Pelvic pain during pregnancy - around your pelvis, bottom and the tops of your thighs - is a common symptom of pregnancy. But, it can be painful and debilitating for those who suffer from it severely.
The definition of pelvic pain in pregnancy is broad. Starting from around the bikini line, the pain can be experienced all around and into the pelvis: the large bone and associated joints between your abdomen and your legs. it can also be known as Symphysis Pubis Dysfunction (SPD) and Pelvic Girdle Pain (PGP).
Senior physiotherapist Myra Robson explains, “Pelvic pain during pregnancy can happen anywhere from the belly button to the perineum (the area between your vagina and back passage). There is a range of easy ways to relieve and reduce the pain you’re feeling, including exercises and lifestyle changes. Heat and massage are very effective, as well as reducing any activities that are one-sided. Don’t stand on one leg, wear a bag on one shoulder or hold your toddler on your hip, for example.”
Signs of pelvic pain during pregnancy
- Pain brought on by activities such as going upstairs, turning over in bed, and changing gear in a car.
- Pain within 30 minutes of walking or standing
- Deep muscular pain in your groin
- Feeling like your hips have moved out of their sockets slightly
- A clicking or grinding sensation in your pelvis
- Worsening pain when you part your legs or do a one-sided activity, like standing on one leg
- Radiating pain that goes down one or both thighs
- A feeling that your joints are moving apart
- Lower back pain
Pelvic pain during pregnancy can come in many different forms - it can be mild or excruciating, depending on where it’s felt and how much strain you’re experiencing. Studies suggest it affects around 1 in 5 women and the usual onset is 14-30 weeks of pregnancy.
The pain can be temporary, only when you do physical activities, or longer-term and make finding a comfortable seated or lying position difficult. The pain can be like a stabbing or shooting sensation or just a milder, chronic and dull sensation of discomfort.
How to relieve pelvic pain during pregnancy?
- Using heat on the affected areas
- Warm baths to loosen inflamed joints
- Not doing “unilateral” movements (one-sided), like standing on one leg
- Using a pelvic support belt
- Avoiding crossing your legs when seated
- Sleeping with a pillow between your knees (squeeze together when you turn over)
- Wearing supportive shoes (avoid high heels)
- Climbing the stairs one step at a time, instead of alternate steps as usual
- Getting dressed sitting down
- Spreading out strenuous physical activities across the week instead of “getting it all done” in one day
- Pelvic floor exercises
Over-the-counter painkillers can be taken, like paracetamol, if you haven’t previously been told to avoid them. Remember that, according to the NHS, anti-inflammatory painkillers, such as ibuprofen, are not recommended in pregnancy.
Recommended products to help with pelvic pain during pregnancy:
Pelvic pain treatments
- Pelvic support garments - maternity support belts have some of the strongest evidence of benefit for the relief of pelvic pain during pregnancy and can help with relieving pain in the lower back pain and pain in the pelvic girdle area, function and mobility improvements, and reducing the risk of falling during pregnancy.
- Massage - studies indicate massage is helpful for short-term, immediate relief of pelvic pain in pregnancy
- Manual therapy - a 'hands-on' approach, which involves a physiotherapist manipulating your joints to increase your mobility and range of movement. However, there is only low to moderate-quality evidence that manual therapy works to treat pelvic pain during pregnancy.
- Exercise - such as inner thigh stretches and other moves to improve mobility - although evidence from studies on the efficacy of exercise for treating pelvic pain in pregnancy is weak.
Myra Robson told us, “Treatments will depend on how far along in your pregnancy you are and how easy it is for you to access the treatment. For some women, the physical and emotional toll of attending treatment and returning home undoes any of the treatment effects.
"There’s not a lot of good quality evidence on many treatments because it’s not ethical to experiment during pregnancy. However, it’s important to realise your limitations and, where necessary, accept bed rest or the use of crutches. The stress of your day will often be reflected in your condition in the evening, so take it easy and pace yourself.”
