The Lowdown on Pelvic Pain During Pregnancy: Understanding and Managing Discomfort

With all the research presented to us with regard to adopting a side-sleeping position as opposed to sleeping on your back or your tummy, it is safe to assume that all pregnant mums will be snoozing on their sides. But some women suffer from chronic pelvic pain during pregnancy – Symphysis pubis dysfunction (SPD) or pelvic girdle pain (PGP) – making it very difficult to get comfortable and to sleep on their sides in particular.

Sleeping on your side can be lifesaving and can lower your risk of experiencing a stillbirth. According to research, women who suffered a stillbirth after 28 weeks gestation were 2.3 times more likely to have slept on their backs than on their sides, the night before the stillbirth occurred. 

With such compelling evidence to support sleeping on your side during pregnancy, what can be done to help mothers who are afflicted with pelvic girdle pain? 

Furthermore, how can you make sleeping on your side through the night an easier task? In this article, we’ll discuss about pelvic pain during pregnancy and how to get relief from this condition.

Where Is the Pelvis Located

The pelvis is located in the lower part of the trunk, connecting the trunk to the legs. It is a basin-shaped complex of bones that supports and balances the trunk and contains and supports the intestines, urinary bladder, and internal sex organs.

The pelvis consists of paired hipbones, which are connected in the front at the pubic symphysis and in the back by the sacrum. It is made up of three bones: the ilium, which accounts for the width of the hips; the ischium, on which the weight falls in sitting; and the pubis. These three bones unite at a triangular suture in the acetabulum, forming the hip joint with the femur.

The pelvis serves as the birth canal in females and provides attachment for muscles that balance and support the trunk and move the legs, hips, and trunk.

Image Source: iStock

Pelvic Pain During Pregnancy

Symphysis pubis dysfunction (SPD), or pelvic girdle pain (PGP)

SPD is an uncomfortable pregnancy condition that affects 1 in 300 pregnancies. Pregnancy comes with a host of uncomfortable aches and pains, and pelvic pain that involves your symphysis pubis joint, which is located in front of the pubic bone, is a common complaint.

Prior to delivery, your ligaments are supposed to stretch and relax. This is your body’s response in conjunction with getting ready for the birth of your child.

SPD occurs when the ligaments that normally keep your pelvic bone aligned during pregnancy, relaxes and stretches well before your due date, leading to making the pelvic joint, that is the symphysis pubis, unstable.

The painful condition causes pain in your pelvis, a sensation that the two sides of your pubic bone are sliding up and down against each other, as well as a few other uncomfortable symptoms that we will read about. 

It is estimated that up to 60% of women experience pain in their symphysis pubis while pregnant, according to Dr Sheila Hill, an OB-Gynaecologist in the hospitalist division of Texas Children’s Pavilion for Women.

In its most severe form, SPD can lead to an actual separation of the pubic bone, with women experiencing extremely painful pelvic and hip pain in this case. However, Dr Hill notes that pubic bone separation is uncommon, occurring in less than 1 per cent of pregnancies.

SPD or PGP is different from lightening crotch, which is the usual cause of pelvic pain during pregnancy in the third trimester.

Causes of Pelvic Pain During Pregnancy

Experiencing pelvic pain during pregnancy can be uncomfortable and worrisome for expecting mothers. It’s important to understand the potential causes of this pain to ensure a healthy and comfortable pregnancy. In this listicle, we’ll explore seven common causes of pelvic pain during pregnancy, providing casual yet informative insights.

1. Ligament Stretching: As your body prepares for childbirth, the ligaments in your pelvic area stretch and become less stable, leading to discomfort and pain.

2. Pelvic Floor Overcompensation: Due to ligament changes, the pelvic floor may overcompensate, resulting in pain when standing, walking, or running.

3. Cervical Stenosis: Narrowing of the opening to the womb can cause chronic pelvic pain during pregnancy.

4. Interstitial Cystitis: This chronic bladder condition can lead to persistent pelvic pain during pregnancy.

5. Irritable Bowel Syndrome (IBS): IBS, a condition affecting digestion, can cause discomfort in the pelvic region during pregnancy.

6. Muscle Spasms: Pelvic floor muscle spasms can contribute to chronic pelvic pain during pregnancy.

7. Vascular Conditions: Certain vascular conditions affecting the blood vessels in the pelvic region may result in ongoing pelvic pain throughout pregnancy.

Who’s at Risk for Getting Pelvic Pain During Pregnancy

During pregnancy, certain factors can increase the risk of experiencing pelvic pain. One common cause is round ligament pain, which occurs as the uterus grows and the ligaments supporting it shift to accommodate the growth.

Pelvic floor pain is also common and can be influenced by hormonal changes and previous pelvic floor injuries. Cramping, particularly in early pregnancy, may be caused by the expanding uterus or rising progesterone levels. Additionally, conditions like ovarian torsion and ectopic pregnancy pose a risk for pelvic pain during pregnancy.

It’s important to seek medical attention if the pain is severe, accompanied by bleeding, or persists for an extended period

Symptoms of SPD in Pregnancy

SPD is a debilitating condition that affects around 60% of pregnant women. Photo: iStock

SPD pain is characterised as a focused pain in the pubic and groin area, but in some case, it radiates to the upper thighs and perineum. 

The most common symptoms are difficulty when walking, and a wrenching pain that feels like your pelvis is tearing apart. 

