An Expert Guide to Pelvic Pain During Pregnancy

With all of the changes that happen to your body during pregnancy, things are bound to get uncomfortable, especially in your third trimester. As your baby bump gets bigger (and bigger, and even bigger), it’s nearly guaranteed that you'll struggle to get up the stairs, tie your shoes, or extract yourself from a deep-seated sofa. But while discomfort may be par for the course, one thing that's never normal is pain.

Unfortunately, aches and pains are so common during pregnancy that when pelvic pain pops up, primary care providers are apt to treat it like no big deal — which leaves pregnant patients with little to do but suffer in silence. At Origin, we are completely and passionately against suffering in silence during your pregnancy and want to give you all the details you need to relieve pelvic pain.

Before we dive in, two important and uplifting things to know about pelvic pain during pregnancy:

1. Although the pain can feel distressing, most types of pregnancy-related pelvic girdle pain are not dangerous for the pregnant person or their baby. That said, pelvic pain can lead to a significant amount of disability, and may even increase your risk of having lingering and prolonged pain that lasts for years postpartum.
2. Pelvic pain in pregnancy (or postpartum) can be effectively treated with pelvic floor physical therapy.

Keep reading to learn why pelvic pain occurs in pregnancy and what you can do if it's happening to you.

What types of pelvic pain typically occur in pregnancy?

Pelvic pain, also known as pelvic girdle or PGP, is pain in the low back or pelvic area, specifically between the top of your pelvis (at the iliac crests) and the bottom of your buttocks. Pelvic pain during pregnancy most commonly affects the sacroiliac joints (the joints at the back of your pelvis) but can also affect your pubic symphysis and any of the muscles, ligaments, or nerves in the pelvis.

Depending on your symptoms, this pregnancy-related pelvic pain can be further classified as:

• Sacroiliac joint dysfunction (SIJD), which describes pain or dysfunction in one or both of the sacroiliac joints at the back of the pelvis.
• Symphysis pubis dysfunction, (SPD) which describes pain or dysfunction in the pubic symphysis joint.

Pregnancy-related pelvic pain is seen in up to 70% of people who are pregnant. Pelvic pain can develop at any point during pregnancy, but it is most commonly seen between weeks 14 and 30.

What does pelvic pain during pregnancy feel like?

Typically, the symptoms of pregnancy-related PGP can vary from person to person, but depending on the specific joints involved there are some common symptoms to note.

People with pregnancy-related PGP often report:

• Pain in the low back/pelvic area. This is typically felt somewhere between the iliac crest (the highest point of your pelvis), and your gluteal folds (the bottom of your buttocks where your glutes meet your thighs) — and can feel like a stabbing, aching, dull, shooting, or burning pain.
• Pain that radiates. Depending on the joints involved, your pain may wrap around your hips to the front of your pelvis, run down the back or inside of your leg(s), and may even spread into your vulva.
• Decreased tolerance for specific activities. For example, standing, walking, or sitting in one position for too long may aggravate your symptoms. You may feel like you have to shift activities or positions often to avoid pelvic pain. Activities that place uneven pain on your pelvis, like climbing stairs, getting in and out of your car or bed, or carrying heavy bags on one side of your body, can also increase your symptoms.
• Developing a classic pregnancy waddle. You may feel like you're limping or walking differently to avoid pain, or you may feel a clicking or popping in your joints.

How intense your pain feels can vary from pregnant person to pregnant person, ranging from mildly annoying to significantly debilitating. Research has shown that mote intense pain is more likely in those who:

• Developed PGP in their first trimester
• Have more involved symptoms (multiple joints or areas in the pelvis are painful)
• Have low back pain in addition to their pelvic pain symptoms

What causes pelvic pain during pregnancy?

While it can be the result of a specific injury — an unexpected step off of a curb for example, or a traumatic injury to your pelvis — pregnancy-related PGP will often occur “out of the blue.” A variety of factors related to the changes of pregnancy can impact the stability and function of your pelvis, increasing the chances that pain will develop.

For example, some research indicates that the pregnancy hormone relaxin, which allows for softening of connective tissues throughout your body to help accommodate body changes during pregnancy, plays a role in pelvic pain. As the ligaments that help to stabilize the joints in the pelvis soften, the pelvic ring can become less stable. With less stability in the pelvis, there can be increased movement in the joints, altered joint mechanics, and more reliance on the musculoskeletal system to help “pick up the slack.” Additionally, changes in your weight, shifts in your posture, and altered body mechanics are likely to overwork and strain the pelvis during pregnancy.

Studies show that you're more at risk for developing panic pain in pregnancy if your personal history includes any of the following:

• Pregnancy-related PGP
• Prior pregnancies
• Injuries or issues with your joints or bones (aka orthopedic issues)
• Increased BMI
• Smoking
• Work dissatisfaction
• Lack of belief of improvement in the prognosis of PGP

Could my pain be anything other than PGP?

It’s important to take any pain that you experience during pregnancy seriously. Although it’s frustratingly common for pain to be downplayed during pregnancy, pain is never normal and symptoms should always be discussed with your OB or other obstetric health care provider.

