in pregnancy
Pelvic girdle pain (PGP) is the umbrella term for all pelvic pain, including pubic pain which was previously called symphysis pubis dysfunction (SPD). PGP includes pain anywhere from the lumbar spine/abdomen down to the thigh, either at the front or back. The pain may range from a mild ache to severe pain which limits your daily activities. This may start at any time during pregnancy, labour or in the weeks after delivery.
It’s hard to say what causes some women to develop PGP and not others. The evidence for risk factors is inconclusive and some evidence is also contradictory. The main risk factor appears to be a history of previous low-back/pelvic girdle/joint pain and/or previous trauma to the pelvis.
Earlier research found that poor muscle function in the back and pelvis at the beginning of pregnancy is related to severe pain and disability throughout pregnancy.
Common signs and symptoms include:
- difficulty walking (a waddling gait),
- pain on weight bearing on one leg e.g. climbing stairs,
- pain and/or difficulty in straddle movements e.g. getting in and out of bath,
- clicking or grinding in the pelvic area (may be audible or palpable),
- limited and painful hip abduction (though some women have normal or only partly limited abduction),
- difficulty lying in some positions e.g. side-lying,
- pain during normal activities of daily life and/or
- pain and difficulty during sexual intercourse.
Symptoms can be aggravated by the increasing weight of the baby, changes in the body’s centre of gravity, and posture. It usually occurs in pregnancy due to the hormone 'relaxin' softening the ligaments in your body, allowing your pelvis to open up and make room for your baby to be born.
The condition is usually diagnosed by its symptoms and by a thorough assessment of the pelvic joints and spine. Your healthcare team will be able to refer you to a specialist physiotherapist. Getting diagnosed as early as possible can help to keep the pain to a minimum and avoid long-term discomfort.
If you suffer from pelvic girdle pain it may be best to try and avoid weight bearing activities. Many women have found that making small changes to everyday activities reduce discomfort. You could try the following:
- Remain active within the limits of pain so avoid activities which you know makes the pain worse.
- Accept offers of help and involve your partner, family and friends in daily chores.
- Rest more frequently or sit down for activities that normally involve standing, e.g. ironing.
- Avoid standing on one leg so try dressing sitting down, for instance.
- Consider alternative sleeping position, such as lying on one side with pillows between your legs for comfort. Turn ‘under’ when turning in bed, or turn over with knees together and squeeze buttocks.
- Explore alternative ways to climb stairs. You could try going upstairs one leg at a time with the most pain-free leg first and the other leg joining it on the step.
- Plan the day by bringing everything you need downstairs in the morning and set up changing stations both up and downstairs. You might find a rucksack helpful to carry things around the house, especially if crutches have to be used.
- Avoid activities that involve asymmetrical positions of the pelvis, such as sitting cross-legged, reaching, pushing or pulling to one side, and bending and twisting to lift or carrying anything on one hip.
- Consider alternative positions for sex, such as lying on the side or kneeling on all fours.
- Organise hospital appointments for the same day if possible, such as combining appointments for antenatal care and physiotherapy.
You should still be able to have a normal birth - talk to your midwife about the options (see section below).
The majority of women will be able to have a spontaneous vaginal delivery if they want to so talk to your midwife about your options. For instance, you could discuss your pain relief options as well as alternative positions for birth, such as supported kneeling or side lying with pillows/knees to chest.
While PGP in pregnancy is common, it isn’t normal. You should always seek help early if you think you’re suffering; it is a treatable, manageable condition.
This article is based on content from The POGP (Pelvic Obstetric and Gynaecological Physiotherapy), a UK-based professional network affiliated to the Chartered Society of Physiotherapy, which provides useful information on PGP.
Last updated April 2015
NCT's helpline offers practical and emotional support in all aspects of being pregnant, birth and early parenthood: 0300 330 0700. We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.
NHS choices has information on pelvic girdle pain.
The Pelvic Partnership is a charity which aims to pass on information about pelvic girdle pain based on research evidence and on other women’s experience.