Pelvic Girdle Pain (PGP) / Symphysis Pubis Dysfunction (SPD)
“Although it’s common, it’s not considered normal to have pelvic girdle pain, so it’s not something that you should just put up with.”
Whilst suffering from Severe Pelvic Girdle Pain / Symphysis Pubis Dysfunction there seemed to be a lot of information out there in different places – we have tried to put this information together from the view point of a sufferer who has actually been through the physical and emotional pain of suffering with this condition, the information below is information that we wanted to know about whilst suffering. We are not offering any medical advice, we simply tried to gather information and applied to our own personal experience to try and support other sufferers and hopefully part of this will help others through what should be such a wonderful time!
Pelvic Girdle Pain (PGP), formerly known as Symphysis Pubis Dysfunction, is caused by a pelvic joint problem. PGP / Symphysis Pubis Dysfunction (SPD), is also often called Osteitis Pubis, and Pelvic Girdle Relaxation. The name really depends on whom you talk to about it. In fact, the name is not very relevant. What matters most is that it is recognised as a mechanical joint problem and that the condition is treated as early as possible, as well as treated safely in pregnancy.
PGP (Pelvic Girdle Pain) is a condition which affects up to one in five pregnant women. It was commonly known as SPD (Symphysis Pubis Dysfunction), but this implies that only the symphysis pubis is affected. You may suffer from PGP or SPD or in some cases can suffer from both.
There is a wide range of symptoms and the severity also varies between women. It is important to remember that Pelvic Girdle Pain is common and, in most or some cases it is a treatable condition. It can be safely treated at any stage during or after pregnancy. So if you have pelvic pain during or after a pregnancy, ask for treatment.
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During pregnancy it is believed that your body produces a hormone called Relaxin. Relaxin softens the ligaments, the tough tissues that connect your joints. But also although women are often told that Pelvic Girdle Pain (PGP) is caused by their hormones, the up-to-date research shows that it could be caused by a pelvic joint problem.
Pelvic Girdle Pain causes pain in any or all of the three pelvic joints. Often one joint becomes stiff and stops moving normally and this causes irritation in the other joints which have to compensate. As a result muscles may also be tight and painful.
This means that if it was hormonal the joints in the pelvis can be more mobile during pregnancy. It happens for a good reason. Having lax ligaments helps the baby to pass through the pelvis during birth.
But having lax ligaments doesn’t necessarily cause painful problems. Usually, the nerves and muscles are able to adapt and compensate for the greater flexibility in the joints. This means the body should cope well with the changes to the posture as the baby grows.
“Although having PGP / SPD will also have an effect emotionally on your partner you may resent the fact that it has affected you emotionally but physically too.”
What else causes pelvic pain?
Pelvic girdle pain is likely and can be caused by a combination of factors, including:
- The joints in the pelvis moving unevenly
- Changes to the way the muscles work to support the pelvic girdle joints
- One pelvic joint not working properly and causing knock-on pain in the other joints of the pelvis
Normally, when you lie down, stand up or walk, your pelvis is in a stable and even position. If you have pelvic pain, you’re probably doing these activities with a less stable, uneven pelvis. The result is irritated joints.
These sorts of discomforts are a common feature of pregnancy. At least half of all mums-to-be are thought to have some sort of back pain or pelvic pain at some point. Although it’s common, it’s not considered normal to have pelvic pain, so it’s not something that you should just put up with.
It’s best to seek help early if you start to feel pain, because it can get worse. About one pregnant woman in five develops serious problems and about one in 12 has severe pain or disability resulting from it.
What is pelvic girdle pain (PGP / SPD)?
Pelvic girdle pain (PGP) is the umbrella term that describes pain in the joints of the pelvis, including:
- The joints that connect the triangular bone, or sacrum, that sits between your hip bones at the back of your pelvis. These joints are called the sacroiliac joints.
- The joint that connects the two halves of the front of your pelvis, called the symphysis pubis joint. The term symphysis pubis dysfunction (SPD) is used to describe pain resulting from problems with the symphysis pubis joint.
What are the symptoms of Pelvic Girdle Pain?
The levels and location of pain can vary from woman to woman. The pain may be one-sided or it may appear to jump from side to side. The pain may be a general ache or it may shoot into your buttocks or down the back of your legs.
Some GPs or practice nurses may confuse Pelvic Girdle Pain with sciatica, as this also causes shooting pain down the back of the leg.
You may feel pain:
- in your lower back
- in your symphysis pubis joint (SPD)
- in your sacroiliac joints
- in your groin
- at the front and the back of your thigh
- at the back of your lower leg
- around your hips
- in your pelvic floor and around the opening to your vagina and your anus (your perineum).
What makes pelvic pain worse?
The pain is often made worse by activities that you previously took for granted, such as lying on your back and turning over in bed. Having sex can be painful, lifting, walking round too much, sitting or standing for long periods can make the problem worse too.
