Pelvic pain in pregnancy

Pelvic girdle pain (PGP) is pain or discomfort in the bones and joints of your pelvis during pregnancy. It is very common during pregnancy. In the past it was called 'pelvic instability' or 'symphysis pubis dysfunction (SPD)'.

PGP can happen at any time, but it usually starts between 14 and 30 weeks of pregnancy. It can also continue after your baby is born.

The joints that most often cause pain are:

• the sacro-iliac joints (where your pelvic bones meet the lower part of your spine)
• the pubic symphysis (where your pelvic bones meet at the front)

Pelvic girdle pain can severely affect your physical abilities. PGP is not dangerous for you or your baby. It usually goes away without treatment within 3 months after birth, but symptoms may return in future pregnancies.

Symptoms of PGP range from mild discomfort to severe pain in your pelvis. You may also find it difficult to walk and move around, especially if your pain is severe.

Pain may extend to your:

• lower back
• lower abdomen
• groin or buttocks (bottom)
• hips,
• thighs
• perineum
• knees and legs

You might also have a clicking or grinding feeling in your joints. The pain might get worse when you:

• walk at a fast pace or for a long distance
• get in or out of a car
• roll over in bed
• go up or down stairs
• stand up from sitting
• have sex

The exact cause isn't fully understood, but it likely involves a mix of hormonal and physical changes that happen during pregnancy.

Normal physical changes in pregnancy can lead to pelvic girdle pain. As your uterus gets bigger, you carry more weight at the front of your body, which changes your posture. This puts stress on the bones and muscles of your spine and pelvis.

During pregnancy your pelvic ligaments relax and other joints become more mobile. This can lead to your pelvic joints being unstable and painful, possibly due to changes in your hormones.

You are more likely to have PGP if you:

• had low back or pelvic pain before your pregnancy or in a previous pregnancy
• have had a back or pelvic injury
• have been pregnant before
• have physically demanding work
• are overweight or living with obesity (Opens in new tab)
• are experiencing emotional distress
• smoke

If you are experiencing back, pelvic or hip pain during pregnancy, you should see your doctor. Your doctor will ask you about your medical history and do a physical examination. They will work out whether your pain is due to PGP.

There are other causes of pelvic pain in pregnancy and some can be serious.

See your doctor immediately to check for other causes of your pain if you:

• have pain that occurs without movement
• have an unexpected fever (Opens in new tab)
• have bleeding or fluid leaking from your vagina
• are losing weight without trying
• are having difficulty controlling your bladder or bowels
• have numbness or weakness in your legs
• have had a fall or an injury

Your doctor can diagnose PGP after asking you about your symptoms, examining you and ruling out lower back problems as the cause. Tests are usually not required.

It's best to avoid x-rays during pregnancy as they can cause harm to your baby. If your doctor refers you for an x-ray, they may be concerned about other causes of pain or if your pain is severe and not getting better. Be sure to remind them that you are pregnant.

There are several strategies that you can use to help you manage and control pelvic girdle pain including:

• pelvic girdle support
• exercises
• pain medicines

You can try and identify what daily activities cause you pain and try to adjust or avoid those activities. Here are some changes you can make:

• Wear supportive, low-heeled shoes.
• Get dressed while sitting down, so you avoid standing on one leg.
• Climb stairs one step at a time.
• Take smaller steps when you walk, and avoid walking and standing for long periods of time.
• Sleep on your side and put a pillow between your legs. When getting out of bed, lie on your side, push yourself up gently with your arms and lower your legs to the floor while keeping your knees together.
• When sitting, avoid crossing your legs. Keep your knees together when you stand up and when you get in and out of the car.
• Ask your partner or a friend or family member for help with household chores that bring on pain.

Wearing a pelvic support garment can also help to reduce pain. Pelvic support garments can help stabilise your pelvic girdle and improve symptoms. Make sure the garment is fitted correctly and use it for short periods of time. Ask your physiotherapist for more information about pelvic support garments.

Which health professionals can help manage PGP?

Your doctor may refer you to a physiotherapist. A physiotherapist can teach you exercises to help you to manage your pain. They can also give you advice on changes you can make to your daily activities to avoid pain. Ask your physiotherapist to suggest an exercise program to help you when you first start to feel pain or discomfort.

How can I relieve pelvic girdle pain at home?

Here are some pain-relieving strategies you can try at home when you experience pain:

• Rest.
• Take a pain-relief medicine such as paracetamol (Opens in new tab). Taking pain relief may mean that you're better able to do the exercises that your physiotherapist has recommended. Ask your doctor or pharmacist what you can safely take during pregnancy.
• Wear your pelvic support garment.
• Apply a heat pack or ice pack to painful areas. You can use whatever feels better.

Extended bedrest without the guidance of a doctor is not recommended. Speak to your doctor if you feel you need to lie down for extended periods of time while you're pregnant.

Severe pelvic girdle pain

If you are unable to walk because of severe pain, you may need to use crutches or a wheelchair.

Rarely, you may need some time in hospital to ease the pain.

If your pain is severe and you are not improving with standard care, your doctor may refer you to a specialist pain service or a surgeon. It is very rare to need surgery for PGP.

Pelvic girdle pain can lead to:

• difficulty completing daily activities and caring for children
• long absences from work
• reduced quality of life
• chronic pain syndrome (Opens in new tab)

In most cases, people with PGP can have a normal labour and vaginal birth

Your physiotherapist can advise you how to position yourself during labour in a way that puts less stress and strain on your pelvis and hips. You might find it more comfortable to labour in a bath, if your birthing room has one.

You will be offered various pain management (Opens in new tab) options during labour. If possible, discuss these options with your medical team ahead of time, during your pregnancy. Let your birthing room team know you have PGP.

If you have PGP during pregnancy, it's very common to have it again in future pregnancies. Unfortunately, your pain may also be worse during future pregnancies.

If you've had PGP in a previous pregnancy, speak with your health team to develop a strategy to manage your pelvic pain early. Managing your pelvic girdle pain early can help to avoid pain from worsening as your pregnancy progresses.

You can reduce your chances of having PGP in pregnancy by getting regular exercise and by keeping your abdominal and pelvic floor muscles strong. Talk to your physiotherapist about how to do this.

If you are having trouble with pelvic pain during pregnancy, talk to your doctor or midwife.

You can visit Women's Health Education Network (WHEN) (Opens in new tab) for more information and support.

The Government of Western Australia has an informative video to help with tips on how to manage pelvic girdle pain (Opens in new tab).

The Royal Women's Hospital provides a pregnancy-related pelvic girdle pain fact sheet (Opens in new tab).

Do you prefer to read in languages other than English?

The Multicultural Centre for Women's Health (Opens in new tab) has a catalogue of health resources for women, available in more than 70 languages.