Risk factors for pelvic pain in pregnancy
- If you have been pregnant before - studies show that 25 percent of women who have been pregnant before experience pelvic pain again
- History of pelvic pain (either in pregnancy or unrelated to pregnancy)
- Depression
- Strenuous, physical job
- Above-average BMI (over 25)
- If you are expecting more than one baby (twins, triplets, etc)
Though pelvic pain during pregnancy can affect anyone who is pregnant, some people are more prone to these risk factors than others.
Myra Robson told us, “As soon as you are experiencing pelvic pain in pregnancy, take it seriously. Early intervention is helpful and prevents future problems. If you find the pain is interfering with your everyday life, seek help from your midwife or your GP”.
Is it normal for your pelvis to hurt during pregnancy?
Some discomfort is, unfortunately, a part of pregnancy for many women, but pain that is severe enough to limit your activities is not normal. While we all have different pain thresholds, pelvic pain during pregnancy that is impacting your day-to-day life should be assessed.
Senior physiotherapist Myra Robson says, “You have to remember that when you’re pregnant, you’re growing a whole new human, so sometimes that will be uncomfortable. However, I would never describe pelvic pain in pregnancy as 'normal'. As soon as we normalise pain in pregnancy, we disempower mothers from seeking help and things can get worse.”
When should I be concerned about pelvic pain during pregnancy?
Though pelvic pain in pregnancy can be a source of stress, for the majority of women, it is mild and doesn’t impact them seriously. For a few women, however, pelvic pain during pregnancy can be very debilitating and have a great effect on their daily life.
Senior Physiotherapist Maya Robson says you should be concerned, “If pelvic pain in pregnancy is starting to impact on your everyday ability to function normally.”
She also told us women experiencing pelvic pain during pregnancy should, “Especially seek help if they are quite early in their pregnancy, so have quite a few weeks to go until birth. Or, if they have personal circumstances which would make temporary limited mobility extra challenging.”
Other issues that may accompany pelvic pain and need immediate medical assessment include:
- The sensation of “pins and needles”
- Any related numbness in your pelvis or legs
- Problems emptying your bladder
- Inability to feel you need to void your bladder or bowel
- If you cannot feel your vagina or anus because of numbness
These symptoms could be signs of rare issues with the nerves in your spine. If you experience them, seek immediate medical assistance by calling NHS 111.
Will pelvic pain during pregnancy affect labour and birth?
Though pelvic pain in pregnancy can be difficult, it should not impact your ability to labour and give birth vaginally. The Royal College of Obstetricians and Gynaecology (RCOG) advises that you put your pelvic pain in your birth plan to allow your team to support you during birth. They will advise you on specific positions that will be more comfortable and support your legs where necessary.
RCOG says there is no evidence that there is any benefit to having a caesarean specifically for those with pelvic pain during pregnancy. Though, of course, the decision to have a caesarean is your choice.
RCOG also suggests that water birth may be beneficial for those suffering from pelvic pain in pregnancy.
When should pelvic pain go away after birth?
Thankfully, once you give birth, pelvic pain goes away relatively quickly. Studies show that most women (around 83%) experience “substantial recovery from severe or moderate” pain within 6 weeks. The good news is that almost half of those women (44%) said they had felt “substantially” recovered within just 2 weeks.
Recovery took longer in women who had a history of (non-pregnancy related) pelvic pain before conception and those who had been pregnant several times before.
Myra Robson, Senior Physiotherapist, says “with our patients, we always say, once you give birth, if you have any pain at all in the six weeks after birth, we will see you. But we rarely see anyone come back because the pain is normally resolved so quickly once the baby is born. Some women do sometimes experience residual symptoms during breastfeeding, but most of the time there is a quick-relief after birth”
Myra Robson is a Senior Physiotherapist and Clinical Lead for the bladder, bowel & pelvic health team at Lewisham & Greenwich NHS Trust. Myra is also part of a collaborative campaign group for pelvic health issues, Pelvic Roar.