Pelvic Girdle Pain is often worse at night, particularly if you’ve been very active during the day. Moving your legs apart, especially when sitting or lying down, can hurt. So getting out of a car or turning over in bed can be painful. You will need to be careful and think more of how you move about.
At what stage in pregnancy does PGP / SPD happen?
PGP / SPD can begin as early as the first trimester or as late as the last few days before giving birth. It can start anytime and even after the birth.
If the pain comes on at the very end of your pregnancy, it may be because your baby’s head is engaging, or moving down into your pelvis. You may even feel pelvic pain for the first time after giving birth.
If you experience Pelvic Girdle Pain in one pregnancy, you may or may not have it again next time you get pregnant. Some women suffer for weeks after birth, some have it for years after too, but not many. It may not be as bad next time if it is well managed from early on, so seek help promptly.
You could consider giving yourself a bit of time from one pregnancy to the next. Losing excess weight, getting fit may reduce the risk of developing Pelvic Girlde Pain in the next pregnancy although there is no direct evidence to support this. It may be worth waiting until your children can walk, reducing the need to lift the children during your next pregnancy.
How is PGP / SPD diagnosed?
Ask your midwife or GP to refer you to a physiotherapist with a qualification from the Association of Chartered Physiotherapists in Women’s Health. You should be able to do this for free if you are referred within the NHS.
If you seek help yourself from a chiropractor or osteopath, make sure that they are experienced in treating pregnant women.
There are lots of groups on Social Media with other women suffering the same symptoms, these groups can be helpful as they are suffering similar to yourself. They understand how you feel, and can sometimes offer advice on support methods and tips!
Your physiotherapist should examine your back and hips to see if the problem is coming from these joints. She’ll take a detailed look at how the muscles of your tummy, back, pelvis and hip are working together.
Some midwives and GP’s will request an x-ray of your pelvis or back, but this would only be done if it was safe during your pregnancy.
How is PGP / SPD treated?
There are a number of tried methods for treating Pelvic Girdle Pain and SPD
Working with your physiotherapist and making some lifestyle changes are the main tactics for treating PGP:
- Maternity Belts can be useful, but make sure that you use maternity belts that actually target the right areas as most maternity belts are to provide Lumbar (back) support and have not actually been designed to manage pain of SPD / PGP
“I purchased the HG maternity support belt when I was 28 weeks pregnant and used it on a daily basis, the support it provided me was fantastic”
View our video page for more information on the HG Maternity Support Belt
- Be careful during everyday activities. Your physiotherapist can show you how to protect your pelvis during movements that are usually painful, such as walking or standing up.
- Your physiotherapist may give you a pelvic support belt. A belt can give relief from pain, particularly when you’re walking, moving around and exercising. The HG maternity support can improve your daily routine giving extra support, it is specifically designed for PGP and SPD and has the support in all the right places whether you have PGP, SPD or both at the same time. – Find out more click here – link to shop
- Exercises, especially for your tummy, pelvic girdle, hip and pelvic floor muscles, aim to improve the stability of your pelvis and back. Exercises in water can be helpful and relaxing.
- Your physiotherapist can gently manipulate your hip, back or pelvis to loosen stiff areas.
- Acupuncture may help to reduce the pain and is safe in pregnancy. But make sure your practitioner is trained and experienced in treating pregnant women. Your midwife or GP might be able to refer you or recommend one.
- If pain is persisting despite physiotherapy treatments and exercises, there are other options to consider. You could try taking regular pain relief, such as paracetamol, or talking to your employer about changes to your work or working hours. Bear in mind that there’s not a lot of evidence to suggest that paracetamol is an effective painkiller. Speak to your GP for advice on how much to take, and for how long. Your midwife may be able to advise you on other ways to treat your pain.
Manual therapy treatment of the pelvic joints and soft tissues is safe and effective during and after pregnancy. This could help.
Will having PGP affect labour?
Most women with PGP are able to have a normal labour and vaginal birth. With the right support, it’s rare for PGP to cause problems, or to be a reason for having labour induced or a caesarean.
If possible, try not to lie on your back to give birth. Try not to get into positions that involve moving one leg only or moving your legs further apart than is comfortable for you.
You’ll find upright or kneeling positions more comfortable, as they protect your pelvic joints. Or you could try lying on your left side. If you want to squat, it’s best to be supported.
It’s worth discussing with your midwife or doctor which positions would be best in case you need an assisted birth. They can talk through your options with you or you may want to see a consultant.
With an assisted birth, a doctor helps your baby to be born with forceps or ventouse. Your doctor will probably ask you to lie on your back with your legs in stirrups to make it easier to help your baby out. You should ask if this way of giving birth will be suitable for you if you are suffereing from PGP or SPD. However, a straightforward ventouse birth may be possible while you lie on your side. Make sure that the healthcare professionals are aware of the condition from the onset and don’t worry about repeating it to them!
If you’re in severe pain, and can’t move much at all, you may be offered a caesarean section. This really would be a last resort, as having a caesarean doesn’t help with PGP. It may slow down your recovery from PGP.
