Pelvic Girdle Pain (PGP)

Pelvic Girdle Pain (PGP) – previously know as Symphysis Pubis Dysfunction (SPD) – is a term used to describe pain experienced in the front, back and side of your pelvis.

This page will help you understand more about it, how you can adapt your lifestyle, and how you can look after yourself during the labour process.

What is Pelvic Girdle Pain (PGO)?

The pelvic girdle is a ring of bones around your body at the base of your spine. PGP
is pain in the front and/ or the back of your pelvis that can also affect other areas
such as the hips or thighs. It can affect the sacroiliac joints at the back and/ or the
symphysis pubis joint at the front.

This pain happens for approximately 20% of pregnant women and can happen at any stage of pregnancy. It can also continue or develop for a small number of women after having a baby.

More common in pregnancy is low back pain (pain in the lower back and/ or back of the pelvis), which happens to 50% of pregnant women.

Symptoms

PGP can be mild to severe but is treatable at any stage in pregnancy and the sooner
it is treated, the more likely you are to feel better. It is more common later in
pregnancy.

Symptoms include pain in the pubic region, lower back, hips, groin, thighs or knees, or clicking or grinding in the pelvic area

The pain may be made worse by movement, for example:

• Walking on uneven surfaces/rough ground or for long distances
• Moving your knees apart, like getting in and out of a car
• Standing on one leg, like climbing the stairs, dressing, or getting in or out of the bath
• Rolling over in bed
• Sexual intercourse

With PGP these symptoms may be varied and uncomfortable. They may affect your
ability to function in your day to day activities. There is a wide range of symptoms and they vary from woman to woman. However, if you get the right advice during
your pregnancy, it usually can be managed well, and in some cases the symptoms will
go completely. However, in a small percentage of women PGP may persist longer
after birth, particularly if left untreated.

What causes it?

The three joints in the pelvis work together and normally move slightly. PGP is
usually caused by the joints moving unevenly, which can lead to the pelvic girdle
becoming less stable and therefore painful. As your baby grows in the womb, the
extra weight and the change in the way you sit or stand will put more strain on your
pelvis. You are more likely to have PGP if you have had a back problem or have
injured your pelvis in the past or have hypermobility syndrome, a condition in which
your joints stretch more than normal.

Initial management

The following simple measures may help:

• Pace yourself. Try not to get all of your daily jobs done in one go. Break up the activities and have a rest in between. Similarly, try to take regular breaks at work and change the position that you are in
• Stand tall with your bump and your bottom tucked in a little
• Change your position frequently – try not to sit for more than 30 minutes at a time
• Sit to get dressed and undressed
• Put equal weight on each leg when you stand
• If you’re struggling with walking, make sure that you are wearing supportive footwear. Try to slow down your walking speed and don’t walk so far
• Place a pillow between your knees for sleeping
• Try to keep your knees together and turn slowly in bed. Do the same when getting in and out of the car
• Lie on the less painful side while sleeping

You should also avoid anything that may make your symptoms worse, such as:

• Lifting anything heavy, for example heavy shopping
• Going up and down the stairs too often
• Stooping, bending, or twisting to lift or carry a toddler or baby on one hip
• Sitting on the floor, sitting twisting, or sitting or standing for long periods
• Standing on one leg, or crossing your legs
• Try not to push through activities that make your pain worse
• Try not sit with your legs crossed or underneath you. Placing a cushion behind your back may help and, if you’re breastfeeding, using a feeding pillow can be more comfortable.

Further management

A referral to a physiotherapist may be necessary; you can discuss this with your
midwife or doctor.
Your physiotherapist will suggest the right treatment for you. However being in
severe pain and not being able to move around easily can be extremely distressing.
Ask for help and support during your pregnancy and after the birth. Talk to your
midwife and doctor if you feel you are struggling.

If you continue to have severe pain or limited mobility, it is worth considering:

• Regular pain relief. Paracetamol is safe in pregnancy and may help if taken in regular doses. If you need stronger pain relief, your doctor will discuss this with you.
• Supportive aids such as crutches or a wheelchair for you to use on a short-term basis. Your physiotherapist will be able to advise you about this. Equipment such as bath boards, shower chairs, bed levers and raised toilet seats may be available.
• Changes to your lifestyle such as getting help with regular household jobs or doing the shopping.
• If you work, talking to your employer about ways to help manage your pain. You shouldn’t be sitting for too long or lifting heavy weights. You may want to consider shortening your hours or stopping work earlier than you had planned if your symptoms are severe

Labour and birth

Even if you have PGP you can have a normal vaginal birth. Some women worry that the pain will be worse during labour, but this is not the case when care is taken to protect the pelvic joints from further trauma.
Tips include:

• Use gravity to help the baby move downwards by staying as upright as possible. Standing, kneeling, or being on all fours can help the labour process and avoid further strain on the pelvis
• Try to avoid lying on your back or sitting propped up on the bed, because these positions reduce the pelvic opening and may slow labour
• The squatting position and birthing stool maybe an uncomfortable position for labour
• If it is a possibility for you, you may find a birthing pool helps to take the weight off your joints and allows you to move more easily

Please note

It is important as you reach term to record how far apart your knees
can separate when lying on your back (your pain free range).

The distance should be recorded in your birth plan so that during the birth care is taken not to move your legs further apart than this

Postnatal

Your pelvic joints will take three to six months to return to their original state. You can easily strain your back during this time, so avoid heavy lifting.

If you do have to lift:

• Bend your knees if the weight is at low level
• Gently draw in your abdomen (use your deep tummy muscles)
• Tighten your pelvic floor muscles
• Breathe out as you lift

Try to avoid any high impact sport for a few months, as well as any activities which you find brings on your pelvic or back pain. Try and avoid any situations where you may be more likely to slip, trip, or fall, as this may also worsen the pain.

Looking after your baby

The following tips will help you to look after yourself while caring for your baby.

• When breastfeeding, ensure that you’re in a comfortable position, with your lower back well supported and good circulation to your lower legs
• Change nappies on a flat surface at waist height
• Do not lift your baby often
• Carry your baby in front of you and not on one hip
• Kneel at the side of the bath rather than leaning over it
• Lower the cot when lifting your baby in or out
• Keep your baby close to you when moving them in or out of their car seat
• Don’t lift them in and out of shopping trollies

Will it happen again in my next pregnancy?

If you have had PGP, you’re more likely to have it again in a future pregnancy. Making sure you’re as fit and healthy as possible before getting pregnant can help reduce the risk or event prevent it recurring. Strengthening your abdominal and pelvic floor muscles also reduces the risk. If you do get it again, flag this as soon as you can, as treating it early should help to control or relieve your symptoms.