Pelvic Girdle Pain (PGP) During Pregnancy: Causes, Symptoms, And Treatment

Pelvic girdle pain (PGP) during pregnancy is not uncommon. If you are pregnant, this is something you must know about. PGP can begin as early as the first trimester or as late as just a few days before delivery.

PGP in early pregnancy can be due to the fact that your baby’s head is moving down the pelvis, a term known as ‘engaging’. PGP starts in pregnancy, but you might feel the pain even after giving birth, and if you are lucky, you will not experience the pain at all. However, if you do, then knowing about the causes, symptoms and treatment will surely be helpful. Read on to know more.

What Is Pelvic Girdle Pain (PGP)?

The pelvis is the area in your body where both your hip bones are located. On the front, the hip bones are joined by the pubis symphysis which is a very stiff joint. At the back, they are attached to the sacrum bone. A network of strong ligaments keeps these bones in place.

Pelvic girdle pain is an umbrella term that is used to describe pain in the joints of the pelvis, and this includes:

• Joints connecting to the sacrum, or triangular bone that is present at the back, between the hip bones of your pelvis.
• Symphysis pubis joint, which is the joint connecting the two halves of your pelvis in the front. This is known as symphysis pubis dysfunction or SPD.

What Happens To Your Pelvis During Pregnancy?

During delivery, your baby needs to pass through the birth canal which is located in the pelvis. A hormone named relaxin is secreted when you are pregnant and helps make the pelvic ligaments soft. The ligaments are thus able to stretch so that the baby can move out comfortably. This is why your pelvic joint moves more when you are pregnant and after you have given birth. While relaxin is secreted in both pregnant and non-pregnant women, the secretion increases during pregnancy and it continues to rise throughout the first trimester. After a steady increase in the initial stage of pregnancy, the secretion of relaxin rises again during the final weeks.

Hormonal influence sometimes relaxes the connecting bones and ligaments leading to a gap of as much as 9 mm between the pelvic bones- a condition known as diastasis symphysis pubis (DSP). However, DSP in pregnancy is not necessarily the cause of PGP. Your muscles and nerves are able to cope and adapt to the greater flexibility of your pelvic girdle. As a result, your body copes well with the changes that your posture undergoes as the baby grows inside the womb.

Causes Of Pelvic Pain During Pregnancy

A combination of factors is responsible for pelvic girdle pain during pregnancy. Some of them are:

• Changes in the way your muscles work in order to support your girdle
• Uneven movements of the joints in your pelvis
• One of the joints not working smoothly, and causing stress to the other joints of your pelvic girdle

Generally, when you are walking, sitting, standing up, or lying down, your pelvis is in a stable or locked position. When you are pregnant, there are times when you have to do these activities with an unlocked or less stable pelvis and this is what causes the pain.
This results in swelling of the joints, which is the primary cause of PGP.

More than half of all pregnant women suffer from pelvic girdle pain or pain in the back.
Though pelvic girdle pain is common during pregnancy, it is not something which should be accepted as normal. It is important that you do not ignore this pain and it is best if you consult a doctor. The pain can get worse if you leave it untreated.

Signs & Symptoms Of PGP/SPD

The location and the intensity of pain usually differs from one woman to another. You may experience the pain on just one side or the pain may jump from one side to another. The pain may also shoot to the back of your legs or buttocks. PGP can easily be confused with sciatica as many of the symptoms are the same.

The symptoms of PGP and SPD include pain in:

• The symphysis pubis joint
• The lower back
• The sacroiliac joints at the back
• At the back and front of the thigh
• The groin area
• Around the hips
• The pelvic floor and around your anal and vaginal openings

The pain usually gets worse if you do not take proper measures. Certain activities which you might consider restful can also make the pain worse. Lying down and turning over on your bed, and even some sex positions can become painful because of PGP. Standing or sitting for a long time can also elevate the pain. The symptoms are usually worse during the night.

Pelvic girdle pain can lead to other issues which may make your pregnancy a difficult journey. The constant pain may sometimes make you resent the cause, and you may experience emotional symptoms like depression, sadness, isolation, frustration, guilt, and anger.

Types Of Pain You Can Feel With Pelvic Girdle Pain

PGP is a wide term which covers various categories of pain. These include:

• Diastasis of the Symphysis Pubis (DSP): This is pain caused when the pubic bones, which are normally joined, are separated causing an abnormally large gap
• Pelvic Joint Syndrome: This is caused by the pain caused by the abnormal movement of the pelvic joint
• Posterior Pelvic Pain: This pain is similar to the pelvic joint pain. It radiates to the back of the thigh from the buttocks

Here are some of the detailed explanations of the different pains that could occur:

• Pelvic Arthropathy: This joint disease causes pain and can limit your mobility.
• Symphysiolysis: This involves the slipping or the separation of the symphysis (cartilaginous joint between two bones).
• Inferior Pubic Shear / Superior Pubic Shear / Symphyseal Shear: This involves the dysfunction of one of your pubic bones.
• Osteitis pubis (usually postpartum): This happens when the pubis symphysis and the surrounding muscles get inflamed.
• Hypermobility: You will be able to move your joints easily beyond the normal range.
• Sacroiliitis: This involves the inflammation and pain in the sacroiliitis joint (where the pelvis and lower spine connect)
• Symphysis pubis dysfunction (SPD): Involves excessive movement of the pubis along with pain.
• Physiological Pelvic Girdle Relaxation: Ligament relaxation that causes too much pain during pregnancy.

