Pelvic pain in pregnancy (SPD)

What is pelvic girdle pain (PGP)? 

The pelvic girdle is a basin-shaped ring of bones that connects the main part of the body (the chest, abdomen, pelvis and back) to the legs. Pelvic girdle pain (PGP) is the term doctors use to describe pain: 

• in the front and/or the back of your pelvis 
• around the hips and thighs  
• at the sacroiliac joints at the back  
• at the symphysis pubis joint at the front. 

Pelvic pain in pregnancy is common, affecting up to 1 in 5 pregnant women and birthing people. While most people have pain that they can manage themselves, some have pain that is severe enough to need medical help.

PGP symptoms usually improve for most people after they give birth.

What are the symptoms of PGP? 

Symptoms of PGP vary. They can be mild, moderate or severe and may include: 

• pain deep in the pubic area, lower back, hips, groin, thighs or knees 
• pain that gets worse with certain movements, such as walking a long way, climbing stairs, getting in and out of a car, having sex or turning over in bed 
• a clicking or grinding feeling in the pelvic area 
• pain across one or both sides of the lower back 
• pain between the vagina and anus (perineum) 
• pain that spreads to the thighs.

PGP can affect your sleep and how easily you can move around. This can all impact on your day-to-day mood and quality of life. Tell your midwife or doctor if your pain is making it hard for you to cope physically or emotionally. They can support you. 

“I developed PGP at around 20 weeks. I had to learn what my limits were. I really knew about it if I tried to overdo it! Working with a physio has been important and learning about pelvic health is helping me to look after myself.” 

Claire 

What causes PGP? 

Sometimes, there is no obvious cause of PGP. For some people, the pelvic joints become stiff and start to move less evenly during pregnancy. This makes the pelvis less stable and can cause inflammation and pain. The added weight of your baby, and changes to the way you sit or stand during pregnancy, can also put extra strain on your pelvis.

Certain factors can increase the chance of  PGP during pregnancy, such as if you: 

• have a history of back or pelvis pain 
• have had a pelvis injury in the past 
• have hypermobility syndrome 
• have had PGP in a previous pregnancy 
• have a physically demanding job 
• have been pregnant before 
• you have a high BMI (are overweight) 

“I had SPD since around 22 weeks pregnant. I thought it was sciatica at first, and just struggled on, but after a few days I found myself bedbound and went to the GP. She referred me to a physio, who gave me some exercises to do.”

Mollie 

How is PGP diagnosed? 

PGP will not affect your baby. But that does not mean you should put up with the pain or treat it as a side-effect of pregnancy. 

Tell your midwife, doctor or GP if you are feeling pain in your pelvis, hips or thighs. Getting an early diagnosis of PGP can help to keep pain to a minimum. It will also reduce your chances of having long-term pain.

How is PGP treated? 

There are several options for treatment, based on the type of PGP you have.  

Physiotherapy 

Your midwife or GP should refer you to a physiotherapist who specialises in pregnancy-related pelvic joint problems. Your physiotherapist may suggest one or more treatments and exercises to relieve pain and help you move around more easily, including: 

• advice on which movements to avoid and how to pace your activities 
• exercises to strengthen your pelvic floor, stomach, back and hip muscles, giving you more stability and improving balance 
• hands-on therapy to get the muscles and joints in the pelvis moving normally again 
• exercises in water (hydrotherapy) 
• advice around labour and birth 
• acupuncture or a TENS machine (transcutaneous electrical nerve stimulation) 
• a pelvic support belt or crutches if they think it may help. 

A TENS machine is a small machine that is attached to your back with sticky pads. It sends out tiny electrical impulses to block pain signals sent from your body to your brain. (They are often used by people during labour for pain relief.) 

You can buy TENS machines from some chemists, pharmacies or medical device specialists. Your maternity unit may also have a free rental service.  

Medication 

Many people worry about taking pain medication during pregnancy. But there are some medicines that are safe for you and your baby, such as paracetamol so long as you stay within the recommended dose. If you think you need stronger medicine, ask your GP, midwife or a pharmacist to find out what you can take and how best to take it. 

Alternative therapies 

You can also try to manage pain with alternative therapies, which could include things like: 

• hypnosis 
• meditation, mindfulness or yoga 
• complementary therapies such as massage or reflexology. 

These treatments are not available on the NHS so you will need to pay for them.  

