Don’t suffer in silence: identify and tackle the pain in your pelvis.
By Amy Curtis – Journalist and certified personal trainer
As if there wasn’t enough to worry about when you have a baby on the way, a small percentage of women also have to deal with pain in their pelvis during pregnancy.
Pelvic girdle pain (PGP) is the umbrella term that describes pain anywhere between your belly button and your pubic bone and sometimes in your thighs, during and after pregnancy.
PGP is a musculoskeletal condition that affects 20 per cent of pregnant women. More specifically, 14-22 per cent of all pregnant women have serious PGP with 5-8 per cent of these having problems with severe pain and disability.
We chat to Amanda Savage, spokesperson for the Professional Network of Pelvic, Obstetric & Gynaecological Physiotherapists, about pelvic girdle pain symptoms, causes and treatment options:
What causes pelvic girdle pain?
When a woman falls pregnant, her body produces a hormone called relaxin, which works to make the ligaments around bone joints more elastic, to enable the skeleton to move and accommodate the growing baby. Relaxin flows throughout the body, not just the pelvis area, so every joint becomes less stable; but it is the pubic bone, hip bones and pelvis/spine that can often feel painful when this happens, as they can start to move unevenly, causing instability and pain. However, this isn’t necessarily the only cause.
Savage says PGP is more likely to be a combination of factors that include the following:
➡️ The pelvic girdle joints moving asymmetrically.
➡️ Abnormal pelvic girdle biomechanics from altered activity in the spinal, abdominal, pelvic girdle, hip and/or pelvic floor muscles.
➡️ A small number of women may have non-bio-mechanical but hormonally induced pain in the pelvic girdle.
➡️ Occasionally the position of the baby may produce symptoms allied to PGP.
What are pelvic girdle pain risk factors?
A study exploring lower back pain and pelvic pain in pregnancy concluded that the evidence for risk factors is inconclusive and PGP may develop in women with no identifiable risk factors. The main risk factor appears to be a history of previous PGP or back pain and/or previous trauma to the pelvis. Factors not associated with PGP include use of the contraceptive pill, time interval since last pregnancy, height, smoking, age or breastfeeding.
It’s important to remember that back pain and pelvic girdle pain in pregnancy are common but not normal and treatment should be sought at the earliest opportunity.
Pelvic girdle pain in pregnancy is common but not normal and treatment should be sought at the earliest opportunity.
‘For most women, pains arise because of the change in the dynamics on the pelvis and the back from the weight and shape of the growing baby. But we all know heavily pregnant women who DON’T have back pain so that shows that it is perfectly possible to carry a pregnancy comfortably,’ says Savage.
‘We often suspect that being pregnant “un-masks” a previous “quiet” problem like a stiff lower back or being a bit asymmetrical from possibly your sitting position or your youthful adventures. Sometimes people can remember those previous events that might have put them at risk, such as old accidents, falling off a horse as a child, slipping down steps, but often as not people can’t remember anything either!’
Pelvic girdle pain symptoms
If you suffer from any of the following, it is likely you have PGP:
❌ Pain in any joint around the hips, pelvis and/or groin area when standing up, getting out of the car, walking upstairs, walking in general,
❌ Clicking in the pelvis/groin area – can sometimes feel more like the bones are grinding together.
❌ Pain in the front/centre of your pubic bone, and/or pain between the vagina and anus.
❌ Discomfort or pain in the hips when moving your legs out sideways (eg stepping sideways, lunging to the side when exercising), or restricted range of movement in this direction.
❌ Pain or discomfort when lying on your side.
Can I prevent pelvic girdle pain?
There are steps you can take to try to reduce your chances of PGP, as Savage explains: ‘The muscles which help to hold us up and take the weight of the growing baby are the abdominals, the pelvic floor, the gluteals – or bottom muscles, so having a strong core is usually considered a good place to start.’
Taking Pilates classes before falling pregnant, or joining a specific pregnancy Pilates class can help with this.
Other pelvic girdle pain factors
There are one or two other things you might want to consider, aside from core strength, as Savage tells us, ‘Sometimes there hasn’t been very long between pregnancies so that women’s bodies haven’t had much time to strengthen after a previous pregnancy.
‘It is also important to have a symmetrical body, so if you are aware that you are carrying an injury that makes you “wonky” or you know that you have a very asymmetrical posture for your work or your hobbies, it is good to look at stretches and mobility exercises to sort these issues out before the baby grows bigger.’
The main thing is to pick up on a problem early and seek help and advice before it becomes too sore or disabling.
‘The main thing is to pick up on a problem early and seek help and advice before it becomes too sore or disabling,’ she adds. ‘There are several free resources and guidelinesto guide women on how to prevent a mild problem becoming a more severe one: the key is to think about provoking activities and how to adapt her lifestyle to put less strain on the pelvic area.’
Pelvic girdle pain treatment tips
Is there anything you can do to minimise the pain? The efficacy of self-treatment is a very common question among women suffering from PGP. ‘Many women find that just following the self-help advice means they have only a mildly inconvenient problem during their pregnancy,’ advises Savage.
‘But if following the general advice and lifestyle changes do not give the woman relief within a few weeks, the most helpful next step is for health professionals like your GP or midwife to facilitate onward referral to an obstetric physiotherapist for individual assessment and tailored treatment,’ she adds.
‘Women can be treated safely at any stage in pregnancy with standard physiotherapy interventions. All maternity departments will have access to a physiotherapist, who will have postgraduate training in the effective management of pregnancy related conditions.
‘Treatment may include mobilisation, exercise, pain relief advice including acupuncture or TENS, lifestyle advice, as well as access to belts, crutches and aids if needed.’
Pelvic girdle pain self-help tips
Savage recommends the following PGP tips to minimise pelvic girdle pain:
✔️ Remain active within the limits of pain and avoid activities which you know makes the pain worse, but if an activity does not increase pain there is no need to restrict that activity.
✔️ Rest is important, it can help to rest more frequently, sitting down or perching for activities that normally involve standing eg ironing or preparing food.
✔️ Try sleeping on your side with a pillow between your knees.
✔️ To turn over in bed, keep knees together, or turn “under” by going on to hands and knees rather than onto your back.
✔️ Avoid asymmetrical activities such as:
- Standing on one leg (try sitting down to get dressed)
- Sitting cross-legged
- Carrying on one hip
- Pushing or pulling to one side (eg helping a young child with a bike or scooter)
Pelvic girdle pain and exercise
Can you carry on exercising as usual? This is very much an individual thing, and you really do just need to listen to your body. If a movement feels painful or wrong in some way, you should avoid it.
‘A thing to watch out for is that if core or strengthening exercises or a support belt are making things worse, then it could be sign that the pelvic area joints are not in a good position; tightening the muscles is just making you more asymmetrical so definitely get a physio assessment before doing more exercises,’ says Savage.
When will pelvic girdle pain go away?
It’s hard to say how quickly your PGP can be dealt with, as every woman is different. As Savage explains, ‘For the majority of women the PGP will just affect a part of their pregnancy, get better and be happily forgotten about. However, some women do suffer all the way through and may need extra help and support during their labour and delivery.
‘There is no reason not to have an active birth but their physio and midwife will liaise to help you avoid painful positions and too much further strain on the pelvis.
‘Similarly, a lot of PGP disappears naturally with the birth but if problems persist there will be help available from the local ward physios and further treatment can be offered after the birth as an outpatient.’
Net Doctor