Pelvic Girdle Pain (PGP) In Pregnancy

What is Pelvic Girdle Pain during Pregnancy?

The Pelvic girdle is the ring of bones around your body at the base of your spine. 

Pelvic Girdle Pain (Previously known as Symphysis Pubis Dysfunction SPD) is pain in the front or back of your pelvis that can also affect other areas such as hips or your thighs. The sacroiliac joins in your back and the symphysis pubis joint at the front can also be affected.

About 1 in 5 pregnant women can suffer from PGP, which can affect their mobility and quality of life.

However early diagnosis can relieve the pain, the treatment is safe during and after all stages of the pregnancy.

 

What Causes PGP?

The three joints in the pelvis work together and will normally move slightly. The most common cause of PGP is the joints moving uneasily, which leads to the pelvic girdle becoming less stable and consequently painful. As the baby grows in the womb, you will change the way you sit or stand, which will put more strain on your pelvis.

If you have had a back injury in the past or suffer from back problems, you are more prone to PGP, also if you have hypermobility syndrome with which your joints stretch more than normal, this will make you more prone to PGP.

 

Can PGP harm the baby?

No while PGP is painful for you, it will not harm the baby.

 

Symptoms of PGP

The sooner PGP is treated the better, it is treatable at any stage of your pregnancy, but it is more common in the later stages of pregnancy.

Symptoms include:-

Pain in the pubic region, lower back, hips, groin, thighs or knees.

A clicking or grinding in the pelvic area.

The pain can be made worse by certain movements, for example

• Walking on uneven surfaces or for long distances
• When moving your knees apart, like when getting in or out of a car
• By standing on one leg, for example climbing stairs, dressing or getting in or out of the bath.
• Rolling over in bed
• During sexual intercourse.

 

How is PGP Diagnosed?

Speak to you midwife or doctor; you will probably be referred to a physiotherapist, who will make an assessment to diagnose PGP. This will involve looking at your posture, back and hip movements, and ruling out other causes of pelvic pain.

 

What can I do to help my symptoms?

The following measures may help.

• Keeping active but also getting plenty of rest
• Stand tall with you bump and bottom tucked in a little
• Try not to sit for more than 30 minutes at a time, changing your position frequency
• Sit down to get dressed and undressed
• When standing put equal weight on each leg.
• Try to keep your legs together when getting in and out of cars
• Lie on the less painful side when sleeping, keeping your legs together when turning over in bed.
• Place a pillow under your bump and between your legs for extra support in bed.

 

Things you should avoid as they may make your symptoms worse.

• Lifting anything heavy, for example heavy shopping, or another young child
• Going up and down the stairs to often.
• Avoid stooping, bending or twisting to lift or carry a toddler or baby on one hip
• Sitting on the floor, sitting twisted, or sitting or standing for long periods
• Standing on one leg or crossing your legs

 

What are my treatment options?

The Physiotherapist will suggest the right treatment for you. This may include

• You will be given advice on the best position for movement and rest, and how to pace your activities to lessen your pain
• Advice on avoiding movements that may be aggravating the pain.
• Exercises that should help you relieve your pain and allow you to move around more easily. These should also strengthen your abdominal and pelvic floor muscles to improve your balance and posture and make your spine more stable.
• Hands on Treatment (manual therapy) to the muscles and joints by the physiotherapist, osteopath or chiropractor who specialises in PGP in pregnancy. This should not be painful.
• Warm baths or heat or ice packs.
• Hydrotherapy
• Acupuncture
• Support belt or crutches.

 

For most women, early diagnosis and treatment should relieve your pain, stop the symptoms becoming worse and help you continue with your normal everyday activities. PGP is not something you just have to put up with until your baby is born.

 

I have tried these measures, but I am still in pain.

It can be extremely distressing being in severe pain and being unable to move around easily. Talk to your Midwife or Doctor, ask for help and support during your pregnancy, and after the birth.

• Regular pain relief. Paracetamol is safe during pregnancy and may help if taken in regular doses. If you feel you need stronger pain relief, speak to your Doctor
• In the short term aids such as crutches or a wheelchair will help. The Physiotherapist will be able to advise you. Equipment such as bath boards, shower chairs, bed levers and raised toilets may be available.
• Get help to change your lifestyle, such as assistance with doing the shopping or housework.
• Talk to your employer about ways to help you manage pain. You should not be sitting for too long or lifting heavy weights. You may want to consider shortening your hours or stopping work earlier than originally planned.

If you are in extreme pain or have very limited mobility, you may be offered admission to the antenatal ward where you will receive regular physiotherapy and pain relief. Being admitted to hospital every now and then may help you to manage your pain.

Can I have a Vaginal Birth?

Yes most women with PGP in pregnancy can have a normal vaginal birth.

Make sure the team looking after you in labour know you have PGP. They will ensure your legs are supported, help you change position and help you to move around.

You may find a birthing pool helps to take the weight off your joints and allows you to move easily.

All types of pain relief are possible, including epidural.

 

Do I need to have a Cesarean Section?

A cesarean section will not normally be needed for PGP. There is no evidence that a caesarean section helps women with PGP and it may actually slow down your recovery.

 

Will I need to be induced early?

Going into labour naturally is better for you and your baby. Most women with PGP do not need to have labour started off. Being induced carries risk to you and your baby, particularly if this is before your due date. Your Midwife or Obstetrician will talk to you about the risks and your options.

 

What will happen after the birth of my baby?

PGP usually improves after birth although around 1 in 10 women will have ongoing pain. If this is the case, it is important that you continue to receive treatment and take regular pain relief. If you have been given aids to help your mobility keep using them until the pain settles down.

If you have severe PGP, you should take extra care when you move around. Ask for a room where you are near to toilet facilities or even an en-suite room, if available. Aim to become gradually more mobile. You should continue treatment and take pain killers until your symptoms are better.

If your pain persists, seek advice from your GP, who may refer you to another specialist to exclude other causes such as hip problems or hypermobility syndrome.

 

What will happen in my next pregnancy?

If you have had PGP you are more likely to have it in the future. Making sure you are as fit and healthy as possible before you get pregnant again may help or even prevent it recurring. Strengthening abdominal and pelvic floor muscles makes it less likely that you will get PGP in the next pregnancy.

If you get it again, treating it early should control or relieve your symptoms.

 

Is there anything else I need to know?

Pregnant women have a higher risk of developing blood clots in the veins of their legs compared with women who are not pregnant. If you have very limited mobility, the risk of developing blood clots is increased. You will be advised to wear special stockings (graduated elastic compression stockings) and may need to have injections of heparin to reduce your risk of blood clots.

 

 

Source: Royal College of Obstetricians & Gynaecologists.