“I am now 35 weeks pregnant and the pain, stiffness and grinding feeling has got a lot worse as the baby is growing. Walking is now causing significant pain, and if I am active in the day, the pain in the evening is more severe.  I have found that having a warm bath has helped to ease the pain at the time by taking pressure off the joints. Wearing comfy, fitted shoes or trainers has also helped with walking. Placing a pillow under my bump and between my legs helps with some of the pain during the night.” 

Rebecca  

What can I do to help my symptoms? 

As well as doing the exercises your physiotherapist recommends, this advice might help. 

• Try to avoid activities that make the pain worse. For example, if parting your legs makes the pain worse, keep your knees together when rolling over in bed. 
• Take stairs one at a time. 
• Stay as active as you can without causing yourself pain. 
• Use a pillow under your bump and between your legs to give you extra support in bed. 
• If you have a toddler, take them out in a buggy so you can use it to support yourself while walking. Try not to go too far if it will be painful getting back. 
• Cycling is a great low-impact aerobic exercise. However, as your bump grows, your balance will change, which could mean you are more likely to fall off. You could use a stationary bike instead. 
• Wear flat supportive shoes. 
• Do grocery shopping online or ask someone to do it for you. 
• Avoid breaststroke if you are swimming, and take care with other strokes. 
• Get dressed and undressed while sitting down. Avoid standing on one leg. 
• Avoid lifting heavy weights, such as other children, vacuum cleaners or wet washing. 
• Try different positions for sex, such as kneeling on all-fours or lying on your side.

Blood clots 

Pregnancy increases the risk of blood clots in the veins of the legs. If you are not moving at all because of the pain, the risk of developing blood clots is higher. Speak to your midwife if you’re worried. They may suggest that you wear special stockings (graduated elastic compression stockings) or to have injections of heparin to reduce your risk of blood clots. 

Can I exercise if I have PGP? 

Try to stay active in any way that does not cause pain.  

It can be frustrating if you have been active to find that you have to stop or reduce your exercise.  

If you can, try different types of activity until you find one that works. Some women say that cycling causes no pain while walking is very painful. Swimming or aquanatal exercises may also help you stay active while supporting the weight of your body. If you are signing up to an aquanatal class, ask the instructor whether they have experience of PGP. They may have extra tips that help. 

The key thing is to stop any activity that causes pain.  

How will PGP affect my labour and birth? 

Most pregnant people with PGP go on to have a normal vaginal delivery. If this is your wish it should therefore be possible.

There is no evidence that having a caesarean section helps people with PGP. But, how you give birth is up to you. Talk to your midwife about your options. 

It is important that the birthing team know you have PGP because they can support you when you go into labour. For example, they can help make sure your legs are supported and help you change positions.

Some people find a water birth to be helpful because the water can give you support and allow you to move more easily. 

Talk to your physiotherapist and midwife about factoring PGP into your birth plan. They will be able to suggest positions that avoid straining your pelvis and help your labour to progress.

How long does it take for PGP to go away after birth? 

PGP symptoms usually improve after you give birth. It can take a few weeks or a few months. However, around 1 in 10 women have pain that lasts for some time.

This can be frustrating and difficult when you have a newborn baby. Try to take the time to rest and accept any help that is offered.  

During pregnancy you might like to think about what support you will need after your baby is born and who may be able to help you while you are recovering. 

If you are still in pain after you’ve had your baby, talk to your midwife or GP. They should refer you to a physiotherapist.

Read more about your body after birth. 

The emotional impact of pelvic pain in pregnancy 

“It is so important to get help sooner rather than later as it is physically and mentally debilitating at times.”

Mollie 

Being in physical pain every day can really wear you down emotionally, especially if you are finding it hard to sleep too. Speak to your midwife or doctor If you feel that PGP is affecting your mood.. 

Our wellbeing plan can help you put your feelings into words if you are not sure how to start the conversation.  

Will I get PGP in my next pregnancy? 

If you have had PGP in pregnancy before, you are more likely to have PGP in your next pregnancy. It may help to try and be as fit and healthy as possible before you get pregnant again.24 This may help ease the pain or even prevent PGP next time.  

It will also help to try and strengthen your pelvic floor muscles.

More support and information 

The Pelvic, Obstetric and Gynaecology Physiotherapists (POGP) are a branch of the Chartered Society of Physiotherapy  

The Pelvic Partnership has more information and support for women with PGP.