March 2010
Pelvic pain in pregnancy
10th March 2010
Pregnancy… A Pain in the Pelvis??
The chances are that either during or after your pregnancy you may have experienced some pain in your low back or pelvic area. It may resolve itself fairly quickly but in some cases pregnancy related pelvic girdle pain can be quite severe and prolonged.
What do we mean by Pregnancy related Pelvic Girdle Pain?
You may have come across some of the different medical terms used to describe this type of pain. Discomfort at the front of the pelvis can be known as symphisis pubis dysfunction (SPD), and at the back of the pelvis it may be described as Sacroiliac joint pain. Guidelines now suggest using the umbrella term Pelvic Girdle Pain (PGP) to group together all of these pre and post natal issues.
It is thought that PGP occurs in as many as 70% of ladies during and after pregnancy, but it is important to remember that it is common, though not normal to have PGP during this time. In around 20% of cases the pain can be quite severe and may prevent walking and climbing stairs. Other more common symptoms include pain or difficulty turning in bed or getting in and out of the car, and you may feel or hear a clicking/grinding sensation in the pelvic area. You may be particularly at risk if you have experienced PGP in a previous pregnancy, have a heavy workload or particularly if you have had any significant low back pain before becoming pregnant.
So what is causing the pain?
Traditionally PGP has been blamed on your hormones particularly one called Relaxin, which allows the joint of the pelvis to become lax in preparation for the birth. It is thought that the small degree of extra movement within the pelvic joints leads to instability, shearing and pain. However it now seems that you are much more likely to suffer with PGP if your pelvic joints start to move asymmetrically, i.e: one side starts to move more that the other, rather than if both sides are just equally lax.
It is also thought that pelvic pain may be caused by the change in the way the deep abdominal and pelvic floor muscles are able to work during pregnancy. These muscles fundamentally support the pelvis and it becomes increasingly hard to provide that foundation as the muscles lengthen and weaken over the pregnancy. These mechanical factors can be addressed by visiting a physiotherapist who will be able to check the position of the pelvis and maintain the strength of your deep muscle through a Pilates based exercise programme.
Pain can also be caused by postural problems due to the growing uterus and the position of the baby causing nerve compression especially towards the end of pregnancy.
You must always consult your GP before visiting any other health care professional to rule out any other factors which may be referring pain to the pelvis, this can include Braxton Hicks contractions or a urinary infection.
What can you do to help the pain?
If you are experiencing PGP, the following options should be discussed with your GP or midwife:
Pain Relief :
- Medication – your GP/pharmacist can advise on over the counter medication for you to take (particularly at night to help with your sleep) so that you are not becoming exhausted by the pain.
- Cold Pack – some women find this helpful to place over the area to decrease inflammation. Never put ice directly on the skin always wrap in a damp tea towel first.
- TENS machine – these use electrical impulses to decrease your pain and avoids the need to take medication. Available in larger chemists and online but it is best to discuss this option with a medical professional first.
Physiotherapy:
An experienced physiotherapist will be able to gently correct the position of the pelvis, which in some cases can give great pain relief.
Once the pelvis is correctly positioned, prescribed exercises should maintain this improvement. Many physiotherapists use a Pilates based exercise approach as this specifically targets the deep core muscles.
In more severe cases your physiotherapist can provide a support belt to ease the pain and walking aids if you need them.
If you are suffering here are some tips to help:
• Try and stay active within the limits of pain
• Avoid standing on one leg, dress sitting down and always stand with your weight evenly on both feet
• Don’t carry children on one hip - this is a large uneven load for the pelvis.
• Sleep in a different position: try on your side with your upper leg fully supported on pillows
• Go up stairs one by one and shorten you walking stride
• Avoid crossing your legs when sitting
• Remember you still need to be careful after the birth (especially when lifting your newborn) as the pelvis will take a while to settle down.
Remember Pelvic Girdle Pain is a treatable condition. Being in pain can be tiring and bring you down at a time that should be exciting and joyful. Don’t struggle on, get help today and free yourself from pelvic pain.
For more details, please contact us.