Pregnancy Related Pelvic Girdle Pain (PRPGP)

The Pelvic Girdle

Pregnancy Related Pelvic Girdle Pain is described as pain and reduced function of the hip joints during and sometimes after pregnancy.

You may have heard the term “pelvic girdle” but may be unsure of what it means. The pelvic girdle is a ring of bones around the base of the spine. It has a joint at the front called the pubic symphysis and two joints at the back called the sacroiliac joints.

Some women experience pain in these joints during pregnancy due to changes in posture and the extra weight of the baby, which make the pelvic girdle more unstable. The pain can remain during childbirth and in the time after birth (the postpartum) in some women.

Certain women are more at risk of Pregnancy Related Pelvic Girdle Pain (PRPGP). This includes those with a history of hyper-mobility (loose joints) or previous injuries to the pelvis or back. A woman with Pelvic Girdle Pain (PGP) in one pregnancy, has a higher risk of PGP in future pregnancies although this risk can be reduced by maintaining her overall health and fitness, and strengthening her abdominal and pelvic floor muscles between pregnancies.

What are the symptoms of Pregnancy Related Pelvic Girdle Pain?

Common PRPGP symptoms range from mild to severe pain and disability when walking, going up and down stairs, getting in and out of the car, rolling over in bed or during sexual intercourse. The pain may be felt in the pubic symphysis and/or the sacroiliac joints but may extend to the lower back, lower abdomen, groin, hips, thighs, knees and legs. Popping and clicking sounds might also be present.

Maintaining a healthy balance of activity and rest helps to reduce the symptoms. Other useful hints include tucking in the tailbone while standing and keeping the knees together when getting in and out of the bed or car. A pillow to support the bump and legs while in bed can also minimise the pain.

How can Pregnancy Related Pelvic Girdle Pain be treated?

Generally, an early assessment and diagnosis by a physiotherapist is key to treating PRPGP successfully. The physiotherapist will recommend appropriate strengthening exercises and support garments such as belts and shorts. They may also perform manual therapy (hands-on treatment) to the affected muscles and joints. Other treatments include hydrotherapy and acupuncture. Helpful aids include heat packs, or sometimes ice packs. Crutches or a wheelchair are only required for severe cases, as it is best to move normally if you can.

What are the birth options with PRPGP?

Most women with PGP in pregnancy can have a normal vaginal birth, including an epidural. However it is best to discuss your individual case with your birth team.

What happens after birth?

Pregnancy Related Pelvic Girdle Pain usually improves after birth although some women have ongoing pain, requiring further physiotherapy treatment and maybe referral to a specialist.

7 tips to help manage your pain:

Avoid standing on one leg (e.g. get dressed in sitting, minimise stair use)
Zip your legs together and swivel when moving in/out of the car
Wear supportive footwear when on your feet for prolonged periods or walking
ICE will help settle inflammation at the joints. You can ice your pubic bone and the joints where the pelvis meets the spine at the lower back. 20 mins every 2 hours
Sleep with a pillow between your knees and feet
Have rest time throughout your day
Avoid doing too much at once

Pelvic Girdle Pain can occur during pregnancy and can present as pain or discomfort in the following areas:

Low back
Hip
Coccyx
Pubic bone

A Women’s Health Physiotherapist can help you. Based on an individualized assessment treatment may include;

Massage to loosen tight muscles
Correcting pelvis biomechanics
Strengthening exercises
Prescribed pelvic support if required

Where can I find more information?

The Mater Hospital in Brisbane has an excellent brochure with practical advice, available at the following link:

http://brochures.mater.org.au/brochures/mater-mothers-private-brisbane/pelvic-girdle-pain-physiotherapy-hints-to-relieve

Further information is available through a Liverpool Women’s Hospital in the United Kingdom at:

http://www.liverpoolwomens.nhs.uk/media/1345/pelvic_girdle_pain_leaflet.pdf

The Patient Journey – Michelle’s Story

I am a mother of three. I had a perfect first pregnancy, mild PRPGP with my second and severe PRPGP with my third. During this last pregnancy, I developed groin and back pain in the first trimester which continued to worsen as the pregnancy progressed. The pain was excruciating when I tried to get out of bed, walk or go up and down stairs. Driving became impossible and I became housebound. I could not care for myself,let alone my family.

I hoped the pain would resolve after the birth of my baby, but that was not the case. I saw numerous specialists before finally getting some answers from a pain specialist. I had become so de-conditioned through inactivity during the pregnancy, and the pain had been going on for so long that it became a chronic (long term) pain. I needed to change my lifestyle. We moved to a house with less stairs where I started my rehabilitation and worked towards recovery. I had physiotherapy and acupuncture home visits and began doing strengthening exercises recommended by the physiotherapist. I slowly became stronger, and once I could drive again I began hydrotherapy and a gym program.

My youngest child is now one and a half years old. I still have a long way to go, but I know I’m on the right track… I’m even training for a charity triathlon at the moment.

If I could do it all again I would improve my overall strength and fitness between pregnancies and access physiotherapy and acupuncture treatments at the first signs of PRPGP.