Pelvic Girdle Pain in Pregnancy: Causes, Relief & Treatment

What Is Pelvic Girdle Pain During Pregnancy?

Pelvic girdle pain (PGP) is pain that originates from the pelvic joints during pregnancy, including the symphysis pubis at the front and the sacroiliac joints at the back. It is caused by increased levels of the hormone relaxin, which loosens ligaments and allows excessive movement in these joints. Approximately 20% of all pregnant women are affected.

The pelvis is a ring of bones held together by strong ligaments at three joints: the pubic symphysis at the front, where the two halves of the pelvis meet, and the two sacroiliac (SI) joints at the back, where the pelvis connects to the spine. During pregnancy, the body produces the hormone relaxin, which causes these ligaments to become softer and more elastic. This natural process prepares the pelvis to widen slightly during childbirth, making it easier for the baby to pass through the birth canal.

However, when the ligaments become too loose, the pelvic joints can develop excessive movement and become unstable. This instability places extra strain on the surrounding muscles, which must work harder to compensate for the lack of ligamentous support. The result is pain and inflammation in and around the pelvic joints, which can range from mild discomfort to severe, debilitating pain that significantly affects daily life. Research published in the European Spine Journal has shown that the degree of ligament laxity does not always correlate directly with pain levels, suggesting that muscle strength, posture, and individual anatomy also play important roles.

Pelvic girdle pain is an umbrella term that encompasses several related conditions. Symphysis pubis dysfunction (SPD) specifically refers to pain and excessive movement at the pubic symphysis, while sacroiliac joint dysfunction involves the joints at the back of the pelvis. Many women experience pain in multiple pelvic joints simultaneously. The condition has been known by many names over the years, including pelvic instability, pelvic relaxation, and the older term "joint loosening."

It is important to understand that PGP is a mechanical problem, not a sign that anything is wrong with the pregnancy itself. The condition does not affect the baby and does not increase the risk of pregnancy complications. However, the pain can significantly impact quality of life, sleep, and mental well-being, which is why early recognition and treatment are important.

The Three Pelvic Joints

Understanding which joints are involved helps explain the pattern of symptoms. The pubic symphysis is a fibrocartilaginous joint at the front of the pelvis. During pregnancy, a gap of up to 9-10 mm is considered normal, but widening beyond this (known as diastasis symphysis pubis) can cause significant pain. The two sacroiliac joints connect the sacrum (the triangular bone at the base of the spine) to the iliac bones on each side. These joints normally allow very little movement, but pregnancy-related laxity can increase their range of motion, leading to instability and pain that often radiates into the buttocks or down the leg.

Who Gets Pelvic Girdle Pain?

Research shows that PGP can affect any pregnant woman, but certain factors increase the risk. Women who had PGP in a previous pregnancy are at significantly higher risk of recurrence, with studies showing rates of 40-70% in subsequent pregnancies. Other risk factors include a history of lower back pain before pregnancy, physically demanding work involving heavy lifting or prolonged standing, a high body mass index (BMI), and hypermobility of joints. Multiparity (having had multiple pregnancies) is also associated with increased risk, possibly due to cumulative effects on the pelvic ligaments.

What Are the Symptoms of Pelvic Girdle Pain?

The main symptoms of pelvic girdle pain include pain over the pubic bone, pain in the lower back and buttocks at the sacroiliac joints, difficulty walking, pain when climbing stairs, a clicking or grinding sensation in the pelvis, and difficulty turning over in bed. Pain typically worsens with weight-bearing activities and standing on one leg.

Pelvic girdle pain during pregnancy can manifest in a variety of ways, and the severity and location of symptoms vary considerably from one woman to another. Some women experience only mild discomfort that is noticeable during certain activities, while others develop severe pain that limits their ability to walk, work, and carry out everyday tasks. The pain often begins gradually and tends to worsen as the pregnancy progresses and the baby grows heavier, placing increasing load on the pelvic joints.

The most characteristic symptom is pain over the pubic bone (symphysis), which may feel like a deep ache, sharp stabbing pain, or a burning sensation. This pain is often aggravated by activities that involve separating the legs, such as getting in and out of a car, climbing stairs, or turning in bed. Many women also describe a feeling of the pelvis "giving way" or being unstable, particularly when standing on one leg, for example while getting dressed.

