Pregnancy Related Pelvic Girdle Pain (PGP)

The bones that make up the pelvis (the pelvic girdle) can cause pain during pregnancy. These pains arise from the sacro-iliac and symphysis pubis joints. Some women experience pain in their lower back, buttocks, thighs, hips, groin or pubic bones at some time during their pregnancy. For most women, the symptoms are mild but for some, they are severe and disabling. Although PGP can be painful and distressing, it will not harm your baby. 

You may have pain or difficulty with activities such as:

  • Walking (especially for prolonged periods)
  • Climbing stairs
  • Turning over in bed
  • Putting on socks/tights/shoes/trousers
  • Getting in/out of the car and driving
  • Sex

Other symptoms of PGP may include clicking or grinding sensations on movement or feeling that the pelvic joints are loose/unstable. The joints are not damaged; PGP is usually a self-limiting condition and most women recover completely within the first month following birth, although 1-2% may experience pain for up to one year.

What are the causes of PGP?

Strong tissues called ligaments hold the bones of the pelvis together; the normal hormonal effects of pregnancy cause the ligaments to be more flexible. This is an important process as it allows the pelvis to widen during the birth of your baby. However, it does mean that your joints are more mobile; this can cause discomfort and is one of the theories of how PGP develops. The ligaments and joints gradually return to normal following delivery. Your growing baby puts more strain on your pelvis, the extra weight of your baby and the way this can affect your posture can also contribute to PGP. You may be more likely to have PGP if you have had low back pain or pelvic injury prior to becoming pregnant, as this may lead to changes in muscle length or joint stiffness. Having a job involving manual work/lifting activities or prolonged standing/walking may also be a factor.

How can I reduce PGP?

Many women find that simple changes and considerations can help their PGP symptoms:
Good posture:

  • Sit on a firm chair with a rolled towel or cushion to support the lower back
  • Do not cross your legs when sitting
  • Directly face your computer screen (avoid sitting in a twisted posture)
  • Place a pillow between your knees and ankles when lying on your side at night
  • Roll onto your side before getting out of bed, keeping your legs together
  • Keep your legs together when turning over in bed and when getting in/out of the car
  • Keep your back straight when moving from sitting to standing and use your arms to push up.

Daily activities:

  • Avoid lifting heavy weights
  • Avoid twisting/bending movements like vacuuming or pushing heavy supermarket trolleys
  • Ask for help from your partner/relatives/friends
  • If you have to vacuum, then reduce the amount you do in one session and come back to it the next day
  • Consider online grocery shopping
  • Sit down to get dressed/undressed
  • Climb the stairs one step at a time
  • Sit down to prepare food or to do the ironing
  • Walk more slowly and with shorter strides
  • Wear comfortable supportive shoes with a good sole (avoid high heels)
  • Avoid prolonged sitting or standing; avoid sitting on the floor.

Toddlers (if you have a young child to care for):

  • Try to avoid lifting your toddler too often and avoid carrying the child on one hip
  • If they want a cuddle, sit down and ask the child to sit beside you or on your lap
  • Remember to let the cot side down when lifting the child in/out (bend your knees, keep back straight)
  • Kneel to bath your child (do not bend over the bath) or preferably ask a partner/relative to help
  • Keep your child close to you when lifting him/her into a car seat (have the front seat pushed well forward to allow more room).
  • Rest.

Try to have a rest for at least half an hour each day, preferably lying down on your side with a pillow between your knees and ankles. Pacing Try to plan your daily activities so that you keep active but do not overdo things.

How can my employer help?

Ask your manager for a risk assessment of your workstation and workplace tasks. If you are an office worker, you should have a supportive, adjustable chair and try to stand up/walk a little every 30 minutes. If your work involves standing/ walking, you should have a few minutes rest sitting down every 30 minutes.

Can I still have sex?

Find a comfortable position which allows you to keep your legs closer together (for example, lying on your side with your partner behind you).

