Pelvic girdle pain (PGP) (2024)

Pelvic pain in pregnancy is caused by stiffness or uneven movement of the pelvic joints (NHS 2019). It’s known as pelvic girdle pain (PGP) or symphysis pubis dysfunction (SPD). Symptoms of PGP include pain in your lower back and in the front and back of your pelvis (POGP 2015, 2018). PGP can also cause pain in your vagin*l area during pregnancy. It’s best to get help early on if you start to feel pain as it can get worse (POGP 2018, RCOG 2015). Read on for tips on how to treat PGP.

What is pelvic girdle pain (PGP)?

• The joints that connect your spine to the two halves of your pelvis at the back. A triangular bone (sacrum) sits at the base of your spine, between your hip bones. Either side are the sacroiliac joints.
• The joint that connects the two halves of your pelvis at the front. This is called the symphysis pubis joint. The term symphysis pubis dysfunction (SPD) is used to describe pain resulting from problems with this joint (POGP 2018, RCOG 2015).

PGP won't harm your baby at all, but it can be very painful for you, and make getting around difficult (NHS 2019, RCOG 2015).

What are the causes of PGP?

However, having lax ligaments doesn't always lead to PGP (Aldabe et al 2012, Verstraete et al 2013, Vøllestad et al 2012). Your nerves and muscles adapt and compensate for the greater flexibility in your joints, allowing your body to cope well with changes in your posture (Verstraete et al 2013, Vleeming et al 2008).

That's why PGP, though common during pregnancy, is not normal, and is not something you should just put up with (POGP 2015, 2018).

Normally, when you lie down, stand up or walk, your pelvis is in a stable, level position.

If you have pelvic pain, the joints may be moving in an unstable way. One pelvic joint may not work properly and cause knock-on pain to the other joints. Or your muscles may not be working well to support your pelvis (POGP 2015).

You may be more prone to PGP if:

• You usually get a bad lower back.
• You've hurt your pelvis in the past.
• You've had PGP in a previous pregnancy.
• You have a physically demanding job (NHS 2019, POGP 2018).

Get help early on if you start to feel pain, because it can get worse (POGP 2018, RCOG 2015). About one pregnant woman in 12 has serious PGP. Among women with serious PGP, about one in 20 will develop severe pain and disability (POGP 2015).

What are the symptoms of PGP?

You may feel pain:

• In your lower back.
• At the front of your pelvis (symphysis pubis joint).
• At the back of your pelvis (sacroiliac joints).
• In your groin.
• At the front and the back of your thigh.
• At the back of your lower leg.
• Around your hips.
• In your pelvic floor, and in the area between your vagin* and your anus (your perineum) (POGP 2015, 2018).

If the pain comes on at the end of your pregnancy, it may be because your baby’s head is engaging, or moving down into your pelvis. You may even feel pelvic pain for the first time after giving birth (POGP 2015, Verstraete et al 2013).

PGP symptoms range from irritating to really painful and upsetting, affecting your quality of life. Daily activities such as getting dressed, walking, climbing stairs, and moving around in bed may hurt. Having sex can be painful, depending on the positions you choose (POGP 2018, RCOG 2015). If you're already a mum, picking up and carrying your toddler may make PGP flare up (NHS 2019, POGP 2018).

How is PGP diagnosed?

How is PGP treated?

Physiotherapy

• Your physiotherapist can show you how to protect your back and pelvis during regular movements that are usually painful, such as walking or standing up (POGP 2015, 2018).
• Your physiotherapist may give you a pelvic support belt (POGP 2015, 2018). A belt can give relief from pain, particularly when you're active (Bertuit et al 2018).
• Exercises, especially for your tummy, pelvic girdle, hip and pelvic floor muscles, aim to improve the stability of your pelvis and back (Davenport et al 2019, POGP 2015, 2018). Gym-type exercises in water can be helpful (POGP 2015, 2018).
• Your physiotherapist can gently manipulate your hip, back or pelvis to loosen stiff areas (POGP 2015, 2018).

Medication

You could try regular pain relief, such as paracetamol (RCOG 2015). Bear in mind that there’s not a lot of evidence to suggest that paracetamol on its own is an effective painkiller for conditions such as low back pain (Moore et al 2015, Saragiotto et al 2016).

