Pelvic Pain in Pregnancy Advice Sheet - June 2018
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Pelvic Pain in Pregnancy
Advice Sheet
0128 – Oct 2018 (V2.2)
June 2018
June 2021
During pregnancy some women can suffer from pain around the pelvis, Post-natal Period
over the sacroiliac joints at the back, or symphysis pubis at the front of the
During the post-natal period it is necessary to ensure you are making a
pelvis. Pelvic pain is often dismissed as the normal aches and pains of
steady recovery by continuing to work on the exercises. Often women find
pregnancy but you can do many things to reduce pain and improve
that immediately after birth they start to feel more comfortable, for some
function.
women it takes a little longer.
Classic symptoms of pelvic pain are: If you feel symptoms do not gradually settle you can access physiotherapy
for additional help.
Pain at the front and/or back of the pelvis, sometimes in the groin,
legs or back (maybe one sided or both sides) To do this:
Difficulty walking and doing activities due to pain eg: getting in/ out If you live in the Cambridge or Huntingdon area, access
of the car or bath, dressing, turning over in bed, climbing stairs. www.eoemskservice.nhs.uk and follow the links for ‘self-referral’.
If you live in the East Cambridgeshire and Fenland area you can ask
Symptoms and severity vary between women and between pregnancies in your GP, Midwife or Health Visitor to refer you to your local
the same woman. It is important to adopt lifestyle changes with specific physiotherapy department.
exercises and pain relief as needed. During pregnancy the aim is to ensure
the pelvis functions as well as possible so pain levels are manageable.
Most women recover quickly after giving birth and with appropriate Further Pregnancies
treatment.
If you have had pelvic pain during one pregnancy, it is likely but not
inevitable that you will have pelvic pain with subsequent pregnancies. You
What causes pelvic pain? should be proactive and practise exercises early – you may well find that
your symptoms are not as severe. It is wise to let your body completely
In simple terms the joints around the pelvis become painful. There is often recover before embarking on another pregnancy.
stiffness and pain in the 3 joints that make up the closed ring of the pelvis.
Since the joints are related to each other, any change in movement at one
joint will affect another joint. Discomfort can increase as the pregnancy
progresses when the normal movements of the pelvis change to
accommodate the growing baby.
The role of the pelvis is to transfer weight from the upper body onto the
legs. The pelvis has to withstand strong forces, so joints are placed under
significant stress. The muscles around the pelvis and trunk allow it to
function, and any change in muscle control will place stress on the joints.
During pregnancy hormones affect the pelvis, preparing it to carry a baby
and for the birth itself. The ligaments are more stretchy and offer less
support to the pelvis. When this occurs, the pelvis relies on muscle function
to compensate, but if the muscle function is inadequate, pain may be felt
around the pelvis.
You should aim to achieve good muscle function around the pelvis
and promote good mobility throughout the back and pelvis.
You should also aim to reduce excessive stress on the pelvis by
following the top tips.
Sleeping Top tips:
Getting a good night’s sleep can make such a difference to how you cope. Keep your legs together to help reduce stress and pain when e.g getting
out/ in the car, turning over in bed.
Use analgesia to help you settle
Use a pillow or folded towels between your Keep your body symmetrical when you move, stand, sit.
knees when lying on your side. You may
Be careful when twisting the body and twisting movements.
benefit from one underneath your tummy too.
Be careful when lifting, squatting, crossing your legs, sitting or standing
with your legs apart, walking long distances.
Sexual Relationships
Sex is often affected by pelvic pain as it can be difficult to move Be careful with activities you know will hurt you – listen to your body.
comfortably. Try different positions and use those that are comfortable for Sit down to dress your lower half.
you.
Use an anti-slip mat in the shower/bath – a slip can be very sore.
Birth Be very careful not to slip or trip.
Many women are able to successfully give birth without the need for Wear low heels and shock absorbing footwear to reduce stress through
intervention, however, you will need to work with the midwife looking after the pelvis.
you to achieve this.
Carry shopping equally in each hand and carry babies in front of you,
You will need to adopt positions
not on your hip. Remember the more you carry, the more stress on your
during labour that do not put
pelvis.
excessive pressure on the pelvis.