What exercise can I do?

  • Regular low-impact exercise using light to moderate effort is recommended for pregnancy
  • Suitable types of exercise include walking, swimming and exercise classes designed for pregnancy (such as antenatal yoga or Pilates)
  • Avoid the ’frog-kick’ leg action of breast-stroke (keep the thighs closer together, as in front crawl, or use a float to support your pelvis and focus on your arm strokes)
  • Avoid high-impact exercise such as running or tennis or any exercise/dance involving jumps
  • If any exercise causes pain, then limit or stop it.

What pain relief is available for PGP?

Physiotherapy - if your PGP is no better after following these guidelines for two weeks, ask your midwife or GP for a referral to a women’s health physiotherapist. The physiotherapist will examine your pelvic, back and hip joints and the muscles around the joints, also looking at the way you move. Treatment may include an individual exercise programme, exercise in water, manual therapy, advice on posture and daily activities.

Pelvic support belt - a maternity support belt or tubigrip may reduce PGP on walking – ask your physiotherapist for advice.

Osteopathy/Chiropractors - this treatment is not available on the NHS, but may be found helpful by some women. If you consult a therapist, check that they are experienced in treating women in pregnancy or postnatally.

Relaxation - to help to relax the muscles and help reduce tension you may consider relaxation techniques, massage or aromatherapy massage, which may ease pain.

Pain killers - regular paracetamol (1g every four-six hours is safe in pregnancy, but no more than right in 24 hours), is safe during pregnancy  and often necessary to provide some pain relief. Sometimes stronger painkillers are required such as dihydrocodeine or codeine, please discuss this with your doctor. Prolonged use of high dose codeine close to the end of pregnancy may cause babies to be jittery or sleepy when born, your baby will be checked carefully and may need to stay in hospital for a day or so for observation.

We recommend you discontinue codeine after the birth of your baby if you are breastfeeding and an alternative painkiller can be prescribed if needed. Anti-inflammatory painkillers, such as ibuprofen are not recommended in pregnancy but can be safely used after birth.

Does PGP affect labour and birth?

A normal vaginal delivery is recommended as best for you and your baby. There is no evidence that an elective (planned) caesarean section has any additional benefit nor that it will improve recovery or the chances of PGP recurring in future pregnancies. Talk to your midwife or physiotherapist about which positions may be more comfortable for you during labour and the delivery of your baby. You can note these in your birth plan and ask your birth partner to help you into positions where your back and legs are well-supported. Sometimes the midwife or obstetrician will need you to change position for certain procedures or to ensure the well-being of you and your baby. This will always be discussed with you first. The best ways to achieve a normal delivery are if labour starts spontaneously and you use comfortable positions. Research has shown that if you are able to use more upright positions you are likely to have a shorter labour and are less likely to require interventions. Women who have a shorter labour are less likely to have long-term PGP symptoms after delivery.

It is not routine practice to induce (start) labour early for women who have PGP. There may be other reasons why induction of labour is recommended for you.Iif you are suffering very badly with PGP and wish to discuss induction, your midwife will refer you to see an obstetrician to discuss with you if the benefits of induction outweigh the risks for you and your baby.

Your pain relief options during labour are the same as all women having babies. Some women find that warm water such as baths or the birth pool may provide relief.

Will PGP reduce after my baby is born?

For most women, their PGP reduces immediately following delivery, as the weight of the baby is no longer affecting the pelvic joints. However, it is still important to follow the advice given for pregnancy, as the ligaments take at least four-five months to return to their pre-pregnancy condition.

  • Gradually increase your walking distance and activity levels
  • Start doing your pelvic floor exercises again as soon as you feel comfortable after the birth
  • If your PGP is not settling within 4 weeks of the birth, ask to be referred to a women’s health physiotherapist.

For more information visit www.nhs.uk/conditions/pregnancy-and-baby/pages/pelvic-pain-pregnant-spd