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Pelvic pain during pregnancy: cause, symptoms and treatment

Pregnant women may experience pelvic pain during their pregnancy. Any type of pelvic pain during pregnancy is often referred to as pelvic girdle pain (PGP) or symphysis pubis dysfunction (SPD). Pelvic pain is very common in pregnant women with some studies concluding that up to 1 in 5 pregnant women suffer PGP to some degree during their pregnancy.

The good news is that it can usually be treated effectively in consultation with a physiotherapist, osteopath or chiropractor experienced in treating PGP. PGP is treatable at any stage of pregnancy, or post-natally as soon as you feel able to visit a manual therapist. The therapist gently uses their hands to release stiff or ‘stuck’ pelvic joints and relieve painful muscles, restoring normal movement to your pelvis and reducing your pain.

What causes pelvic pain and symphysis pubis dysfunction in pregnant women?

Your pelvis is mainly formed of two pubic bones that curve round to make a cradle shape. The pubic bones meet at the front of your pelvis, at a firm joint called the symphysis pubis. The joint's connection is made strong by a dense network of tough tissues (ligaments). During pregnancy, swelling and pain can lead to the symphysis pubis joint becoming less stable, causing SPD.
During pregnancy, weakening occurs to the ligaments surrounding and bridging the pubic joint (symphysis) as a result of the hormone relaxin. In preparation for childbirth, the hormome relaxes the ligaments in the pelvis and softens and widens the cervix. The hormone usually disappears after childbirth and the ligaments usually become strong again. In some women the weakness persists, and activities such as carrying their baby or stepping up even a small step can cause a slight but continuous separation or shearing in the ligaments of the symphysis where they attach to the joint surfaces, even causing lesions in the fibrocartilage and pubic bones. Symptoms include one or more of the following: pain in the pubic area, hips, lower back, and thighs. This can take months (or even years) to go away.

Symphysis pubis dysfunction (SPD) is one type of pelvic girdle pain. Diastasis symphysis pubis (DSP) is another type of pelvic girdle pain which happens when the gap in the symphysis pubis joint widens too far.
 Diastasis symphysis pubis (DSP) is rare, and can only be diagnosed by an X-ray, ultrasound scan or MRI scan 

How do I know if I have SPD?

Pain in the pubic area and groin are the most common symptoms, though you may also notice: 

  • Back pain, pain at the back of your pelvis or hip pain.

  • Pain, along with a grinding or clicking sensation in your pubic area.

  • Pain down the inside of your thighs or between your legs.

  • Pain whilst walking or going up or down stairs


SPD can occur at any time during your pregnancy or post pregnancy.


SPD can be triggered by:

 

  • the joints in your pelvis moving unevenly

  • changes to the way your muscles work to support your pelvic girdle joints

  • one pelvic joint not working properly and causing knock-on pain in the other joints of your pelvis


These problems mean that your pelvis is not as stable as it should be, and this is what causes SPD.

 

You're more likely to develop SPD if:

  • you had pelvic girdle pain or pelvic joint pain before you became pregnant

  • you've had a previous injury to your pelvis

  • you've had pelvic girdle pain  in a previous pregnancy

  • you have a high BMI and were overweight before you became pregnant

  • hypermobility in all your joints

 

How is SPD diagnosed?

Your doctor, midwife or health professional will recommend treatment. You may be tested for the stability, movement and pain in your pelvic joints and muscles.

 

How is SPD treated?

Consultation with your medical professional will determine the best way to treat SPD.

Treatment often includes: 

  • Exercises to strengthen your spinal, abdominal muscles pelvic girdle, hip and pelvic floor muscles.These will improve the stability of your pelvis and back. You may need gentle, hands-on treatment of your hip, back or pelvis to correct stiffness or imbalance.

  • advice on how to make daily activities less painful

  • Acupuncture may help reduce the pain and is safe during pregnancy. Make sure your practitioner is trained and experienced in working with pregnant women.

  • Other manual therapies, such as osteopathy may help. See a registered practitioner who is experienced in treating pregnant women 

  • A pelvic support belt may give relief, particularly when you're exercising or active. These belts are cumbersome and can often restrict movement. Supacore’s medical grade TGA approved pregnancy Coretech range can help reduce pain and provide back support to help stabilize the pelvis.

 

What can I do to ease the pain of SPD?

  • Be as active as you can, but don't push yourself so far that it hurts.

  • Continue with your pelvic floor and core strength exercises that your physiotherapist recommends.

  • Avoid activities that make your pain worse or that put your pelvis in an uneven position, such as sitting cross-legged or carrying your toddler on your hip. If something hurts, stop doing it. If the pain is allowed to flare up, it can take a long time to settle down again.

  • When climbing stairs, take one step at a time. Step up onto one step with your best leg and then bring your other leg to meet it. Repeat with each step.

  • Take care when getting in and out of the car, bed or bath  Keep knees together and swivel whole body rather than stretching to step out of the car etc. If you are lying down, pull up your knees as far as you can to make it easier

  • Rest regularly or sit down for activities you would normally do standing, such as ironing.

  • Supacore’s medical grade TGA approved pregnancy Coretech range can help reduce pain during activity and everyday movement.

  • Try to sleep on your side  with legs bent and a pillow between your knees. This position is also best for your baby.

  • Try not to do heavy lifting or pushing.

 

Will I recover from SPD after I’ve had my baby?

You’re very likely to recover within a few weeks to a few months after your baby is born. If you can, continue with physiotherapy and core exercises after the birth. This will help with the strenghthening of your core muscles. Wearing Supacore shorts or leggings during your post-natal recovery can be helpful in keeping your pelvis stable .

 

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