Why Is The Pelvic Position Important In Pregnancy?

A strong pelvis will always aid in your pregnancy and make the delivery less painful for you. Pregnancy puts a lot of stress on your pelvic floor and it tends to become weaker before the baby is born. It also becomes stretched. Doctors recommend pelvic floor exercises so that it doesn’t become weak. Strong muscles will support your baby’s weight and help in healing the muscle between your anus and vagina, after delivery.

The pelvis is one of the most crucial body parts that will be stressed during child birth. It is crucial that it is taken care of and not stressed too much as any complications could cause severe pain later on.

Who is Most at Risk?

Women in the later stages of pregnancy are at a higher risk for PGP. The risk of PGP increase in the following cases:

1. You have a history of lower back pain.
2. You have experienced PGP in a previous pregnancy.

Diagnosis Of PGP

If you are experiencing any pain in and around your pelvic region, it is advisable to visit a doctor. Do also talk to your doctor if you experience acute lower back pain. The doctor will examine you and ask questions to know where exactly the pain is originating. Make sure you know what kind of movements or activities are inducing the pain so that you are able to provide all information that your doctor needs for an accurate diagnosis.

PGP is often thought to be sciatica, even by the doctors. You can get yourself checked by physiotherapists as well, just to be sure. However, the physiotherapist should be someone who has experience with pregnant women.

Treatment Of Pelvic Pain In Pregnancy

Treatment for pelvic pain in pregnancy is not difficult. There are many things that you can do yourself to reduce the pain. Certain lifestyle changes and regular exercise can go a long way in treating PGP and making your pregnancy better.

Here are some ways to get relief from pelvic pain during pregnancy:

Ask your doctor to show you how to lock your pelvis while walking, standing up, or other performing other activities which are painful for you. By being a little careful while doing your daily activities, you can ease the pain.

If the intensity of the pain is too high, your doctor will give you a pelvic support belt.
Specific exercises meant for the pelvic floor and tummy can be helpful too.
Aquanatal classes are also recommended, and involve exercising in water. This can provide relief to some extent. However, make sure that the class you join is conducted for pregnant women.

Acupuncture is also known to offer great relief. However, before you book an appointment, do make sure that the acupuncturist is experienced in treating PGP in pregnant women.If nothing of this helps, your doctor will most likely give painkillers like paracetamol.

Does PGP Affect My Labour?

Ideally, PGP should not affect your labour in any way. If you are apprehensive, here a few positions you can try:

• Try sitting upright or try the kneeling position during delivery
• Avoid lying down on your bed with your back at the time of your delivery

Enlist your doctor’s help to identify the correct positions to ensure that the delivery is less painful and easier for you.

Giving Birth With Pelvic Girdle Pain

Pelvic girdle pain can make it difficult for you to open your legs, and if you are facing this issue, talk to your doctor to know which will be the best position for you. You might even need an assisted birth if the pain is severe. If most of the positions are painful for you, your doctor will opt for epidural to make the entire process as comfortable as possible.

Your doctor will offer a caesarean section if you are in severe pain and movement is a problem for you. This is, however, the last option available. The Caesarean section does not really help with PGP symptoms. In fact, it can make it more difficult for you to recover from PGP after giving birth.

Help & Support

It is important that you have people around you when you are pregnant, and more so when you are experiencing pelvic girdle pain. You will need to rest more and you will also need to do less of the household chores. Having people to help you will make your journey easier.
If you are experiencing PGP, here are some of the things that you can do to ease the delivery process:

Avoid Painful Activities

Avoid all kinds of activities that increase the pain as it will usually take a very long time for the pain to settle down. Do not sit on the floor and avoid sitting cross-legged as well. Ask people around to help with the household chores.

While you may not feel the pain initially, it may start much later during the day or when you go to bed.

Ample Rest

Taking rest at regular intervals is important. Sight upright and make sure your back is arched and well-supported. Lying down on one side will help as well.

Proper Turns

Turning on the bed may become difficult with time. Try and sit up directly from lying down on your back. This will ease the pain to some extent. However, as the bump grows, this will become difficult to do. Before moving, tighten your lower tummy muscles, pelvic floor, and arch your back.

Walk With An Arched Back

Arch your back while walking and swing your arms. This helps in locking the pelvis in a stable position and makes the pelvic joints stiff.

Maintain A Correct Posture

Whether you are sitting or standing, make sure to maintain the right posture. Do not sit slumped or lie on your back with your legs at the same level. Whenever you have to lie down on your back, make sure that you have a rolled towel to support your back. You can also place a side pillow in between your legs and sleep sideways. In fact, this is something that you will find comfortable. This helps to keep your hips aligned.

Sleep On A Soft Mattress

Sleeping on a soft surface can offer temporary SPD pain relief. Just place a soft quilt or duvet below the bed sheet.

• Some of the other things that you need to keep in mind are:
• Do not lift heavy weights and objects
• While wearing a pair of bottoms do not try and put your legs inside while standing. Sit down and then pull the clothing towards you
• Do pelvic floor and lower abdominal exercises to strengthen your back

If you have experienced PGP in one pregnancy, chances are that you will experience it when you get pregnant again. However, it will not be as bad as the first time, as you already know what needs to done to reduce the symptoms. If you have suffered from PGP in one pregnancy, it is advisable to wait for a few years before the second one. If you are overweight, consider losing weight as excess weight puts pressure on your pelvis. Exercise regularly to increase your flexibility and to stay fit.

All these measures will help manage PGP efficiently and are sure to reduce your discomfort during delivery.

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