What a pain in the pelvis!

Posted on 26/03/2019 by Antenatal Online | Leave a Comment

Imagine this; you have just had the excitement of a positive pregnancy test, but within a few weeks you start feeling a sharp twinge of pain by your pubic bone (symphysis pubis). You mention it to your midwife, who dismisses it as hormonal and who reassures you it will go.

A little niggle at the back of your mind isnít convinced it will. As the weeks go by, this niggle gradually increases and the pain is almost always there, but worse after walking around for a while. Other parts of your pelvis start hurting and going up and down stairs is agony, as is turning over in bed.

Now your midwife realises itís not just a hormonal thing and youíre referred to the obstetric physio, but your midwife warns you that the waiting list is over a month long.

Pelvic Girdle Pain (PGP) or SPD are mentioned and you do a little googling. Itís described as a minor pregnancy ailment, but it doesnít feel minor, youíre in chronic pain and have to stop working because walking, standing, sitting and lifting hurts. Itís affecting every part of your life and you become dependent on your familyís help around the house.

The physio appointment comes, PGP is confirmed, youíre given some tips on how to move, which you knew anyway due to Google, you get an ineffective support belt, instructions to do pelvic floor exercises and the offer of crutches, which you accept. The crutches help, but walking is still painful and you become as good as housebound until the birth of the baby. You try to find an osteopath, but most are scared to treat a heavily pregnant woman, when you do find one: relief, albeit temporarily. After the birth you recover, but it takes time.

Does this scenario look familiar? This is my own story with PGP and the reason I feel strongly about this topic. My experience is that most HCP are aware of the condition, but not aware of how debilitating it can be. I remember only taking baths, which relieved the pain, when my husband was in or I would be stuck in the bath, I remember the helplessness you feel, because doing your everyday household chores are literally a pain.

So what is PGP exactly?

Your pelvis is not one bone, but a ring of bones around your body, at the base of your spine. PGP is pain either at the front or back of your pelvis or both in areas where 2 bones meet. The most common areas are at the front (symphysis pubis) and just above your buttock/lower back (SI joints). This is why the old name: SPD or Symphysis Pubis Dysfunction is not used anymore.

It used to be thought that PGP was a hormonal condition, but this is wrong. PGP is a mechanical condition, which means that it is treatable with manipulation and that breastfeeding after birth wonít have any effect on your recovery.

Another myth is that it does not occur in early pregnancy, as my story shows, it can occur from very early on; on the other hand, for some women it doesnít appear until the very last weeks of pregnancy.


The most common symptom is a pain in the pubic area and groin. Others are pain in the lower back, a grinding or clicking sensation in your pubic area. Lifting a leg tends to induce the pain, which is how physiotherapists diagnose the condition.

What can you do to relieve it?

  • Get help. Find yourself a physio, osteopath or chiropractor that is specialised in pregnancy. They should be aware of the most effective treatments for PGP, which is manipulation of the pelvis to realign your pelvis.
  • Watch your posture. PGP means that the joints in your pelvis move more than they should. So whenever you move, you must make sure you move with your knees inline and hip with apart. E.g. keep your knees together when moving in and out of the car/bed. Walk up stairs one step at the time.
  • Sleep with a cushion between your knees to maintain the alignment of your pelvis.
  • Wear flat shoes
  • Use a backpack, instead of a shoulder bag
  • Shop online, the invention of online groceries was a life saver in the early 2000ís when I had my first encounter with PGP.
  • Ask for help. When you have PGP the simplest tasks can be difficult to achieve. Donít be afraid to ask for help, whether thatís your partner, parents, friends or paid help if you can afford it.
  • Visit pelvicpartnership.org.uk. This is the best online resource with advise, tips and the most recent research on effective treatments for PGP you can find in the UK.
If you are still in pain despite all of the above, ask your GP for pain relief; there are options available.

What about giving birth?

PGP does not mean you cannot have the birth you want, including homebirth or waterbirth. You will need to be aware of which positions you find comfortable so you can adopt these in labour. Avoid lying on your back or having your legs in stirrups. Upright and kneeling positions are especially good as these allow you to keep your pelvis in line. Make sure your midwife knows you have PGP so she can support you appropriately.

It may be tempting to ask for an induction of labour in the hope that this will instantly resolve the discomfort, however most women continue to have a degree of pain and PGP can take a while to resolve.  Induction also means regular vaginal examinations and continuous monitoring both of which mean you are likely stuck in an uncomfortable position which increases pain.  So it is important to research this option carefully and weigh up the pros and cons for you very carefully.

I hope that this blog is helpful to you. If you have further questions, do get in touch and I will try my best to answer your questions.

Elke De Keyser



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