Pregnant with pain: coping with pelvic instability (‘pelvic girdle pain’)

Reports vary, but around 20–50% of women will experience some degree of pain or discomfort while pregnant due to pelvic instability. The condition, also commonly known as ‘pelvic girdle pain (PGP)’, reflects increased and/or uneven movement of the joints that make up the bony pelvis. This occurs in response to a combination of factors that arise due to the normal processes and bodily stresses of pregnancy.

But first, what is the pelvic girdle?

The pelvic girdle is a group of bones that form a bony ring at the base of your spine (see diagram below). There are two symmetrical hip bones, each consisting of three parts. These hip bones join at the front via the pubic joint (symphysis pubis) and at the back by the sacroiliac joints (sacrum).

During pregnancy, these joints and the soft structures supporting them (muscles, tendons and ligaments) are working overtime to support the weight of you and your growing baby. Add to this the numerous changes taking place in your body – such as the stretching of tummy muscles as your baby grows and an increase in the hormone relaxin to loosen the pelvic ligaments in preparation for labour – and suddenly, the soft tissues supporting your bony pelvis are either stretched too tight or more lax than usual.

Under these conditions, the joints of the pelvis are less well supported; they become unstable and begin to move unevenly. The degree of instability created will vary from one woman to the next and may be worse on one side than the other. This can lead to mild discomfort for some women but serious pain and reduced mobility for others. Pain seems to be particularly problematic for women with asymmetric instability – where one side of the pelvis is affected more than the other.

What you might feel

Women with pelvic instability will most commonly complain of pain in their lower back (over their sacroiliac joints) and in one or both hips, and/or pain at the front of their pelvis where their hip bones meet (over the pubic joint). This may also be accompanied by referred pain in the buttocks and/or down the back of the leg (sometimes confused with sciatica), as well as the groin and inner thigh. You may also hear or feel clicking, crunching or grinding in the pelvic area.

Depending on severity, the pain may vary from a mild, constant ache or feeling of stiffness through to a sharp, stabbing pain, particularly with movement. It’s common for women to experience pain (or worse pain) when climbing stairs or bearing weight on one leg, when turning over in bed, when getting in and out of a bath or car, and during straddling movements.

Symptoms can begin at any time but are usually first noticed late in the second trimester (from around 5 months on), with the severity of the pain typically increasing as the pregnancy progresses. While it is unusual for someone to be severely affected throughout their entire pregnancy, pelvic instability does tend to recur and start earlier during second and subsequent pregnancies.

Pelvic instability – it’s not normal

Unfortunately, pelvic instability and its associated pain may be dismissed by some healthcare professionals as a ‘normal’ part of pregnancy. This really isn’t the case – if you’re feeling discomfort such as that described, it’s important to let your obstetrician or GP know so we can advise on supportive measures. Studies have shown that pelvic instability can adversely affect a woman’s ability to perform daily activities, especially if there are other young children to care for and/or her job is physically demanding.

Managing the pain associated with pelvic instability

The pain you are experiencing can generally be controlled – i.e. relieved to a point where you can continue to function day-to-day, even if the pain is not entirely relieved – through a combination of physiotherapy, physical support, pain medication and modified activity.

Physiotherapy

It’s important to choose a physiotherapist who specialises in women’s health and can advise on:

• The kinds of physical activities you should avoid or modify
• Stretches to relieve overly tight muscles such as your gluts
• Exercises to improve your core stability so your abdominal muscles are better able to support your pelvis (clinical pilates can also help; just be sure to choose an instructor who is familiar with modifying programs for pregnant women, including those with pelvic instability)
• The need to wear a supportive belt or brace around your pelvis (this can be a particularly effective way to reduce pain while mobilising throughout the day but also while sleeping at night)
• The need for a mobility aid such as a walking stick or frame
• Physical supports you can use while sleeping, e.g. placing a pillow underneath your bump and another between your legs.

Modified activity

In terms of activity, where possible:

• Try not to sit or stand for long periods at a time
• Carry your weight equally across both legs (i.e. avoid leaning or standing on one leg)
• Avoid heavy lifting, including other children (although this can be difficult)
• Wear flat shoes, even for work
• Make a point of keeping your knees together when getting in and out of the bed or car, or when turning over in bed (sudden ‘legs apart’ movement is a common precipitant of pain in affected women)
• Avoid/limit movements or positions that stretch the pelvis, such as:
  • Sitting cross-legged
  • Climbing stairs
  • Vigorous walking
  • Changing direction suddenly
  • Breast stroke (if swimming).

Pain medication

Paracetamol is okay to use during pregnancy but stay clear of anti-inflammatories (like ibuprofen or diclofenac) unless your obstetrician or GP has advised otherwise. Occasionally, we may be required to prescribe stronger pain relief.

Other measures

Warm baths, heat/ice packs, regular massages to relieve tight muscles and acupuncture may also provide some relief. Putting some Epsom or magnesium salts in your bath water can also help to relieve restless legs (which often accompanies pelvic instability). If possible, seek help or alternative solutions for household chores, e.g. order groceries online and have them delivered, hire a cleaner temporarily.

It’s also important to recognise that pain can trigger feelings of sadness, anger, frustration, isolation and anxiety. Let your obstetrician or GP know if you are experiencing any of these symptoms so together we can provide you with the appropriate support and ensure that you are making the most of the relief measures described above.

What about delivery?

PGP is harmless to your baby and does not impact on your planned type of delivery. Sometimes symptoms can be severe enough to bring forward your delivery to 38–39 weeks. If you suffer from PGP, we will specifically tailor the physical support we provide during labour and help you find birthing position(s) that don’t exacerbate your pain, e.g. where possible, we will avoid prolonged legs apart positions.

When will the pain go away?

Not only is a huge weight suddenly removed after birth (!) but relaxin levels gradually decrease. For most women, the pain they have been experiencing usually stops within a few weeks of delivery. Some women even report immediate relief following birth. For best recovery, your postnatal routine should include a strengthening program for your abdominal and pelvic floor muscles – ask your physiotherapist to provide you with a suitable plan. This will also help ensure that these muscles are strong and well able to support your pelvis should you become pregnant again. While a very small number of women may take a while longer to recover after their baby is born, it’s important to know that the vast majority of women make a reasonably quick and complete recovery — until the next one that is!

Don’t suffer from pelvic pain

There are ways to manage pelvic instability to minimise pain or discomfort. If you need support to cope with pelvic instability during pregnancy, call my rooms on (03) 9418 8299 or book online to arrange an appointment.