Getting and staying comfortable in bed may be one of your biggest challenges during pregnancy. Backache and pain in your pelvis are just two common niggles that can disturb your slumber.
More than two-thirds of pregnant women suffer from back pain and almost a fifth have pelvic pain. These pains may affect you more as your pregnancy progresses.
Lie on your left side, with your knees bent up and two or more pillows placed between your knees. This keeps the pressure off the muscles around your hips and pelvis. Placing a wedge-shaped pillow under your bump in bed can help ease the strain on your back.
Always make sure that your healthcare professionals are aware of your condition as they will be able to best advise!
What can I do to help myself?
- Be as active as you can, but don’t push yourself so that you feel pain. Resting too may help.
- Stick to the pelvic floor and tummy exercises that your physiotherapist has recommended.
- Ask for and accept offers of help with daily chores. Ask family and friends to help you.
- Plan ahead so that you reduce the activities that cause you problems. You could use a rucksack to carry things around, both indoors and out. This is particularly helpful if your symptoms are so severe you’re having to use crutches. If your pain is severe and your mobility is severe you may need to use a wheelchair. A Zimmer frame might be of use for you around the house. Don’t try to struggle along, use aids that help you.
- Take care to part your legs no further than your pain-free range, particularly when getting in and out of the car, bed or bath. A turn seat might be useful, a bath seat, silk sheets and nightwear that makes getting in and out of bed more easily.
- If you are lying down, roll onto your side, squeeze your knees together, swing your legs off the bed and push yourself up to sitting.
- If you are sitting, pivot round if necessary, keep your feet together, and stand up, using your arms to pull yourself up.
- Avoid activities that make your pain worse or that put your pelvis in an uneven position, such as sitting cross-legged or carrying your toddler on your hip. If something hurts, stop doing it. If the pain is allowed to flare up, it can take a long time to settle down again.
- Try to sleep on your side with legs bent and a pillow between your knees. Long roll pillows may help as you can put the between your knees and round to support your back.
- Rest regularly or sit down for activities you would normally do standing, such as ironing. If you have SPD, you could sit, leaning forwards slightly, on a birth ball to take the pressure off the symphysis pubis joint.
- When you can, get down on your hands and knees to take the weight of your baby off your pelvis. Swimming or just floating in water can help you take the weight off. This might give you some relief.
- Try not to do heavy lifting or pushing. Pushing supermarket trolleys can often make your pain worse, so shop online or ask someone to shop for you.
- Try not to go up and down stairs too often. When you have to climb the stairs, take one step at a time. You may want to face the banisters and hold onto going up stepping up onto one step with your best leg and then bring your other leg to meet it. Repeating with each step up.
- Avoid standing on one leg. When getting dressed, sit down to pull on your knickers or trousers. Ask for help.
Wear a HGR harness for stability, support and comfort
How soon will PGP go away?
PGP usually clears up within a few weeks or a few months of the birth. About one woman in 13 finds it lingers for longer. It’s more likely to persist if you had severe pelvic pain during pregnancy.
Although you’re unlikely to have pain that lingers, you may have a mild recurrence just before your period. Hormones released at this time can have a similar effect to pregnancy hormones.
If your pain does persist, you can help yourself to recover by carrying on with the exercises your physiotherapist gave you during pregnancy. Pilates or yoga are also great for building the type of core strength that keeps pelvic pain at bay.
Emotional effects with having PGP / SPD
You should not feel guilty for having PGP / SPD, it is not your fault, you aren’t the only one with PGP / SPD, it’s a common condition which affects one in five women.
You may feel lots of different emotions during this time, feelings such as:
- feeling frustrated with not being able to look after yourself or your family in the way you used to
- Inadequate and you may feel a burden to your family and friends
- Angry about your loss of independence and finding it difficult to ask for help
- Disconnected from your partner, you may not feel like you can tell him about the pain you’re feeling, tell him how you feel
- Guilty about having PGP, that it is somehow your fault
- Hopeless, wondering if you will ever get better
- Isolated, lonely and not knowing that anyone else is with the same condition as you
- Sad or cheated out of the joy usually felt about pregnancy, this was supposed to be a happy time and you may feel sad about your suffering
- you may be questioning whether you should have become pregnant in the first place, was this your fault.
Sometimes it helps to talk about these feelings with your partner, family or friends rather than bottling them up or some women find it easier to talk to someone outside of the family such as a counsellor. It may be helpful for you and your partner to talk to a relationship counsellor if you are finding that PGP / SPD is having a negative impact on your relationship. You will feel better if you can talk about it rather than bottling it up.
You may have to give up working or doing certain things, you may have to give up your hobbies or activities you enjoy, this can have a huge psychological effect on you, you may resent others that are still able, you may resent the fact that this hasn’t affected your partner. Although having PGP / SPD will also have an effect emotionally on your partner you may resent the fact that it has affected you emotionally but physically too.
Find out more on the HG Maternity Support Belt that has been specifically designed to manage pain during SPD / PGP