Experiencing pelvic pain does not Rest. Take the weight off your pelvis. Lie down.
mean you need a caesarean
Plan your day – limit frequent trips up and down the stairs.
section. Some women opt for a caesarean based on pain levels, mobility
and previous experiences amongst many other issues. Ask small children to come to you for cuddles rather than lifting them up.
Gather as much information as possible before making any decisions.
Remember a caesarean is a major operation.
Pain relief
Use ice to relieve pain directly over the pubic bone (frozen peas wrapped in
a damp tea towel). For buttock pain try a heat pack over the painful area:
Think about 3 principles throughout your labour. eg hot water bottle, wheat bag.
Allow the sacrum at the back of the pelvis to move freely. Don’t wait for pain to become a problem, as it is more difficult to relieve.
Encourage effective contractions by making sure your back is straight. Seek advice from your local pharmacist about the use of common
analgesia. Get advice from your GP about analgesia if this is not sufficient.
Measure your ‘pain-free gap’ – the distance you can comfortably
separate your knees. Record this in your maternity notes or birth plan
and make sure it is not exceeded during labour.Exercise Therapy Mini-Squatting
The majority of women will respond well to physiotherapy exercises and Encourage the pelvic floor and deep buttock muscles to
lifestyle modifications. In many cases there is either too much or too little work together by practising mini squats. Keep your feet
movement occurring at one joint in the pelvis, which places excess parallel. Only go as far as you comfortably can.
pressure on other joints. The use of exercises to improve the mobility of the
pelvis and muscle function is usually sufficient to improve this and therefore
ease discomfort, you should practice exercises regularly. Pelvic Tilting
Perform the following exercises in a Encourage the lumbar spine to move freely by tilting your
comfortable position. pelvis backwards.
Aim for up to 10 repeats of each exercise
but you may need to start with fewer and These exercises may cause a pull but should not cause severe or
gradually build up. prolonged pain. If any of the exercises cause a sharp pain or make you
feel worse, stop doing that exercise for a few days, and then try again.
Repeat 2-3 times a day if possible.
Please contact your physiotherapist if you have any questions regarding
this information.
Deep Stomach Muscle
Exercise within your pain limits. Be guided by your pain as to what
Breathe in gently. As you breathe out, gently pull in the lower part of the
you can do.
stomach, drawing your ‘bump‘ in towards your spine. Don’t move your
back. Aim to hold for 5 breaths in and out. Aquanatal exercise classes run by qualified midwives are a good way
to exercise – tell your instructor about your pelvis.
Some women who do not respond well to exercises need to have an
Pelvic Floor Muscles
assessment of their pelvic function, and this can be done by a
Contract your pelvic floor by drawing up your front and back physiotherapist. The physiotherapist can use additional treatment options
passages. The feeling is one of ‘squeeze and lift’. Aim to in conjunction with exercises.
hold for up to 5 breathes in and out.
Use these deep stomach muscles and pelvic floor muscles by
Pelvic Support
gently contracting them during activities that give you
discomfort, such as lifting, getting out of a chair/bed. A physiotherapist may offer you an elasticated tubular support to help
support the pelvis and reduce pain whilst you are doing activities. It should
be worn double thickness to offer a good level of support. It can also be
Deep Buttock Muscles (Gluteus Medius) worn at night if needed. If the elasticated support in not supportive enough
you may be offered a maternity belt. The belts are not suitable to wear
Working these is important, particularly if you have pain on one side of your
when sitting or at night.
pelvis, or if you are worse when walking. In side-lying. Gently contract your
pelvic floor and abdominal muscles. Many companies also make support belts that you can purchase yourself. It
Keep these muscles working as you is wise to ask the advice of a physiotherapist or midwife before purchasing
separate your knees. Do not twist your a belt, since not all belts are suitable. Maternity support pants can be of
spine. If required for comfort do not benefit to some women.
separate your knees so far, use a pillow
Whatever support you are using it need to be low around your pelvis and it
between your knees and feet, and
need to be fitted correctly. Follow the instruction carefully. The support
ensure your pelvic floor and abdominal muscles are working.
should be worn only during activities that give you discomfort.You can also read
