Pelvic Girdle Pain (PGP) in Pregnancy: Symptoms and Relief

Pelvic Girdle Pain (PGP) is an umbrella term used to describe a collection of uncomfortable symptoms caused by a stiffness or uneven movement of the pelvic joints. In the past, this was frequently referred to as Symphysis Pubis Dysfunction (SPD), but PGP is now the preferred clinical term in the UK as it acknowledges that the pain can occur at the back of the pelvis (sacroiliac joints) as well as the front.

According to NHS guidance, PGP can start at any stage of pregnancy, though it is more common in the second and third trimesters. It is not harmful to your baby, but it can make daily life, mobility, and sleep significantly more difficult for the mother. Understanding the causes and seeking early intervention is essential for managing the condition effectively.

The experience of PGP varies between individuals, but the pain is typically localised to the pelvic region. You may feel a dull ache, a sharp stabbing sensation, or a grinding feeling in the joints. Common symptoms include:

• Pain over the pubic bone at the front, level with your bikini line.
• Pain across one or both sides of your lower back (sacroiliac joints).
• Pain in the area between your vagina and anus (perineum).
• Pain that radiates to your thighs or groin.
• A clicking or grinding sensation in the pelvic area when walking.

These symptoms are often exacerbated by specific movements, such as walking on uneven surfaces, climbing stairs, getting out of a car, or rolling over in bed. If you find that your mobility is restricted by these sensations, it is important to consult a healthcare professional.

There are several physiological reasons why PGP develops during pregnancy. The primary factor is the production of the hormone relaxin. This hormone is vital for birth as it softens the ligaments in the pelvis to allow the baby to pass through the birth canal. However, this increased laxity can cause the joints to move unevenly or become slightly misaligned, leading to inflammation and pain.

Other contributing factors include:

• Shift in centre of gravity: As your bump grows, your posture changes, putting additional strain on the pelvic joints.
• Weight gain: The extra weight of the baby and amniotic fluid increases the load the pelvis must support.
• Previous injury: A history of lower back or pelvic trauma can increase the likelihood of developing PGP.
• Strenuous activity: A job or lifestyle that involves heavy lifting or repetitive movements may trigger symptoms.

While PGP often requires professional input, there are several adjustments you can make at home to reduce discomfort. NICE clinical knowledge summaries suggest that modifying daily activities is a cornerstone of management.

Do's:

• Remain as active as possible within your pain limits; avoid pushing through sharp pain.
• Keep your knees together when getting in and out of the car or turning in bed.
• Sleep with a pillow between your knees for better pelvic alignment.
• Sit down to get dressed to avoid standing on one leg.
• Use stairs one at a time—step up with your 'best' leg and bring the other to join it.

Don'ts:

• Avoid lifting heavy objects (such as toddlers or heavy shopping bags).
• Do not sit cross-legged or stand on one leg.
• Avoid twisting your body while lifting or reaching.
• Try not to sit on the floor or in positions that force your legs wide apart.

In the UK, the gold standard for PGP treatment is a referral to a specialist women's health physiotherapist. A physiotherapist can provide a manual assessment to see how your joints are moving and offer a tailored recovery plan. Treatment may include:

• Manual therapy: Gentle joint mobilisation to ensure the pelvis is moving correctly.
• Prescription exercises: Specific movements to strengthen the pelvic floor, stomach, back, and hip muscles.
• Pelvic support belts: These can provide temporary stability to the joints and offer relief during activity.
• Acupuncture: Some women find that pregnancy-safe acupuncture helps manage chronic pelvic inflammation.

Regarding medication, paracetamol is generally considered safe for use in pregnancy when taken according to the instructions. However, you should always consult a GP or pharmacist before starting any new medication while pregnant.

If you are struggling with pelvic pain, you may find it difficult to travel to a physical surgery. A UK online doctor can be an excellent first point of contact for an initial assessment. During a video consultation, a GP can discuss your symptoms, review your medical history, and help rule out other causes of pain, such as a urinary tract infection (UTI).

An online GP can provide guidance on safe pain relief options and, if necessary, issue a sick note if your PGP is making it impossible to perform your duties at work. They can also advise on the pathway for a physiotherapy referral within the NHS or private sector. Speaking to a GP online allows you to get professional medical advice from the comfort of your home, reducing the physical strain on your pelvis.

For the majority of women, PGP improves significantly after the baby is born and the levels of relaxin begin to decrease. However, it is a myth that the pain disappears instantly for everyone. For some, the physical strain of labour or the demands of lifting a newborn can prolong symptoms.

It is important to continue your physiotherapy exercises in the weeks following birth. If your pain does not show signs of improvement by your 6-week postnatal check, you should mention this to your GP or health visitor. Ongoing PGP is treatable, but it may require more intensive rehabilitation to ensure the pelvic joints are fully supported by the surrounding muscles.