Pelvic girdle pain in pregnancy

What is pelvic girdle pain?

Pelvic girdle pain (PGP) is a general term for all pain in the pelvis. It affects 1 in 5 pregnant women and birthing people. It is commonly experienced as pain while walking, climbing stairs, or turning over in bed (RCOG, 2015).

For most women and birthing parents, early diagnosis and treatment can relieve pain and help to continue with normal everyday activities (RCOG, 2015).

Symptoms of pelvic girdle pain

PGP includes pain in the (RCOG, 2015):

• pubic region at the front of the pelvis
• lower back
• hips
• groin
• thighs
• knees

The pain commonly starts later in pregnancy and may range from a mild ache to being so severe it limits daily activities (RCOG, 2015).

Some people also experience clicking or grinding noises in the pelvis (RCOG, 2015; NHS, 2022).

What causes pelvic girdle pain?

In pregnancy, the hormone relaxin softens the three joints in the pelvis, in preparation for birth (Society for Endocrinology, 2021). In some people, this causes the pelvis to become less stable and the joints to move unevenly (RCOG, 2015).

As the baby grows in the womb, the extra weight and the way the pregnant woman or person moves puts strain on the pelvis (RCOG, 2015).

PGP is more likely if the pregnant woman or person has (NHS, 2022; RCOG, 2015):

• a back problem
• injured their pelvis in the past
• hypermobility syndrome (where the joints stretch more than normal)
• a physically demanding job
• a high BMI.

Self-help for pelvic pain

While many people try to push through the discomfort, it is worth telling the midwife about any pain. They will offer some tips to manage while waiting for diagnosis and further treatment (RCOG, 2015; NHS, 2022):

• Rest when possible.
• Put equal weight on both legs if standing, and avoid activities that are unbalanced, such as stooping or twisting.
• Remain active, but some activities such as getting dressed might be easier when sitting down. However, unless using a wheelchair, avoid sitting for more than 30 minutes at a time.
• Keep knees together when getting into or out of a car, or turning over in bed.
• Sleep lying on one side with pillows between the legs and under the bump.
• A support belt can be effective if used regularly for short periods.
• Paracetamol taken regularly is safe in pregnancy, and hot and cold packs might help.
• Accept offers of help with day-to-day tasks from a partner, family or friends.
• Exercises will strengthen the pelvic floor and abdominal muscles.

Some people find it helps to:

• Plan the day by bringing everything needed downstairs in the morning.
• Set up changing stations for older children both up and downstairs.
• Use a rucksack to carry things around the house, especially if crutches are needed.
• Talk to their employer to find ways to avoid activities that increase the pain. This might include shortening hours or stopping work earlier than planned (RCOG, 2015).

What treatment is available?

PGP isn’t something that has to be put up with, and treatment is available. When the woman or birthing person mentions the pain to the midwife, they should be offered an appointment with a physiotherapist (physio). The physio will rule out any other causes of pain (RCOG, 2015).

In addition to the self-help measures, treatment could include (RCOG, 2015; NHS, 2022):

• Manual therapy from an osteopath, chiropractor or physiotherapist who specialises in PGP.
• Hot and cold packs, hydrotherapy, a TENS machine, or acupuncture.
• A support belt or crutches, or a wheelchair for the most severe cases.
• Other equipment to support at home, such as a raised toilet seat.
• If the pain is severe, then stronger pain relief might be discussed.
• In the most severe cases, admission to hospital for periods of physiotherapy and pain relief.

The emotional impact of pelvic girdle pain in pregnancy

PGP can take away a sense of independence and lead to social isolation. It can also affect the ability to care for other children, leading to feelings of guilt (Mackensie et al, 2018).

A physiotherapist should be able to suggest relaxation techniques to help cope with the distressing effects of living with chronic pain (NHS, 2022).

Planning birth with pelvic girdle pain

Most women and birthing people with PGP can have a vaginal birth. When the healthcare team know about the PGP, they will be able to support positions that are most comfortable (NHS, 2022). 

It is important that your birth partner and the healthcare team understand your individual needs during labour and birth. Some positions and forms of pain relief may risk making the pain worse (Pelvic Partnership, no date). The Pelvic Partnership explains what to consider and offers tips on preparing for birth.

Using a birth pool may help free movement and take weight off the joints. All types of pain relief including epidural remain possible (RCOG, 2015; NHS, 2022).

Induction or a caesarean birth are not treatment options for PGP as they can make recovery from PGP longer (RCOG, 2015). Induction or a caesarean birth may be recommended for reasons unrelated to PGP.

After the birth

For 9 in 10 women and birthing people PGP resolves after birth. Care is needed while mobility gradually improves and pain lessens (RCOG, 2015).

Anyone who has had PGP is more likely to experience it in a future pregnancy. Strengthening exercises will help and may prevent it (RCOG, 2015).

Further information

The POGP (Pelvic Obstetric and Gynaecological Physiotherapy) is a UK-based professional network affiliated to the Chartered Society of Physiotherapy, which provides useful information on PGP. 

The Pelvic Partnership is a charity which offers information, support, and signposting to further resources to help treat pelvic girdle pain.