What is Pelvic Girdle Pain?
Pelvic girdle pain (PGP), which used to be known as Symphysis Pubis Dysfunction (SPD).
PGP/SPD is a debilitating condition during pregnancy that causes pain, discomfort and mobility problems.
The Symphysis Pubis is the fibro-cartilaginous joint between the 2 pelvic bones at the front, but PGP can also be caused by instability with the sacroiliac joints at the back of the pelvis.
During pregnancy your body produces a hormone called Relaxin that softens the ligaments around the pelvis, which allows the baby to pass through the birth canal as easily as possible.
Unfortunately, this can allow your ligaments to move too much causing the joints to become increasingly mobile which leads to the pelvis becoming unstable and “grind” together, causing pain and inflammation.
This may not present a problem to a lot of pregnant women, but for some the movement can be unbearable and treatment needs to be to help ease the pain.
The symphysis pubis gap in a non-pregnant woman is 4-5mm but can move 2-3mm in pregnancy. Symphysis diastasis is when the gap is more than 10mm wide and can be diagnosed by X-ray, MRI or ultrasound.
What causes SPD/PGP?
SPD/PGP is caused by a combination of hormone changes during pregnancy and body movement, plus the extra weight of the baby putting pressure on the pelvic bones.
Other risk factors that can increase your chances of getting symphysis pubis dysfunction is women who are hyper-flexible when non-pregnant, also women that have over stretched the joint prior to pregnancy i.e. ballet dancer/gymnast’s etc.
Women with pre-existing pelvic injuries with uneven strain of the symphysis pubis can mean there is uneven pulling on each side.
Weak abdominal and/or pelvic floor muscles, possibly due to lack of movement in sedentary modern lifestyles i.e. sat at office desks and driving around rather than walking.
When can PGP/SPD occur?
PGP/SPD can occur any time in the pregnancy, during labour or postnatally. In the first pregnancy it can appear from the 3rd trimester and usually starts earlier in subsequent pregnancies.
When it occurs in labour, it is usually because of being in stirrups for a long time or in a squatting position.
Some women have a higher risk ¹ of developing PGP than others these include:
- Strenuous work (twisting and bending the back)
- history of low back pain
- Previous trauma to the pelvis
What are the symptoms of PGP/SPD?
The main symptom of PGP/SPD is pain, and this can be anywhere on the pelvic region either at the front with the symphysis pubis or the back along the sacro-iliac joints.
Pain can also be felt around the coccyx, one or both hips, lower abdomen, groin and inner thigh.
The types of pain that can be felt is either a bruised feeling, burning sensation, aching, sharp or simply heavy feelings of muscle fatigue.
The pain can be mild to severe, intermittent or constant chronic pain.
Other symptoms that can be associated with PGP is:-
- Clicking or grinding
- Bladder dysfunction
- Waddling gait
Assessment of PGP
Assessment is usually based on pain and limitation of movement and the condition is referred to instability or dysfunction.
The signs are groin pain when:
- Turning over in bed at night
- Getting in and out of the car
- After doing stretches or during doing stretches which involve abduction
- Standing on one leg getting dressed/undressed
- Lifting one leg at a time i.e. going up stairs
- Weight bearing/lifting
The treatment you receive will depend on the severity of your symptoms, but can include some or all of the following:-
- Painkillers – prescribed by the GP
- Physiotherapy – They will give you exercises to strengthen your pelvic floor muscles, give you advice on what you should avoid doing and information on how PGP might impact your labour.
- Massage – help with relaxing and loosening up tight muscles around lower back, hips and thighs
- Osteopath/Chiropractor – to help relieve symptoms – see a registered practitioner who is trained and experienced in working with pregnant women
- Pelvic support belt – to give quick relief
Are there any self-help tips?
- Pelvic floor exercises to strengthen the muscles
- Try not to move your legs apart, imagine you have a band around your legs keeping them together
- Take care getting in and out of cars, beds and baths, move legs together
- Rest to give your joints time to heal
- But move little and often, you might not get the pain until later or when you have gone to bed
- Go up steps slowly, one step at a time.
- Know your limits, do not push through the pain!
Will having PGP/SPD affect my labour?
It does not stop you having a normal vaginal delivery but having PGP/SPD will mean that your birth plan will need careful planning with your midwife or consultant, i.e. avoid stirrups if at all possible, giving birth in all fours position or the position that you find most comfortable.
Make sure everyone looking after you is aware that you have PGP/SPD, especially when it comes to examinations and the pushing phase so that you stay within your comfort level.
Any time you have pain, do not suffer in silence, get checked out by your Midwife or Consultant, as the quicker you get treatment the quicker you will be pain free!