Pelvic pain (SPD) in pregnancy

Medically reviewed by Dr Deborah Lee, Dr Fox Online Pharmacy

Pregnancy can be a pretty painful and uncomfortable experience at times. Whether you've got puffed-up ankles like the Michelin man, backache, tender breasts and well, MORE backache from being hunched over the toilet with morning sickness, there are times when you just think, 'Give me a break!'

On top of all that, some women find that their pelvic region - anything from their groin to their hips and even their bum starts to hurt in the later stages of pregnancy (oh, the joy).

If you're expecting and are finding that your general baby-making area is hurting, then we fill you in on everything you need to know about SPD during pregnancy and what you can do about it.

What is it?

According to Dr. Deborah Lee: "Pregnant women may experience pain or discomfort in the pelvic region during pregnancy. This is called symphysis pubis discomfort (SPD) or pelvic girdle pain (PGD).

Research studies have shown SPD affects between 1 in 300  - 1 in 20,000 pregnant women. However,  it is frequently under-reported and is probably far more common than is realised.

Around 70_%_ of pregnant women have some form of pelvic discomfort, and in 20%, this is described as severe.

The symptoms of SPD arise from the anatomy of the pelvis and the natural changes that occur as  a pregnancy advances.

The female pelvis is a hollow, basin-shaped structure made up of several bones, held together with ligaments. The pelvic muscles form a sling across the inside of the pelvic bones. These support the pregnant uterus which  is suspended inside it. The left and right side of the pelvis are held together at the front in a central joint called the symphysis pubis (SP), says Dr. Lee.

The ligamentous attachments of the pelvic bones are necessary as they soften in pregnancy, allowing the pelvis to expand with the growing pregnancy and to widen to allow for childbirth.

Symptoms

Women may complain of pain/discomfort in the region of the SP. The pain may radiate out on either side, into the groin, the inner aspect of the thighs, and/or to the lower back over the sacroiliac joints. The pelvis may feel loose, wobbly and unstable. Occasionally they may hear a grinding or clicking sound. Sometimes, there may be shooting pains in the thigh or groin.  In some women the pain is mild, but in others, it can be severe and debilitating, says Dr. Lee.

A woman may find specific movements bring it on, such as standing from sitting, getting in and out of the car or turning over in bed. It can make walking difficult, and she may walk with a waddling gait. Women may find it harder to pass urine or open their bowels. It can restrict her ability to exercise. Sometimes SDP can contribute to painful sex.

Although SPD is unpleasant it does not harm the baby. Most women with SPD can still anticipate a vaginal delivery.

Signs

There may be specific tenderness over the symphysis pubis (SP) to gentle pressure by light palpation.

Occasionally there may be localised oedema (swelling) at this point.

There may be a palpable widening at the SP joint.

The woman may walk with a duck-like waddle.

Tests

The sufferer may be referred to a specialist physiotherapist. An ultrasound examination of the SP can help make the diagnosis. X-rays, CT and MRI scans are usually avoided in pregnancy wherever possible as they may pose a risk to the fetus.

Why does it happen?

During pregnancy, the female body makes a hormone called relaxin which softens ligaments to assist the body in the changes of pregnancy. Symptoms of SPD may occur in the first trimester but can occur at any time, even in the postpartum period. In one Norwegian study, women continued to experience SPD for an average of 6.5 years after delivery, says Dr. Lee.

Risk factors include  -

How to manage it

General advice

Keep active as much as possible. Avoid sitting in the same position for any more than 30 minutes. Don’t cross your legs.

Wear flat, supportive shoes with cushioned soles.

Maintain good posture at all times. Make sure when you stand you distribute your weight evenly on each foot. This means standing with your shoulder back and your bottom tucked in.

Sit down to get dressed and undressed, to avoid standing on one foot.

Don’t carry heavy objects unless absolutely necessary.

Avoid twisting, lunging and squatting.

Sleep on your side with a pillow between your knees. This helps stop twisting the spine.

Use an ice pack or a heat pack on the sacroiliac area.

Treatments

A referral may be made to a specialist maternity physiotherapist. They will advise on exercise to improve pelvic muscle function and help stabilise the pelvic girdle.

The physiotherapist may advise the use of a pelvic support belt or crutches for walking if needed, says Dr. Lee.

Other treatments include

The use of ice packs or hot packs, massage, and hydrotherapy. Immersion in warm water/swimming can be very helpful as the water takes the weight off the pelvis, while the muscular action of swimming stretches the muscles and improves the circulation.

Acupuncture may be useful. In one small single-blind, randomised study, acupuncture was superior to stabilising exercises for pregnant women with SPD.

A chiropractor may also be able to treat SPD. Research supports this can be effective.

Ask your GP about pain relief. Paracetamol is safe to take in pregnancy. The recommended dose is 2 x 500 mg tablets, at 4 hourly intervals, making sure that no more than 8 x 500 mg tablets are taken in any 24 hours. Non-steroidal anti-inflammatories (NSAIDs) are generally not advised in pregnancy, says Dr. Lee.

