Pelvic Pain during Pregnancy

Pelvic pain, also referred to as PPGP (pregnancy-related pelvic girdle pain), is a normal symptom associated with pregnancy. It can result from a wide range of factors from the changing hormone levels to the relaxing muscles and ligaments for the growth of the uterus. In some women, mild to severe pelvic pain may occur during the first trimester as an early sign of pregnancy. But, sometimes, the pain may indicate a more serious health condition such as kidney stones. Pelvic pain in pregnant women can also be associated with a condition named symphysis pubis dysfunction (SPD).

Symptoms of Pelvic Bone Pain in Pregnancy

• Pain over your pubic bones especially at the front and central parts
• Pain across the sides of the lower back region as well as the upper legs along with the pelvic bones
• Pain in and around the perineum area (between the vagina and anus)
• Pain radiating from the pelvic area to the thighs with a characteristic clicking or grinding feeling or sound
• Sharp pain in the pelvic region during activities like walking and climbing stairs
• In some cases, the pain makes it difficult to move the legs apart, such as when getting into a car

Causes for Pelvic Pain during Pregnancy

The principal factors may vary depending on the stage of your pregnancy:

Accommodation of the Growing Uterus – You may feel a cramping pain in the pelvic area between the eighth and twelfth weeks of pregnancy. The pain resembles that occurring before a period. It is caused by the expanding uterus which pushes the muscles and organs to make room for the baby. This type of pain is more common in a first pregnancy compared to subsequent ones.

The pain worsens as the growing uterus gradually dislodges the pelvic joints and muscles

Ovarian Cysts – These cysts often develop due to any alteration in the way the ovaries produce or release eggs. They are generally noncancerous and harmless, growing larger in size during pregnancy. The growing uterus often puts pressure on the ovaries which can lead to persistent pain. It is advisable to seek medical assistance if you suspect the presence of an ovarian cyst as they may cause extreme pain in case of a rupture.

Round Ligament Pain – This is often the reason behind pelvic pain during the second trimester. It is caused by stretching of the ligament that runs down to your groin area from the upper regions of the uterus. You are most likely to feel the pain while walking or rising from a sitting position.

Pressure from the Baby’s Weight – Lower pelvic pain commonly felt during the third trimester is usually caused by the increasing weight of the growing fetus. As the fetus grows in size, it applies pressure on the nerves running from the vagina into the legs. It is usually felt during movements like walking, rolling in your bed at night and riding in a car.

Braxton Hicks Contractions – Pressure felt in the pelvis region, coming and going on their own without causing considerable pain, is most likely to be caused by practice contractions known as Braxton Hicks contractions. The main difference between a true labor contraction and a Braxton Hicks one is that the latter occurs more sporadically and is generally painless. This practice contraction is commonly caused by dehydration occurring from the 20th week of pregnancy.

Relaxed Pelvic Joints – During the later part of pregnancy, your body produces higher amounts of the hormone named relaxin, which helps to stretch the muscles and ligaments to prepare your body for childbirth. Additionally, relaxin often loosens the pelvic joint and separates the two bones to a certain extent. These factors can lead to mild to moderate pain near the pubic bones and a feeling of instability in your legs.

Constipation – Constipation during pregnancy can lead to pelvic pain and discomfort in some women.

Urinary Tract Infection or UTI – Around 10% of all women get affected by UTI at some stage in their pregnancy. IT can lead to various symptoms including pain or burning sensation with urination, bloody urination, pelvic pain and abdominal pain.

More serious causes may include ectopic pregnancy, miscarriage, preterm labor, uterine fibroid, uterine rupture and appendicitis.

Pregnancy Pelvic Pain Treatments

Regular exercise, physiotherapy and massage are some of the best treatment options:

• Manual therapy by an expert physiotherapist for ensuring proper movement of your spine, hip and pelvis joints
• Prenatal massage
• Soft tissue strengthening, mobilization and stabilization exercises for strengthening your stomach, back, hip and pelvic floor muscles (check Exercises During Pregnancy)
• Postural exercises
• Pool workout or exercise in water (check Pregnancy Water Exercises)

Management of Pelvic Pain in Pregnancy

You can avoid or reduce the frequency of the sharp pain in your pelvic area during pregnancy by following these simple tips:

• Taking a warm shower helps to relax your muscles and reduce the chances of pain. Make sure that the water is not too hot as it may be harmful for your baby.
• Applying ice or a cold pack on the pubic symphysis area regularly helps to keep the pain and inflammation in check.
• Application of a heat-pad on the surrounding musculature can help to relax the muscles by reducing the spasm and tightness.
• Make sure to sit down before performing activities that may trigger the pain.
• Get plenty of rest.
• Do not step over object lying on the ground.
• Avoid bearing weight for a prolonged period of time.
• Do not lift or carry heavy objects as it puts additional pressure on the pelvic region.
• To get into your car, sit on the seat before bringing the legs together into the car.
• To get out of a car, first bring both of your legs out and then get your body out. Make sure to push equally with both the legs while standing up to avoid the pain.
• While rolling in bed, keep your legs together by placing a pillow between your knees.
• To get in bed, first sit on the edge keeping the legs together, then lie down on your side before bringing both your legs up sideways.
• Avoid climbing stairs as much as possible.
• Avoid deep squatting.
• Avoid quick movements or twisting and turning your body sharply as these may put pressure on the pelvic region.
• Wear flat or low-heeled shoes providing proper arch support. Do not wear high heels.
• You can also wear pelvic support garments that help to minimize the pressure of the growing uterus on the pelvis.

It is never advisable to follow any exercise schedule without consulting with your doctor and physiotherapist. They will be able to educate you on the strategies and mechanics for minimizing the pain while performing all your daily activities.

• References +
  • Pelvic Pain Pregnancy  (Parents.com)
  • SPD (NHS.uk)
  • Symphysis Pubic Dysfunction (Athletico.com)
  • Pelvic Discomfort  (WhatToExpect.com)