Pelvic pain during pregnancy

What causes pelvic pain in pregnancy?

About one in four pregnant women have pelvic pain – sharp pain felt most often in the hips or groin. Experts believe that pelvic pain, also known as pelvic girdle pain, is caused by a variety of factors related to normal pregnancy changes.

Starting as early as 10 weeks, the developing placenta produces increased levels of a hormone called relaxin. This hormone does just what its name implies: It relaxes your ligaments, including the ones that hold the bones of the pelvis together. This makes it easier for your baby's head to pass through during delivery.

Higher levels of the hormones estrogen and progesterone during pregnancy may also contribute to this loosening effect.

Relaxed ligaments can hurt if they stretch too far, or when they allow the bones they hold in place to move too easily. These bones can shift and put pressure on nearby muscles, causing pain.

Weight gain and your changing center of gravity can also contribute to pelvic pain. As your belly grows, your pelvis is pushed forward, and the curve of your lower back becomes more pronounced. This can place a lot of strain on the muscles and ligaments in and around the pelvis. In fact, lower back pain and pelvic pain are often related.

What are the symptoms of pelvic pain in pregnancy?

Loosened ligaments in the pelvis can cause soreness, stabbing, stinging, or burning sensations that can occur anywhere from the top of your hip bones down to the fold of your buttocks, either in the front or back.

Some women feel it when lifting, bending, or walking. Going up and down stairs, getting up from a sitting position, and turning over in bed may be especially painful. Some women find the pain is worse at night, especially after a very active day. Some find that their pelvis feels unstable.

What are the different types of pelvic pain in pregnancy?

Symphysis Pubis Dysfunction (SPD) The pubic symphysis is the joint where the two sides of the pelvis meet in the front, right underneath where your pubic hair grows. It's supported by a network of ligaments, and when these ligaments relax, the joint moves too much and causes pain ranging from mild to excruciating.

Diastasis Symphysis Pubis (DSP) This condition occurs when the gap in the pubic symphysis widens too far. The joint normally widens about 2 to 3 millimeters during pregnancy to help your baby pass through your pelvis. In some women, the pubic symphysis widens so much that it becomes unstable.

Sacroiliac joint pain. The sacroiliac joints contain ligaments that connect the sacrum – the structure composed of the last five vertebrae of your spine – to the "wings" of the pelvis on either side. If these ligaments relax too much, it can cause the bones in this area to move, putting pressure on nearby nerves and muscles. With sacroiliac joint pain, one side of your pelvis may hurt more than the other. The pain may radiate down your legs, into the back or front of your thighs. Or you may have a combination of very low back pain and feeling like the bones of your pelvis are unstable.

Round ligament pain. There are two round ligaments that attach your uterus to your pelvis. As your uterus grows up out of the pelvis, the ligaments pull, stretch, and thicken to accommodate and support it. These changes can cause pain which typically lasts just a few seconds as you change position. This pain is concentrated in your groin where your abdomen meets your legs, although occasionally it can shoot down the inside of your thigh.

Who's at risk for pelvic pain in pregnancy?

You may be more likely to develop pelvic pain if you:

• Had pelvic pain in a prior pregnancy.

• Have had multiple pregnancies.

• Have a history of pelvic trauma, like a back injury or pelvic fracture.

• Perform strenuous activities such as lifting, twisting, and bending.

Being overweight or carrying a very large baby (a condition called macrosomia) may also raise your risk for pelvic pain, but evidence is conflicting.

How is pelvic pain diagnosed in pregnancy?

If you're experiencing pain anywhere during pregnancy, it's important to tell your doctor or midwife. They'll want to make sure your pain isn't due to any other health problems, and they'll offer options for relief.

Your healthcare provider will examine you and may have you do certain movement tests to help pinpoint where the pain is coming from. In some cases, you may need to have an ultrasound or magnetic resonance imaging (MRI), which provides pictures of the soft tissue and bones.

How is pelvic pain in pregnancy treated?

There are many treatments available. While you may not get complete relief from pelvic pain during your pregnancy, you can take steps to prevent it from getting worse. Many women use more than one of these techniques to maximize their relief.

Pregnancy girdles, bands, and belts. These work by applying gentle pressure to the pelvis to give you more stability. They can be effective when combined with gentle exercise.

Sleep positioning. Pregnancy pillows that support your belly and hips can ease the strain on your pelvic ligaments and allow you to get a good night's sleep. You may need to experiment to find one that's right for you. Women's hips are wider than their knees, especially in pregnancy. Sleep with a pillow between your knees to keep your hips in a neutral position and avoid extra stress on your hips and lower back. Read more about the best pregnancy sleeping positions.

Physical therapy. Studies show that certain exercises – especially in water – can be helpful in reducing pelvic pain. Ask your doctor or midwife for a referral to a physical therapist who specializes in pregnancy. (Your insurance may pay for part or all of the cost.) You'll learn stretches to relieve your pain and exercises to strengthen your core, pelvic floor, and back to provide your pelvis with more stability. A physical therapist can also teach you how to avoid pain when getting out of bed and doing daily tasks.

Acupuncture. Some women find that acupuncture helps with pelvic pain. When performed by a licensed practitioner, acupuncture is considered safe for expecting moms.

Pain relievers. Acetaminophen (such as Tylenol) is an over-the-counter medication that has a long history of safety during pregnancy. Avoid ibuprofen (Advil, Motrin) and other nonsteroidal anti-inflammatory drugs, like Aleve and aspirin.

What else can I do to ease my pelvic pain during pregnancy?

In addition to the treatments that your doctor or midwife recommends, there are ways you can reduce pain as you go through your day:

Avoid painful activities. Limit activities that cause discomfort, such as heavy lifting and carrying, standing or walking for long periods, and strenuous exercise. Find new ways to do the things that cause you pain. For instance, instead of getting out of bed by sitting straight up, try rolling to your side first and pushing up from that position.

Take frequent breaks. Try to rest a few minutes in a comfortable position as often, and as regularly, as possible.

Exercise gently. Try mild to moderate exercise, such as gentle abdominal strengthening exercises, Kegels, prenatal yoga, and walking. Don't overdo it, and avoid exercises that require squatting or spreading your legs, which can aggravate hip pain.

Practice good posture. Keep your back straight and aligned. Try not to slump, especially when seated.

Apply ice or heat. Try using an ice pack or rubbing an ice cube on the areas where it hurts. (For low back pain, get one of those flat ice packs that go in lunch bags and tuck it into your waist band.) Ice helps tame inflammation. If you're also experiencing low back pain, a heating pad can be soothing – but use it only on your back (for about 20 minutes at a time), not in the front where your uterus and baby are.

Will pelvic pain affect my labor and delivery?

Here are a few things you may need to consider:

• As you approach your due date, make sure your healthcare provider has reevaluated your condition and tested your pain level and range of motion, especially if you plan to get an epidural. This information helps determine if any special accommodations need to be made for you during labor and delivery.

• Depending on your mobility, here are some alternative positions for giving birth: kneeling while someone supports you from behind, lying on your side with someone holding your leg, or delivering your baby on all fours.

• If you choose epidural or spinal anesthesia, you could overstretch your already sensitive ligaments while you're numb. Discuss this possibility with your practitioner so you can plan to avoid this problem.