After delivery, if symptoms persist, occasionally a steroid injection may be given into the symphysis pubis.

When to see the doctor

It’s never too early to tell your GP, midwife or Obstetrician you are suffering from SPD. As with most symptoms, the sooner you take note of the symptoms and taker steps to control them, the better the likely outcome", says Dr. Lee.

What happens?

The condition is caused by the joints moving unevenly, meaning the pelvic girdle (the ring of bones around your body at the base of your spine), can become less stable. As your baby grows week-by-week, the weight gain and the change in your posture will put more strain on your pelvis, making this pain more noticeable. You are also more likely to suffer from SPD in pregnancy if you have previously suffered from back problems, have had a previous pelvic injury or if you have hypermobility syndrome.

"As well as this, when we get closer to our due date, our relaxin hormone increases, which soften the ligaments in the joints of our pelvis," Beth says. "This is great for birth as it means that our pelvis can move and widen to accommodate your baby travelling through. But, in pregnancy this softening of the ligaments can cause our pelvis to shift unevenly, and not be as well supported, causing the pain."

When should I seek help?

The sooner the better, Beth advises. "If you feel like the pain is affecting your day to day living then self refer to a physio for some help. The quicker it’s picked up the better it can be managed."

"SPD in pregnancy doesn’t always get worse in pregnancy but it doesn’t get better and is unlikely to go away until after your baby is born so get help from a physio," Beth adds.

As well as seeing a physio, seeing your GP is also a good idea if you need some medication for the pain. Remember ibuprofen isn’t recommended in pregnancy.

What treatment is available?

Whilst you wait to see a physio there are some things that you can do at home to help. The main thing is to keep your legs close together when you do day to day activities. For example, when you climb the stairs, take one step then meet your feet together before taking the next step, when you get out the car turn your legs out of the car together before you stand (sitting on a plastic bag can help with this) and when you get dressed avoid standing on one leg to put trousers on and sit down instead.

Your physio will most likely give you some exercises to do at home, potentially with an exercise ball and some manual therapy checking that your spine, pelvis and hips are moving normally. They may also recommend walking aids such as crutches or a TENS machine to manage the pain.

You could also see another professional that specialises in the treatment of PGP such as a chiropractor or osteopath.

Find your 'pain-free range of movement'

If you do have pain when you move your knees and legs then it is important you find out your 'pain-free range of movement'.

The NHS explains how to do this:

• Lie on your back or sit on the edge of a chair and open your legs as far as you can without pain.

• Your partner or midwife can measure the distance between your knees with a tape measure. This is your pain-free range.

• To protect your joints, try not to open your legs wider than this during labour and birth.

Finding this range is important for labour and birth. If you have an epidural as pain relief you will no longer feel pain so you need to make sure you are not separating your legs too far. Lying on your side may limit the separation of your legs and it is perfectly safe to give birth in this position if it is comfortable for you. If you do go beyond your pain-free range, you will need to be assessed after your birth.

How does SPD affect labour and birth?

More often than not, pelvic pain does not prevent mothers from having a vaginal birth and does not necessarily mean they will have to have a caesarean. If you have been diagnosed with SPD, note it down in your birth preference, so that your midwives and those supporting you through your labour are aware of the condition and can treat you accordingly.

"The majority of women who have SPD are able to labour without their SPD causing too much bother," Beth reassures. "For those who have severe SPD, you may find that there are certain positions that won’t be comfortable for you such as squatting or on a birth stool. It may be that you want to avoid certain positions or have an active labour because standing and walking are too painful for you."

Many women are worried about labour contractions intensifying their SPD but often women find that this isn’t any worse in labour.

A water birth may also be beneficial for SPD sufferers. The birthing pool may help to ease the pain and support the weight of your body. Discuss this with your midwife as it is important you can get in and out of the pool easily.

How long does it take for SPD to go away after birth?

For the majority of women SPD goes away pretty much straight away after birth. For some women it can take a little longer than this. If you’re still experiencing discomfort a few weeks after baby then refer to your GP and/or physiotherapist.

Meet the expert

Dr. Deborah Lee worked for many years in the NHS, mostly as Lead Clinician within an integrated Community Sexual Health Service, Dr Deborah Lee now works as a health and medical writer, with an emphasis on women's health, including medical content for Dr Fox pharmacy. She has published several books and remains passionate about all aspects of medicine and sexual health. After completing her Medical Degree at University of Southampton Medical School in 1986, Dr Lee trained as a GP and after a number of years specialised in Sexual & Reproductive Health (S&RH).

About the author

Emily Gilbert  is the Features & Reviews Editor for Mother&Baby and has written for the website and previously the magazine for six years. Specialising in product reviews, Emily is the first to know about all the exciting new releases in the parenting industry