Pain in the sacroiliac joints at the back of the pelvis is equally common and may radiate into the buttocks, the back of the thighs, or the groin. Some women describe the sensation as similar to sciatica, though true sciatic nerve compression is a separate condition. The pain typically increases with prolonged sitting, standing, or walking, and often feels worse at the end of the day after accumulated physical activity.

A distinctive feature of PGP is a clicking, popping, or grinding sensation in the pelvic area, which occurs as the loosened joints move more than they should. While this can be alarming, it is generally not harmful. Some women also notice that the pain switches sides or seems to move around the pelvis from day to day, reflecting the involvement of multiple joints.

Activities That Trigger Pain

Understanding which activities tend to aggravate PGP is important for managing the condition. Common triggers include walking (especially on uneven ground or for long distances), climbing stairs, standing on one leg (such as when putting on trousers or shoes), getting in and out of a car, carrying heavy objects, and prolonged sitting or standing in one position. Many women find that the pain is at its worst at night, when turning over in bed becomes painful and sleep is disrupted.

When Symptoms Become Severe

In approximately 5-8% of pregnant women with PGP, symptoms become severe enough to significantly impact daily functioning. These women may need to use crutches or a walking frame to get around, may be unable to work, and may require help with basic activities like cooking, cleaning, and caring for older children. In very rare cases, women may become largely immobilized and require a wheelchair. Severe PGP can also have a significant impact on mental health, leading to anxiety, depression, and feelings of isolation. If you find that your pain is escalating and you are unable to manage daily activities, seek help from your healthcare provider promptly.

What Causes Pelvic Girdle Pain in Pregnancy?

Pelvic girdle pain is primarily caused by the pregnancy hormone relaxin, which loosens the ligaments holding the pelvic joints together. This creates instability that the surrounding muscles must compensate for, leading to pain and inflammation. Additional contributing factors include the weight of the growing baby, changes in posture and center of gravity, and the mechanical stress of pregnancy on the musculoskeletal system.

The primary cause of pelvic girdle pain is hormonal. During pregnancy, the ovaries and later the placenta produce increasing amounts of the hormone relaxin, along with estrogen and progesterone. These hormones work together to soften the connective tissue and ligaments throughout the body, but their effects are particularly pronounced in the pelvis. Relaxin specifically targets the collagen in ligaments, making it more elastic and allowing the pelvic joints to become more mobile. This is a biologically advantageous process, as it allows the pelvis to expand slightly during labor to facilitate the passage of the baby.

However, when this loosening process goes too far, or when the muscles that normally stabilize the pelvis are not strong enough to compensate for the increased laxity, the result is pelvic joint instability. The joints begin to move in ways they are not designed to, causing irritation of the joint surfaces, inflammation of the surrounding tissues, and strain on the muscles and ligaments. This is the fundamental mechanism behind pelvic girdle pain. Research from the British Journal of Sports Medicine has demonstrated that women with PGP often have reduced strength in the pelvic floor muscles, gluteal muscles, and deep abdominal muscles compared to pregnant women without PGP.

The weight of the growing baby and uterus adds significant mechanical stress to the pelvis, particularly in the second and third trimesters. As the baby grows, the center of gravity shifts forward, causing many women to adopt a swayback posture with increased lumbar lordosis (inward curve of the lower spine). This altered posture changes the forces acting on the pelvic joints and can exacerbate the instability caused by hormonal laxity. The combined effect of hormonal and mechanical factors explains why PGP typically worsens as the pregnancy progresses.

Other contributing factors include asymmetric movement patterns in the pelvis, where the two sacroiliac joints move unevenly, creating shearing forces across the pubic symphysis. Previous injury to the pelvis or lower back, poor core muscle strength before pregnancy, and occupations that involve heavy lifting, prolonged standing, or repetitive bending can all increase the likelihood of developing PGP. There is also emerging evidence that psychological factors, such as high levels of stress or anxiety, may influence pain perception and the development of chronic symptoms.

