Pelvic pain in pregnancy (SPD)
Pelvic pain in pregnancy was originally called Symphysis Pubis Dysfunction (SPD) but health professionals now call it Pelvic Girdle Pain (PGP) because it affects all the joints of the pelvis not just the one called the Symphysis Pubis.
Symptoms of PGP
- pain deep in the pubic area and groin (between the vagina and anus)
- the pain can be manageable or severe
- it can be brought on by some types of activity, such as walking, climbing stairs and turning over in bed
- you may also have pain across your lower back
- you might have a grinding or clicking sensation in your pubic area
- the pain can be made worse by parting your legs or by leaning on one leg.
Causes of PGP
For some women in pregnancy the pelvic joints become stiff or less stable. This can cause inflammation and pain, which varies in severity. The pain can range from a dull ache to severe pain. Most sufferers are in the mild to moderate category.
It is usually possible to successfully treat PGP, though the earlier a diagnosis is made and treatment is started, the better.
Certain types of movement, such as widening the legs or leaning on one leg, can make the pain worse.
For those with bad to severe pain, the condition can make it difficult to continue doing normal day to day activities. Pain can also affect your sleep, causing your emotional health to suffer too.
As PGP doesn’t affect the baby, sometimes women feel as if they should just put up with it and that it is not a priority. This is not the case and if you’re suffering from it, talk to your midwife or GP. They should be able to refer you to a physiotherapist who has experience of treating pelvic joint pain.
"I have 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 bed bound and went to the GP. She referred me to physio who gave me some exercises to do.” Mollie
Watch our Facebook live about pelvic pain in pregnancy
Treatment for PGP
Physiotherapy treatment for pelvic pain might be different depending on your physiotherapist, but it is likely to include the following:
- hands-on therapy to restore normal movement of muscles and joints in the pelvis
- exercises to strengthen your pelvic floor, stomach, back and hip muscles
- exercises in water
- advice around labour and birth
- they may give you a pelvic support belt or crutches if they think these may help you.
Many people worry about taking pain medication during pregnancy, but there are some safe options for you and your baby. Ask for advice from your GP, midwife or a pharmacist to find out what pain medicine you can take.
You can also try to manage pain with alternative therapies, which could include things like:
- a TENS machine
- meditation, for example mindfulness or yoga
- complementary therapies such as massage or reflexology.
It’s a good idea to find a therapist or instructor with experience of treating PGP and understands the condition.
If you get the right advice and treatment it can really help so don’t hesitate to bring it up with your midwife or doctor.
Everyday tips to help ease PGP
- Try to avoid the activities that make the pain worse. For example, if parting your legs makes the pain worse, roll out of bed and take the stairs one at a time.
- Get help with minding other children if possible.
- If you have a toddler, take them out in a buggy so you can use it to support yourself while walking (and avoid having to carry them) and try not to go too far if it will be painful getting back.
- Wear flat supportive shoes.
- Do your shopping online or ask someone to shop for you.
- Avoid breaststroke if you’re swimming and take care with other strokes.
- Get dressed sitting down.
Can I exercise if I have PGP?
As well as physiotherapy exercises you should still continue to stay active in any way that does not cause you pain. Your level of activity is likely to depend on the severity of the pain. It can be very frustrating if you were previously active to find that you have to stop or reduce your exercise.
If you can, try different exercises until you find one that works. Some women say that cycling causes no pain while walking is very painful, for others swimming or aquanatal exercises can provide some comfort. If you are signing up to an aquanatal class ask the instructor whether they have experience of PGP.
When swimming, avoid the breast stroke as this is likely to cause more pain.
The key thing to remember is to stop any activity that causes pain.
How does PGP affect labour and birth?
You can ask the physiotherapist and your midwife for help in factoring PGP into your birth plan.
A water birth might be helpful because the water can give you support and allow you to move more easily. You may also find some labour positions better than others and they can advise you on which may be best.
How long does it take for PGP to go away after birth?
It will depend on the severity of your PGP, but most women can expect their symptoms to improve 2 to 6 weeks after birth as their hormones and body recover from pregnancy.
This can be frustrating when you have a newborn baby but take the time to rest and accept any help that you are 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’re still in pain when you see your GP for your 6 week check, let them know because they may be able to refer you for physiotherapy.
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’re finding it hard to sleep too. If you feel that PGP is affecting your mood, and you’ve been upset more often than normal for two weeks or more, speak to your midwife or doctor.
Tommy’s wellbeing plan can help you put your feelings into words if you’re not sure how to start the conversation.
The Pelvic, Obstetric and Gynaecology Physiotherapists (POGP)
POGP are a branch of the Chartered Society of Physiotherapy whose examined membership should be available if you require advice, further information or treatment.
The Pelvic Partnership
The Pelvic Partnership provide women and healthcare professionals with information about best practice for the treatment and management of pregnancy-related PGP. Go to pelvicpartnership.org.uk for information and support.
Share your experience of PGP, and swap tips with others in the same boat in BabyCentre’s friendly PGP support group.
- NHS UK (2016). Pelvic pain in pregnancy: https://www.nhs.uk/conditions/pregnancy-and-baby/pelvic-pain-pregnant-spd
- Pelvic Partnership (2017). Symptoms of PGP: https://pelvicpartnership.org.uk/what-is-pgp-symptoms-of-pgp/
- Pelvic Obstetric & Gynaecological Physiotherapy (2015). Pregnancy-related Pelvic Girdle Pain. https://pogp.csp.org.uk/system/files/pogp-pgppat_3.pdf [accessed 06/12/18]
- Pelvic Partnership (2017). Alternatives to medication: https://pelvicpartnership.org.uk/pain-in-pgp-alternatives-to-medication/