For any new, and unexamined symptoms — particularly if your pain is severe, does not improve with rest, or was associated with trauma/injury — the first step is to check in with your OB or other obstetric health care provider. They will help to rule out any medical causes of your pain and help you find the appropriate treatment to support you throughout the rest of your pregnancy.

How is pelvic pain during pregnancy diagnosed?

Pelvic pain during pregnancy is most often diagnosed with a physical exam. After reviewing your health and social history and ruling out any possible medical or pregnancy-related conditions that could be causing your pain, your healthcare provider will perform a physical examination to find the specific causes of your pain.

A pelvic pain evaluation may include an assessment of:

• Your posture, and body mechanics during the specific activities that cause your symptoms
• The joints in your low back, hips, and pelvis
• Strength and muscle performance testing
• The irritability of the surrounding muscles, nerves, and ligaments
• Your balance and endurance

Proper diagnosis of pelvic pain in pregnancy is important in order to get the appropriate treatment. While pelvic pain during pregnancy may go away on its own without any treatment, it may also persist or worsen if not properly treated, which can increase your risk for developing chronic pelvic pain, and/or pelvic pain in any future pregnancies.

What are the best treatment options for pelvic pain during pregnancy?

During pregnancy, one of the safest and most effective treatments for pelvic pain that isn't caused by an underlying condition is pelvic floor physical therapy. There are many evidence-based treatment techniques that a physical therapist who specializes in obstetrics can take to help improve your musculoskeletal function, increase the stability in your spine and pelvis, and minimize your pain.

Recently, the Academy of Pelvic Health Physical Therapy, in conjunction with the American Physical Therapy Association published some Clinical Practice Guidelines for the treatment of pelvic pain in pregnancy, and here is what is recommended:

• Exercise: The American College of Obstetrics and Gynecologists (ACOG) recommends exercise during pregnancy for its many health benefits for the pregnant parent and their baby. Exercuse can also be used to help manage pelvic pain in pregnancy. Using individualized exercises that encourage safe movement, and improve the musculoskeletal function in those who have pelvic pain, physical therapist-led exercise should be part of a comprehensive plan of care.
• Manual therapy: Your physical therapist can use a variety of manual therapy techniques to help address pelvic pain during pregnancy. This may include manual techniques to improve joint alignment or address myofascial pain.
• Support Belts: Pelvic support belts can be worn around your pelvis to help provide additional stability to your joints when you have pelvic pain. A pelvic physical therapist can help you find the most appropriate pelvic belt for your symptoms, and work with you to properly fit and find the best wear schedule for your symptoms and daily activities.

A physical therapist who specializes in obstetric health will also be extremely important in lowering your risk factors for developing significant pelvic pain during pregnancy. By providing evidence-based treatment as soon as your pain develops, providing education about your symptoms, and teaching you how to move safely and without fear, throughout your pregnancy. They can even help you prepare for birth by teaching you the laboring and birthing positions and techniques to best protect your pelvis during delivery.

3 At-home tips for managing pelvic pain

Again, for any new pain that you encounter during your pregnancy, it is best to run your symptoms by your OB, especially when your pain is severe, does not improve with rest, or is associated with trauma/injury. Once any medical or pregnancy-related causes of pelvic pain have been ruled out, physical therapy is the next best step for getting your pain under control.

As research shows, pelvic pain is likely to become more intense and persist in the postpartum period if left untreated, it is best to see a physical therapist as soon as you notice pelvic pain. The obstetrically trained physical therapists at Origin are highly qualified and able to address your concerns whether in person at one of our beautiful clinics, or in the comfort of your own home thanks to our popular virtual care.

In the meantime, here are some things you can do on your own at home:

1. Apply ice or heat.

Ice is often recommended to manage pain after an injury, but for stubborn pelvic pain, either heat or ice can ease your symptoms. Choose whichever calms your symptoms better. During pregnancy, avoid placing ice or heat directly on your abdomen or allowing your body heat to rise too high. Instead, place an ice or heat pack over your low back (plus several layers of clothing/towels to protect your skin).

To prevent added irritation, ice for no more than 10 minutes and limit your heat time to 5-7 minutes.

2. Avoid staying in one position too long.

Try and switch up your body position every 15 to 30 minutes to minimize strain that can cause pain to flare.

3. Support your pregnant body with plenty of pillows.

It's commonly recommended to sleep on your left side during pregnancy, but this can also aggravate pelvic pain. Try these supportive sleeping adjustments:

• Pick a pillow to support your head in line with your spine, not tilted up or down. This may need to be a bit thicker than usual if you usually sleep on your back.
• Next, grab a pillow to hug to your chest, which will help support your top arm.
• As you lie on your side, place a pillow or two between your knees so that it supports your top leg from your pubic bone down to your ankles. Ideally, your top leg (including your knee and ankle) should be in line and level with your top hip.
• Place a small pillow under your waist to support your spine and keep it from bending to the side as you sleep.
• Place a small wedge or throw pillow under your growing abdomen to better support its weight.
• For an extra-supported feel, add a pillow behind your back as well to act as a bolster and keep you comfortably on your side.

For more personalized tips and a comprehensive pain-relief treatment plan, book a visit with a pelvic floor PT.