Pelvic pain in pregnancy

Pregnancy is a new and exciting experience. But how do you know the additional body pains you feel are normal or if they are more than just your usual aches and pains?

Pelvic girdle pain (PGP) in pregnancy occurs in about 20% of women and can occur at any stage of pregnancy. It can involve the sacroiliac joint at the back or pubic symphysis pain at the front. It also can occasionally present as lower back pain, referred leg pain or lower abdominal pain. This must be a new onset pain, not a recurrence of a pre-existing lower back or pelvic pain.

However, on a more positive note, 90% of women fully recover from PGP within 3-12 months after birth!

Causes of PGP

PGP usually starts around the 18th week and peaks between 24-26 weeks, however, it can start earlier or later. The exact cause is unknown; however, it’s thought to be due to the changes in hormone levels plus biomechanical factors such as a decreased ability to transfer load through the pelvis, altered posture, altered centre of gravity, changes in pelvic support (muscular force) and changes in everyday activity.

Prognosis

Without treatment the pain often continues to get worse as the pregnancy continues. The goal of treatment is to reduce pain and keep you at a level where you are active and exercising, without increasing the pain. It is more likely to become chronic if there are more than 3 joints involved however if the pain is isolated there is a 90% chance of a full recovery 2 months post natal.

Risk factors for developing PGP

• Previous history of lower back pain or SIJ pain
• Previous trauma to the pelvis or lower back
• High/strenuous workload
• Position of baby e.g. if the baby is sitting posteriorly it can potentially increase lower back pain

Just because you had PGP in your first pregnancy, doesn’t automatically mean you’ll have it in your second or third pregnancies!

Symptoms

• Pain in the pelvis (at the back), lower back pain or groin pain
• Pain at the pubic symphysis bone (at the front)
• Pain with taking long strides when walking or running
• Pain with single leg movements such as climbing stairs, standing on 1 leg
• Pain with transitional movement such as getting in/out of the car or rolling over in bed
• Pain with prolonged stationary positions e.g. standing >45 minutes
• Pain during or after intercourse

Treatment

The majority of physiotherapy treatment for PRPGP is related to long term symptoms management through:

• Modification of activities e.g. walking speed
• Exercise education and changes. Exercise can help for pain relief (if doing the correct modes of exercise e.g. swimming and Pilates)
• Advice regarding postures (including sleeping)
• Manual therapy which includes massage, joint mobilisations, dry needling etc
• Using supportive garments such a SIJ belts
• Ice/heat for pain relief
• Correcting ergonomics

Post natal support considerations

It’s important to ensure you look after your body after giving birth, there is vastly different advice depending on if you have the birth vaginally or caesarean. However, the following factors should be addressed by your physiotherapist:

• Pelvic floor assessment
• Pain management
• Training of abdominal muscles (when appropriate)
• Specific return to sport guidelines
• Ergonomics and positioning for repetitive tasks such as lifting the baby or breastfeeding

Pregnancy related pelvic girdle pain can be successfully treated with a combination of physiotherapy, lifestyle adaptions and strengthening exercises. If you are suffering from PRPGP you should get it assessed as early as possible, if it’s left untreated it can continue to get progressively worse.