Pelvic Pain in Pregnancy
Many pregnant women experience pelvic pain in the pubic area, often starting around the 12th week of pregnancy.
For some, this can also include pelvis instability. This pain is caused by the effects of the pregnancy hormones relaxin, oestrogen and progesterone which soften and relax the ligaments and joints of the body, allowing the pelvis to open slightly in preparation for labour and birth.
Firstly, rest assured that this is perfectly normal – however, some women experience more severe discomfort, this is known as Symphysis Pubis Dysfunction (SPD).
What is SPD?
The Symphysis Pubis are the two large bones that form a joint at the front of the pelvis. SPD is the condition that occurs when this joint is not working properly.
Diastasis Symphysis Pubis (DSP) is another, more serious, condition that occurs when these two bones separate and a large gap forms between them. The normal non-pregnant gap is 4-5mm, while in pregnancy this will increase to around 8-9mm. In the case of DSP the gap is abnormally large and can be upwards of 10-11mm wide.
Symptoms of SPD
The symptoms of SPD can vary from one woman to the next but usually include sharp pains and tenderness directly behind the pubic bone.
Some of the other symptoms include:
- A feeling of extreme pressure in the pubic area
- Pain in the hips and lower abdomen
- Shooting pains into the buttocks and down the thighs into the legs
- Pain on walking or performing other weight bearing exercise
- Pain climbing stairs or any movement that involves lifting one leg
- Sufferers may sometimes hear or feel a clicking sensation in the pelvis
- Severe pain on moving or turning over in bed
- Hip movement can become very difficult and some women find that their hips seem to stick when they get out of bed and it takes a few minutes before they can move.
- Slight incontinence on changing position.
What you can do
If you are suffering from pelvic pain you should avoid back exercises and any vigorous exercise, you should try to avoid walking up stairs where possible, standing on one leg, heavy lifting and sitting for prolonged periods.
The following tips can help to ease your discomfort:
- Listen to your body – avoid any activities that cause discomfort.
- Rest – take the weight of your body off your pelvis whenever possible.
- Take tiny steps to go up stairs one at a time, setting off with one leg than bringing the other up to meet the first before going up another step.
- Sit down whilst doing tasks you would normally stand for – for example, ironing or preparing food.
- Be ladylike! Avoid straddle movements and keep your legs together for getting in and out of the car or bed.
- Go swimming – many pools run aquanatal classes, but tell the instructor about your condition and avoid the breast-stroke.
- Bend your knees and keep your legs ‘glued’ together when turning in bed and when getting in or out of bed.
- Try a pelvic support – some women find maternity support belts helpful.
- Avoid twisting movements of the body, always face what you are doing.
What are the causes of SPD?
Though the exact causes of SPD are not known, there may be some increased risk if you have had a lot of children or have had large babies. If you have experienced pelvic or back pain in the past, or been involved in a car accident or other trauma that might have damaged the pelvic girdle, you may be more likely to develop pelvic pain.
It may be that in some women, either excessive levels of hormones or extra sensitivity to hormones causes the area to become overly relaxed, or pelvic misalignment puts extra pressure on the joint.
What are the implications?
Extra care should be taken during labour and birth in order to prevent trauma. While you shouldn’t automatically need a Caesarean, some association has been reported between SPD and the baby being breech or otherwise malpositioned, in which case there is a high intervention rate.
Make sure that your midwife and healthcare team know about your condition. Certain delivery positions put less pressure on your back. Discuss this in advance with your midwife and partner.
Treatment for SPD
Medical: your GP may prescribe painkillers or anti-inflammatories to relieve the pain.
Physiotherapy: an obstetric physiotherapist can treat you both antenatally and postnatally. You may be given crutches if movement is very difficult.
Chiropractic: Chiropractic care aims to realign the pelvis, the back, and all affected areas through the use of manual adjustments. Many women with pelvic pain anecdotally report the greatest improvement from chiropractic or osteopathic treatment.
Other Treatments: acupuncture, aromatherapy and massage may also help.
Can it be cured?
Pubic pain usually goes away after pregnancy, though not always immediately, in most women it has disappeared within three months. Some women find that it improves but doesn’t go away completely.
If you undergo treatment for your pelvic pain during pregnancy, some research has shown that you are less likely to have ongoing problems after the birth.
If the pain persists you can have an x-ray to see if the condition has developed into DSP which can be treated with surgery.