Pregnancy Related Pelvic Girdle Pain (PRPGP)

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

The pelvic Girdle

The pelvic Girdle

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.

The pelvic Girdle

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.

The pelvic Girdle

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.

The pelvic Girdle

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.

The pelvic Girdle

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.

 

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 pelvic Girdle

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.

The pelvic Girdle

References

https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-pelvic-girdle-pain-and-pregnancy.pdf

https://beta.health.gov.au/resources/pregnancy-care-guidelines/part-i-common-conditions-during-pregnancy/pelvic-girdle-pain

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1181256/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987347/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4196110/

https://www1.racgp.org.au/ajgp/2018/july/pelvic-girdle-pain-in-pregnancy

https://www.bmj.com/content/331/7511/249

https://www.pregnancybirthbaby.org.au/pelvic-pain-during-pregnancy