"It hurts to turn over in bed"
Rolling over at night has become a project. Getting out of the car means swinging both legs out together. Putting your knickers on standing on one leg is out of the question. If this sounds familiar, you may have pelvic girdle pain in pregnancy, often shortened to PGP and sometimes called symphysis pubis dysfunction (SPD).
PGP is very common, it is not harmful to your baby, and most women with PGP can have a vaginal birth (NHS, 2022). It can be genuinely painful and limiting, though, and you do not have to just put up with it. Support and the right kind of movement help.
What is pelvic girdle pain?
The pelvis is a ring of bones joined at the front by the symphysis pubis and at the back by the two sacroiliac joints. In pregnancy, hormonal changes, the growing baby, a shift in posture and changes in how the muscles around the pelvis work all change the load on this ring. In PGP, the joints become stiff or move unevenly, and the area becomes sensitive (NHS, 2022).
PGP is common. A Cochrane review estimated that almost one in five pregnant women experience pelvic pain, and more than two thirds experience low back pain, with the two often overlapping (Liddle and Pennick, 2015).
Typical symptoms
- pain over the pubic bone at the front
- pain across one or both sides of the lower back, or deep in the buttock
- pain in the perineum or spreading to the thighs
- a clicking or grinding feeling in the pelvis
Pain is often worse when walking, on the stairs, standing on one leg, turning over in bed or moving the legs apart, for example getting out of a car (NHS, 2022).
What the evidence says helps
Staying active, with the right exercise
A large meta-analysis of 32 studies and more than 52,000 pregnant women found that exercise during pregnancy did not stop back or pelvic pain from appearing, but women who exercised had less severe pain, both during pregnancy and in the early weeks after birth (Davenport et al., 2019).
The Cochrane review reached a similar picture: an exercise programme of eight to twelve weeks reduced the number of women reporting combined low back and pelvic pain, and land-based exercise reduced sick leave related to this pain (Liddle and Pennick, 2015). The quality of evidence is low to moderate, so the effects should be read with some caution, but the direction is consistent.
For most pregnancies without medical complications, guidelines encourage at least 150 minutes of moderate activity a week, spread over at least three days, combining aerobic and strength exercise (2019 Canadian guideline, Mottola et al., 2018). If you have a complication such as placenta praevia, pre-eclampsia or a risk of premature labour, check with your midwife first.
Tailored exercise, not just "rest"
Rest has a place on bad days, but long periods of inactivity tend to make stiffness and weakness worse. A specialist therapist can choose exercises that strengthen the pelvic floor, tummy, back and hip muscles without provoking the pain (NHS, 2022). Typical examples include:
- gentle pelvic floor exercises
- side-lying clams and bridges with small range
- sit to stand from a higher chair, knees hip-width apart
- water-based exercise, which many women find comfortable
- walking in shorter, more frequent bouts rather than one long walk
Support and aids
A pelvic support belt can ease pain for some women, and crutches can help for a period if walking is very painful (NHS, 2022). These work best alongside exercise, not as a replacement for it.
Everyday tips that make a difference
Small changes to how you move often bring the quickest relief (NHS, 2022; RCOG, 2015):
- Keep your knees together when getting in and out of bed or the car. Roll onto your side and push up with your arms.
- Sit down to get dressed, rather than standing on one leg.
- Take stairs one step at a time, leading with your less painful leg going up and the more painful leg going down.
- Sleep with a pillow between your knees, and consider a satin sheet or silky pyjamas to make turning easier.
- Avoid wide-legged positions, such as breaststroke kick, deep lunges or sitting cross-legged, if they provoke pain.
- Split heavy tasks like carrying shopping into lighter loads, or ask for help.
- Plan your day with rest breaks, and avoid standing for long periods.
- Tell your midwife about your pain so it can be considered in your birth plan, for example positions that keep the knees closer together.
When to get help
Contact your midwife or doctor if moving around has become difficult, it hurts to get out of a car or turn over in bed, or stairs are painful (NHS, 2022). Being assessed early can help keep pain to a minimum and avoid long-term discomfort.
Contact your midwife or maternity unit straight away if pelvic or back pain comes with bleeding, fluid loss, fever, regular tightenings, pain when passing urine, or a change in your baby's movements. These are not typical of PGP and need to be checked urgently.
Call 999 or go to A&E if you have pain and swelling in one calf, sudden breathlessness or chest pain (possible signs of a blood clot), or numbness around the saddle area (between the legs) with changes in bladder or bowel control.
After the birth
For most women PGP improves after the baby is born, often within weeks. If it lingers, continues to limit you or returns with later pregnancies, a structured programme can help you regain strength and confidence.
Frequently asked questions
Will PGP harm my baby? No. PGP can be painful for you, but it is not harmful to your baby (NHS, 2022).
Should I stop exercising? Usually not. The aim is to change the type of exercise, avoiding positions that provoke pain and keeping the ones that feel comfortable.
Can I still have a vaginal birth? Most women with PGP can. Talk to your midwife about positions that suit you.
The bottom line
Pelvic girdle pain in pregnancy is common, real and treatable. Exercise chosen for you, practical changes to everyday movements and, when helpful, a support belt can make the coming weeks much more manageable.
If you would like an assessment and a programme adapted to your stage of pregnancy, create an account at bpr.clinic and book an appointment with one of our therapists. At the assessment we listen to your history and how your pregnancy is going, look at how you move, and give you a plan you can follow at home until the birth.
References
- Liddle SD, Pennick V. Interventions for preventing and treating low-back and pelvic pain during pregnancy. Cochrane Database of Systematic Reviews. 2015;(9):CD001139. https://doi.org/10.1002/14651858.CD001139.pub4
- Davenport MH, Marchand AA, Mottola MF, et al. Exercise for the prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy: a systematic review and meta-analysis. British Journal of Sports Medicine. 2019;53(2):90-98. https://doi.org/10.1136/bjsports-2018-099400
- Mottola MF, Davenport MH, Ruchat SM, et al. 2019 Canadian guideline for physical activity throughout pregnancy. British Journal of Sports Medicine. 2018;52(21):1339-1346. https://doi.org/10.1136/bjsports-2018-100056
- NHS. Pelvic pain in pregnancy. Page last reviewed 12 December 2022. https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/pelvic-pain/
- Royal College of Obstetricians and Gynaecologists. Pelvic girdle pain and pregnancy (patient information). 2015. https://www.rcog.org.uk/for-the-public/browse-our-patient-information/pelvic-girdle-pain-and-pregnancy/
