Pelvic Girdle Pain was previously referred to as SPD (Symphysis Pubis Dysfunction). It has been renamed because SPD suggests that pain is only caused in the Symphysis Pubis, however, women can suffer from pain from all areas of the pelvis and was renamed PGP.
PGP may affect up to 25% of pregnant women and the severity can vary greatly. If you find that you are suffering, you must seek help, it is a common complaint and the majority of cases can be treated safely and effectively during pregnancy.
Pelvic Girdle Pain does not only affect pregnant women, some sports players such as rugby are also prone to it but it is more common during pregnancy. The main cause of PGP during pregnancy is as your body prepares for labour, there is an increase in the hormone relaxin. The hormone softens your ligaments, especially those in your pelvis so that your pelvis can move and change shape slightly to allow baby to pass through. This moving of your pelvis can cause inflammation and pain. It is also thought that one side of your pelvis moves more than the other causing more irritation and pain. As the ligaments are so soft, your pelvis is also likely to move much more while carrying out daily activities such as sitting, walking and sleeping instead of your pelvis being in a locked, still position, again cause pain as the joints move.
Symptoms of PGP
PGP can occur at any time during your pregnancy, labour and in a very few women after birth. The pain can come on very quickly but can also start gradually and get worse with time. The symptoms may be mild to severe pain in the pubic bone area and may affect you at the front or back, top or bottom. You may also get pain in the hips, the groin, in your lower abdomen, your bottom, your lower back or your inner thighs. You will find that any movement you do which involves opening your legs may be very painful and sometimes women can hear or feel a clicking sensation as the pelvis moves. Many women find that the pain only affects one side of their body. Movements that may cause pain can be everyday small activities including things like rolling over in bed, walking, going up or down stairs and getting in and out of the car.
Unfortunately, if you have suffered from PGP in a pregnancy, it is very likely that you will suffer again in any future pregnancies and for many women the symptoms are more painful.
Treatment for PGP
If you think you are suffering from PGP, it is essential that you get medical advice as early as possible as early intervention can help with the pain and the recovery. Sometimes the symptoms of PGP can get confused with sciatica, however sciatica is rarer complaint during pregnancy and you should see your midwife or doctor to discuss your symptoms. You should be referred to a specialist or a physiotherapist who will be able to assess your condition and give you specific exercises and help to aid your pain. Please see Backache during pregnancy for more advice and tips for helping and easing with pain. Many women have also found that sleeping with a pillow between their knees also helps.
Your Physio will assess where in your pelvis you are feeling the pain and may advise on exercises to do to help strengthen the core muscles and improve your pelvic stability. These can include gentle rocking on all fours, pelvic floor exercises and sitting on a birthing/exercise ball, as well as swimming (though not breaststroke). You should only do exercises that feel comfortable to you, and stop if you feel any pain; the pain of PGP is a warning that you are doing too much. You may be fitted with a pelvic support band that will help provide the support where needed.
There are certain things you can do to avoid aggravating the PGP, these include:
- When you turn in bed, keep your legs together
- Use a maternity pillow between your knees
- When getting out of bed, sit up first then get up, so that you do not put too much weight on one leg
- When getting dressed, sit down when putting on trousers, socks and pants
- Go up stairs slowly and put both feet on one step before moving on
- When getting out of a car, put both feet on the ground before standing up
- Avoid lifting anything too heavy, this includes other children and wet washing!
- Avoid hoovering, or other one-sided activities
- Avoid sitting on the floor
- Do not cross your legs when you sit, keep your legs out in front of you
- Make sure your back is supported well when sitting
- Avoid sitting in bed all day: if you are unable to move, it is better to sit
- Change postition frequently
- Shower, rather than bathe, if you are having trouble getting in and our of the bathtub
- Avoid twisting, turning and squatting
- Avoid any movement which involves your knees being apart
- If it hurts, STOP
- Do what you can, but don’t be afraid to ask for help, whether its for a spot of cleaning, the school run or just helping you get around, it’s better to see if someone else can do something for you than make it worse.
If you find that you are unable to manage the pain and that it gets too bad, speak to your midwife, doctor or physio department again: they may decide you need to use crutches or even a wheelchair. If you are working, you may be signed off work if the pain is unbearable.
PGP can also be a great emotional burden: the idea of going for the rest of the pregnancy with this increasingly bad pain can be very upsetting, and the feeling of helplessness at not being able to do things for yourself can make it worse. If you feel this is causing you undue stress, make sure you speak to someone as stress and tension will just make the pain worse.
PGP and Labour
You will need to discuss with your midwife and physiotherapist how labour will work for you and which positions and options you have available to you for delivery. You should make sure that your condition is clearly marked in your hand-held antenatal notes so that anyone medical who is assisting with your delivery knows your situation. You should also make sure that it is discussed in your birth plan and that you state how able you are when opening your legs apart incase you decide to have an epidural. By having an epiduralyou will lose all pain in your legs and you won’t be able to tell how far you can comfortable open them.
There is no reason why you must have an epidural if you are suffering from PGP, however, the condition cannot stop you from having one. Many women with PGP manage natural births and only a very few women need to have a caesarean section due to the condition.
Using a birthing pool may help you cope with the pain, however, you will not be able to use a birthing pool if you cannot quickly get out in an emergency. You may need to arrange a trial session with your midwife to see if it will be a possibility during labour.
Although you will discuss labour positions with your midwife, you may find that a squatting position may suit you best for delivery as this helps your pelvis to widen. You may also find kneeling upright or on all fours to be comfortable. Depending on where you give birth, you may be able to use a birthing stool which you may also find comfortable. It is best to avoid the use of stirrups during labour if possible.
If your labour is not progressing, you may find that you need to have an assisted birth. This can be quite difficult if you are suffering from PGP as you will need to lie with your legs in stirrups. You will need to listen to your midwife who will help you get into position and assist you.
PGP after pregnancy
Most women find that their PGP symptoms ease with time after the birth. Some women find that the pain can re-occur just before their period. However, a small number of women suffer continuously with PGP after their pregnancy. If you are still suffering from pain at your six-week post-natal check-up, you should ensure that you talk to your doctor. You may get referred to a specialist who will be able to help you to recover. In very severe cases you may need medical intervention to help stop the pain. This is very rare although you doctor will be able to discuss with you in detail any individual needs that you have.
If you have any questions regarding back ache or PGP it is important that you speak with your midwife or doctor and they will be able to answer any questions that you have.
by Jenny, mum to William and James