Pelvic girdle pain (PGP or SPD) in pregnancy: what helps

Pelvic girdle pain is common in pregnancy, and it can be treated. Here’s what it feels like, what helps, and when to ask about a referral.

What is pelvic girdle pain?

Pelvic girdle pain (PGP) is pain in the joints of your pelvis. It used to be called symphysis pubis dysfunction (SPD), and you may still hear that name. The Royal College of Obstetricians and Gynaecologists (RCOG) describes it as pain in the front or back of your pelvis, or both, that can also affect your hips or thighs. The NHS says it’s linked to the pelvic joints being stiff or moving unevenly.

It’s common, and it can be treated

The RCOG says PGP affects 1 in 5 pregnant women. It can be mild or severe, and it’s treatable at any stage of pregnancy. The NHS says PGP is not harmful to your baby, but it can be painful and make it hard to get around.

The RCOG says PGP is not something you just have to put up with until your baby is born.

What it feels like

The NHS says you might feel pain:

over your pubic bone at the front, in the centre
across one or both sides of your lower back
in the area between your vagina and anus (the perineum)
spreading to your thighs

Some people feel or hear a clicking or grinding in the pelvic area. The NHS says the pain is often worse when you’re walking, going up or down stairs, standing on one leg, turning over in bed or moving your legs apart.

What can help

The NHS suggests:

keeping active, but avoiding things that make the pain worse
resting when you can
wearing supportive shoes
putting equal weight on each leg when you stand
sitting down to get dressed or undressed
putting a pillow between your legs in bed
keeping your knees together when you get in and out of the car

The NHS suggests avoiding sitting or standing for long periods, going up and down stairs too often, and lifting heavy things such as shopping bags. The RCOG suggests trying not to sit for more than 30 minutes at a time.

Pain relief. The RCOG says paracetamol is safe in pregnancy and may help if taken in regular doses. Tommy’s, the pregnancy charity, says the NHS recommends paracetamol as the first choice in pregnancy, at the lowest dose and for a short time. If it isn’t helping, Tommy’s says to get advice from your doctor or midwife.

Seeing a physiotherapist

The NHS says getting diagnosed as early as possible can help keep pain to a minimum and avoid long-term discomfort. Tell your midwife or GP about your pain. The NHS says you may be referred to a physiotherapy service that specialises in pelvic joint problems in pregnancy, and NICE guidance says midwives and doctors should consider this referral.

The RCOG says the physiotherapist will assess you to diagnose PGP. Treatment may include:

hands-on treatment (manual therapy) to your muscles and joints
exercises to strengthen your stomach and pelvic floor muscles
a pelvic support belt, or crutches to help you get around

The RCOG says treatment is safe at any stage during or after pregnancy. The NHS says pelvic joint problems tend not to get completely better until the baby is born, but treatment from an experienced practitioner can improve the symptoms during pregnancy.

How you’re feeling

Tommy’s says being in pain every day can wear you down emotionally. The NHS says your physiotherapist should be able to give advice on coping with the emotional side of living with long-term pain. If your pain is causing you a lot of distress, let your GP or midwife know. See anxiety, low mood and loneliness in pregnancy.

Labour and birth

The NHS says many women with PGP can have a normal vaginal birth. Tommy’s says there is no evidence that a caesarean is better for people with PGP. The NHS suggests:

writing in your birth plan that you have PGP, so the people supporting you in labour know about it
thinking about the birth positions that are most comfortable for you, and adding them to your plan
talking to your midwife about using water, which can take the weight off your joints and help you move more easily

The RCOG says all types of pain relief are possible, including an epidural, and that your team will make sure your legs are supported and help you change position. See writing a birth plan and water birth.

After the birth

Tommy’s says PGP improves soon after giving birth for most people. The RCOG says around 1 in 10 women have ongoing pain. Talk to your midwife or GP if you’re still in pain. The RCOG also says that if you’ve had PGP, you’re more likely to have it in a future pregnancy.

When to get help

Call your midwife or GP if you have pelvic pain and it’s hard to move around, or it hurts to get out of a car, turn over in bed, or go up or down stairs. The NHS says these can be signs of PGP.

Tommy’s says the risk of a blood clot in a leg vein (deep vein thrombosis, or DVT) is higher in pregnancy, and that you’re more at risk if you’re not moving around much. Let your midwife or GP know if you’re having difficulty moving.

Call your midwife, GP or NHS 111 straight away if you have swelling, pain or tenderness in one leg, usually at the back of your calf, warm skin in the painful area, or red or darker skin, especially at the back of your leg below the knee. Tommy’s says these can be signs of a DVT.

Call 999 if you’re coughing up blood, have sudden difficulty breathing, or have pain or tightness in your chest or upper back.

Questions people ask

Will PGP harm my baby?

No. The NHS and the RCOG say PGP is not harmful to your baby, although it can be very painful for you.

Will I need a caesarean?

The NHS says many women with PGP can have a vaginal birth, and Tommy’s says there is no evidence that a caesarean is better for people with PGP. Talk to your midwife about your options.

Can I have an epidural if I have PGP?

Yes. The RCOG says all types of pain relief are possible, including an epidural.

Should I buy a support belt?

The NHS says a physiotherapist may recommend a pelvic support belt. Ask your midwife or GP about seeing a physiotherapist, so you get advice on what suits you.

Will I get PGP again next time?

The RCOG says that if you’ve had PGP, you’re more likely to have it in a future pregnancy.