Pelvic Pain during Pregnancy

Pelvic pain during pregnancy often called Pregnancy-related Symphysis Pubis Dysfunction (SPD) or Pelvic Girdle pain (PPGP) is a wrenching pain in the pelvis area which may hit anytime during pregnancy.

Who gets Pelvic pain during pregnancy?

It affects 1 in 5 pregnant women having issues like previous damage to the pelvis and pelvic joints moving unevenly. Factors that may make a woman develop PPGP include:

  • A hard physical job
  • A history of pelvic girdle pain or lower back pain
  • The previous injury to the pelvis by a fall or accident
  • Having PPGP in a previous pregnancy

Pressure vs. Pain

The pressure in the pelvis is similar to an ache you experience while having periods coupled with aching in your lower back. Pain, on the other hand, is a sharp stab while walking or even standing for which you need immediate medical attention. The situations to call your doctor include:

  • A severe headache
  • Dizziness
  • Intense pelvic pain
  • Sudden swelling of your hands, face, feet

Causes

  • Round Ligament Pain: As you enter the second trimester due to the growing baby, the uterus that expands creates pain in the ligaments affecting the pelvis.
  • Ovarian Cysts: Pressure by the ovaries can cause constant pain resulting in nausea or vomiting.
  • Braxton Hicks Contractions: Contractions leads to the tightening of the pelvis creating pain.
  • Constipation: Hormones slow the digestive tract causing constipation.
  • Pressure from the baby’s weight: The weight of the growing baby presses the nerves running from the vagina to legs.
  • Urinary Tract Infection (UTI): UTIs may affect the kidneys resulting in preterm labor. The symptoms including sudden pain while urinating or burning sensation while peeing can cause pelvic pain.

More Serious Causes

  • Ectopic pregnancy
  • Miscarriage
  • Preeclampsia
  • Preterm birth
  • Uterine fibroid
  • Placental abruption
  • Uterine rupture
  • Ovarian torsion
  • Appendicitis
  • Kidney stones

Symptoms

PPGP is not harmful but can cause severe pain in the pelvic area including:

  • Pain in the pubic bone
  • Pain in the ‘Perineum’ (between the vagina and anus)
  • lower back side pain

The pain can also move to the thighs making it difficult to walk, climbing stairs, standing on one leg or while turning over in bed.

Remedies

  • Take a warm hot bath
  • Get a prenatal massage
  • Exercise regularly
  • Try to avoid sudden movements while standing or walking
  • Wear comfortable footwear
  • Try a pelvic support garment
  • Take frequent breaks while working
  • Practice good posture
  • Apply cold or heat packs
  • Avoid doing painful activities
  • Sleep in a comfortable position
  • If you want to have sex consider
  • Drink plenty of water to stay hydrated

You should also avoid

  • Crossing your legs
  • Standing on one leg
  • Vacuuming
  • Pushing heavy objects
  • Standing or sitting for longer periods
  • Lifting heavy weights
  • Carrying baby on one hip

Labor & birth with Pelvic pain

Many women with pelvic pain can have a normal vaginal delivery. Make a plan and write down in the PPGP so that the people supporting you in labor knows your condition. Talk to your healthcare specialist about delivery in water to take the weight off your joints allowing you to move easily.

Pelvic pain after the baby is born

Most women get relief within a few months of delivery, but others have residual pain which calls for further treatment, medications, belts or girdles or any physical therapy to strengthen muscles. In severe cases where the pubic symphysis has been separated, surgery is done to stabilize the pelvis.

Diagnosis

Tell your doctor if you experience pain anywhere during pregnancy for which they may have to perform certain tests to know the source of the pain. In some cases, you may need to have an ultrasound or magnetic resonance imaging that showcases the bones and the soft tissues.

Treatment

Physiotherapy relieves pain and improves muscle function while improving the pelvic joint position and stability including:

  • Manual therapy to examine the movement of your joints, spine, and hip
  • Exercises in water
  • Exercises to strengthen your back and hip muscles
  • Pain relief
  • Advice and suggestions for birth and labor
  • Use of Crutches or pelvis support belts if necessary
  • Sleep pillows:  Pillows supporting your hip and belly can ease the strain on your pelvic ligaments
  • Acupuncture: It is safe for expecting mothers.
  • Pain relievers: Pain relievers like Tylenol is an over-the-counter medication safe medication during pregnancy.

Note: Avoid using ibuprofen (Advil, Motrin), Aleve and aspirin as they are unsafe for women during pregnancy.

When to contact the doctor?

Consult the doctor if you see these symptoms including:

  • Dizziness
  • Fever/chills
  • Constant vomiting or nausea
  • Eatery or bloody discharge
  • A severe headache
  • Any bleeding
  • Sudden swelling of face, hands or feet
  • Less than ten fetal kicks in one hour
  • More than four contractions in an hour

References

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