You may also suffer from the following:

• Back and/or hip pain, and pain at the back of your pelvis or hip 
• Pain together with a grinding or clicking sensation in your pubic area
• Inner thigh pain or pain between your legs
• Pain that worsens when you part your legs, walking, perform weight-bearing activities, take the stairs or move around in bed
• Pain that worsens at nighttime and disrupts your sleep. The pain sometimes makes going to the bathroom in between sleep, extremely painful

The condition can occur at any time during your pregnancy or after giving birth, and you may notice it for the first time during the second trimester of your pregnancy.

How to Relieve Pelvic Pain During Pregnancy

There are many ways on how to ease pelvic pain during pregnancy. Some of these are physiotherapy, exercise, massage, and acupuncture. 

Physiotherapy is the best treatment for SPD. Aside from minimising your pain, it can also help improve muscle function and help stabilise your pelvic joint and its position.

You can also wear a belly band, or a pregnancy support band to support the pelvic bones and help maintain correct alignment, thereby reducing pain.

Meanwhile, there are a lot of exercises for pelvic pain during pregnancy. These include exercises in the water, which will help take the stress away from your joints so you can move better. You can also try Pilates, which focus on posture control and core support. 

Other exercises for pelvic pain during pregnancy that you can try are pelvic titles, pelvic circles, inner thigh stretch, and child’s pose stretch. 

Furthermore, we all know that a prenatal massage has many benefits. How about getting a massage for pelvic pain in pregnancy? 

A 2020 study showed that massage for pelvic pain in pregnancy can play a part in managing the condition and providing relief. 

When it comes to how to ease pelvic pain during pregnancy, here are some things you should avoid:

• Pushing and carrying heavy objects, including your toddler
• Standing on one leg
• Bending or twisting to carry something
• Sitting or standing for a long period of time
• Crossing your legs
• Vacuuming 

How to Sleep With Pelvic Pain During Pregnancy 

Sleeping with a pillow in between your knees will help alleviate SPD. Photo: iStock

There are a few steps you can take to ensure sleeping on your side is a little easier if you suffer from SPD. 

• Sleep with a pillow in between your knees. This will help keep your pelvis aligned and will take the stretch off your hip and pelvic muscles when lying on your side by slightly elevating your top leg. A regular extra pillow may be used for this purpose, or you may want to invest in a specialised pregnancy pillow, a body pillow or leg spacer.
• Prop a pillow under your belly when sleeping to lift your stomach. This also takes pressure off your low back and improve your spinal and pelvic alignment
• Swap your regular cotton nightwear with silk or satin pajamas as you can slide around in bed, rather than having to pick yourself up to turn over
• Continue wearing your belly band even when sleeping

However, if none of this works and you are very uncomfortable sleeping on your side, trying sleeping at an incline position. You can also try sleeping in a recliner chair or on the couch propped up with pillows.

We hope these tips answer your question of how to sleep with pelvic pain during pregnancy.

How to Prevent Pelvic Pain During Pregnancy

Experiencing pelvic pain during pregnancy is a common occurrence due to the changes happening in your body. This discomfort can range from pressure to sharp pains, making it important to find ways to prevent and alleviate pelvic pain.  Here are eight tips that can help you prevent pelvic pain during pregnancy:

1. Take Frequent Breaks: Avoid standing or sitting for extended periods. Take breaks, stretch, and change positions regularly to relieve pressure on your pelvis.

2. Practice Good Posture: Maintain proper posture to distribute weight evenly and reduce strain on your pelvic region. Use supportive cushions or a pregnancy pillow for added comfort.

3. Wear Supportive Shoes: Opt for comfortable shoes with good arch support to minimise stress on your pelvic joints. Avoid high heels and choose footwear that provides stability and cushioning.

4. Exercise Regularly: Engage in pregnancy-safe exercises such as prenatal yoga, swimming, or walking to strengthen your core and pelvic muscles. Consult with your healthcare provider for suitable exercise routines.

5. Practice Pelvic Floor Exercises: Strengthening your pelvic floor muscles can provide support to your pelvis. Perform Kegel exercises regularly to strengthen these muscles and reduce the risk of pelvic pain.

6. Use Proper Body Mechanics: When lifting objects or performing daily activities, use your legs instead of your back to minimise strain on your pelvic region. Avoid heavy lifting and ask for assistance when needed.

7. Sleep in a Comfortable Position: Use pregnancy pillows or regular pillows to support your belly and align your body while sleeping. Sleeping on your side with a pillow between your knees can help prevent pelvic discomfort.

8. Practice Stress Management: Stress can contribute to muscle tension and exacerbate pelvic pain. Engage in relaxation techniques such as deep breathing, meditation, or prenatal massages to reduce stress levels and promote overall well-being.

When to Seek Help

When should I worry about pelvic pain during pregnancy?

While most home remedies can help alleviate the pain caused by SPD, there are instances when medical advice should be sought. Do not hesitate to consult your doctor …

• If you experience intense or severe cramping in the pelvic region.
• If the pain gets progressively worse or does not subside.
• If there is heavy bleeding similar to a period.
• If you notice blood in the urine.
• If you have symptoms of a kidney stone, such as intense back pain and cramping.
• If there are signs of liver problems, such as upper right abdominal pain.
• If you have a fever accompanying pelvic pain.
• If you are unable to tolerate the pain or it becomes unbearable.
• If you have symptoms of an ectopic pregnancy, such as sharp and overwhelming pain, especially if you are at risk factors like previous ectopic pregnancy or pelvic inflammatory diseases.

Remember, talk to your doctor about safe pain relief medication if your pain is too severe. It is important to know the difference between SPD/PGP and lightning crotch, which is pelvic pain during pregnancy in the third trimester. 

Pregnancy is a long journey that can sometimes be made difficult by conditions such as these. We hope you hang in there mamas, and that our tips help you.