Speak to your GP for advice on how much to paracetamol take, and for how long (POGP 2018, RCOG 2015). Your GP may suggest combinations of pain-relieving medication or using stronger medications at certain times (POGP 2015).

It's important to take care of yourself when you're suffering with PGP. Try not to feel guilty if you need to take painkillers to give you some relief. If you're always in pain, you can end up feeling as if you can't go out, or do anything that you used to do (MacKenzie et al 2017, POGP 2018).

Do tell your medical team if PGP is making you feel lonely, or depressed (MacKenzie et al 2017, POGP 2018). As well as giving you physical help, your medical team are there to support you emotionally.

Alternative therapies

Acupuncture may help to reduce the pain and is safe in pregnancy (Liddle and Pennick 2015, POGP 2015, 2018). But make sure your practitioner is trained and experienced in treating pregnant women. Using a TENS machine is also safe, and may help (POGP 2018).

What can I do to help myself?

• Be as active as you can, but don't push yourself so that you feel pain. If something hurts, stop doing it. If the pain is allowed to flare up, it can take a long time to settle down again (POGP 2015, 2018, RCOG 2015).
• Stick to the pelvic floor and tummy exercises that your physiotherapist has given you (POGP 2015, 2018).
• Ask for and accept offers of help with chores. Vacuuming and lifting heavy shopping can make PGP flare up (POGP 2015, 2018).
• Plan ahead so that you reduce the activities that cause you problems. You could use a rucksack to carry things around, both indoors and out (POGP 2018). This keeps your frame symmetrical as you move about (POGP 2015, 2018).
• Take care to part your legs no further than your pain-free range, particularly when getting in and out of the car, bed, or bath (POGP 2018, RCOG 2015).
• If you can, try to "turn under" on your hands and knees when turning in bed. Or turn over with your knees together and your buttocks squeezed (POGP 2018, RCOG 2015).
• If you are lying down, roll onto your side, squeeze your knees together, swing your legs off the bed and push yourself up to sitting (POGP 2018).
• Keep your knees together when getting in and out of the car (Pelvic Partnership 2016, POGP 2018). A swivel cushion or a plastic bag under your bottom can help you swing your legs around together (Pelvic Partnership 2016). Pull out the plastic bag before driving, though, in case you slip on it when braking.
• Avoid activities that make your pain worse or that put your pelvis in an uneven position, such as sitting cross-legged or carrying your toddler on your hip (POGP 2015, 2018).
• Try to sleep on your side with legs bent and a pillow between your knees (POGP 2015, 2018, RCOG 2015). This position is also best for your baby – by the third trimester, sleeping on your side reduces the risk of stillbirth compared to sleeping on your back (Gordon et al 2015, Heazell et al 2017, 2018, McCowan et al 2017, Stacey et al 2011).
• Rest regularly or sit down for activities you would normally do standing, such as ironing (POGP 2015). If you have SPD, you could sit, leaning forwards slightly, on a birth ball to take the pressure off the symphysis pubis joint (Pelvic Partnership 2017).
• When you can, get down on your hands and knees to take the weight of your baby off your pelvis (Pelvic Partnership 2017).
• Try not to do heavy lifting or pushing. Pushing supermarket trolleys can often make your pain worse (POGP 2015), so shop online or ask someone to shop for you.
• Try not to go up and down stairs too often (RCOG 2015). When you have to climb the stairs, take one step at a time. Step up onto one step with your best leg and then bring your other leg to meet it. Repeat with each step (POGP 2015).
• Avoid standing on one leg (RCOG 2015). Get dressed slowly and carefully, sitting down to pull on knickers or trousers (POGP 2015, 2018, RCOG 2015).

How does PGP affect labour and birth?

How soon will PGP go away after birth?

If your pain does persist, you can help yourself to recover by carrying on with the exercises your physiotherapist gave you during pregnancy (POGP 2015, 2018). Pilates or yoga are also great for building the type of core strength that keeps pelvic pain at bay (Kawanishi et al 2015, Mazzarino et al 2015, Oktaviani 2018).

You could consider giving yourself a bit of time from one pregnancy to the next. Losing excess weight, getting fit and waiting until your children can walk may help to reduce the symptoms of PGP next time (POGP 2015, 2018).

Where can I find support?

• Learn how to exercise your pelvic floor.
• Check out our article on coping with back pain in pregnancy.

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