Hormonal Changes Throughout Pregnancy

Relaxin levels begin to rise in the first trimester and typically peak around weeks 12-14, which explains why some women develop PGP symptoms earlier than expected. However, the clinical effects of relaxin on joint laxity continue throughout pregnancy and may even increase in the later stages as the ligaments become progressively softer. After delivery, relaxin levels drop relatively quickly, which is why most women experience significant improvement in their PGP symptoms within the first few months postpartum. If breastfeeding, relaxin levels may remain slightly elevated, which can delay recovery in some women.

Risk Factors for Developing PGP

Several factors have been identified that increase a woman's risk of developing pelvic girdle pain during pregnancy. The most significant is a history of PGP in a previous pregnancy, which raises the risk of recurrence to 40-70%. Other established risk factors include a history of lower back pain or pelvic injury, high BMI, multiparity, physically demanding work, and hypermobility syndrome. Interestingly, age does not appear to be a significant independent risk factor, and PGP affects both first-time mothers and experienced mothers.

• Previous PGP: 40-70% risk of recurrence in subsequent pregnancies
• Lower back pain history: Pre-existing musculoskeletal conditions increase vulnerability
• High BMI: Additional weight increases mechanical load on pelvic joints
• Multiparity: Cumulative ligament laxity from multiple pregnancies
• Physical work: Heavy lifting and prolonged standing increase risk
• Hypermobility: Naturally loose joints are more susceptible to instability

How Can I Relieve Pelvic Girdle Pain at Home?

You can relieve pelvic girdle pain at home by keeping your knees together when turning or getting out of bed, sleeping with a pillow between your knees, avoiding standing on one leg, taking shorter steps when walking, sitting down to get dressed, and using a pelvic support belt. Rest when needed, but stay as active as possible within your pain limits.

Managing pelvic girdle pain effectively often starts with making simple but important changes to how you move in daily life. The core principle is to minimize asymmetric loading of the pelvis, which means avoiding movements that put unequal forces on the two sides of the pelvis. This is why activities like standing on one leg, climbing stairs, or stepping over obstacles tend to aggravate pain, while symmetric movements like walking with small, even steps or swimming are better tolerated.

One of the most impactful changes you can make is to keep your knees together when turning in bed. Instead of rolling with your legs apart, bend your knees, squeeze them together, and roll as a unit. Placing a satin or silk sheet on the bed can reduce friction and make turning easier. When getting out of bed, bring your knees together, roll onto your side, and push yourself up with your hands while swinging your legs off the bed simultaneously. These small adjustments prevent the twisting motion that irritates the pelvic joints.

Sleeping with a firm pillow between your knees is one of the simplest and most effective strategies for managing nighttime pain. The pillow keeps the pelvis in a neutral, aligned position and prevents the top leg from pulling the pelvis into an uncomfortable rotation. A full-length pregnancy pillow that supports both the belly and the legs can be particularly helpful. Some women find it helpful to also place a thin pillow under the belly for additional support.

During the day, sit down to get dressed rather than standing on one leg to put on pants, socks, or shoes. When walking, take shorter, more even steps and try to avoid uneven surfaces. If climbing stairs is unavoidable, go one step at a time, leading with your stronger leg going up and your weaker leg going down. Avoid carrying heavy bags on one side; use a backpack or divide the weight equally between two hands.

While rest is important when pain is acute, it is equally important to stay as active as possible within your pain limits. Complete rest and inactivity can actually worsen PGP by allowing the stabilizing muscles to weaken further. The goal is to find a balance between activity and rest, pacing yourself throughout the day and avoiding prolonged periods in any one position.

Sleeping Positions and Night Pain

Night pain is one of the most challenging aspects of PGP because it disrupts sleep, leading to fatigue that can lower your pain threshold and worsen symptoms the following day. The best sleeping position is on your side with a pillow between your knees and ankles. Keep the pillow thick enough to keep your top leg level with your hip, preventing the pelvis from dropping and twisting. If you need to turn over during the night, bend both knees, squeeze them together around the pillow, and roll slowly as a unit. Some women find that placing a folded towel under the waist area when lying on their side provides additional support and comfort.

Pain Management Without Medication

Non-pharmacological pain management strategies can be very effective for PGP. Ice or cold packs applied to the painful area for 15-20 minutes can reduce inflammation and numb acute pain. Warm baths (not hot) can relax tense muscles and provide temporary relief. Gentle massage of the buttock muscles and lower back can help release muscle tension that develops as a result of the pelvic instability. Some women find relief from using a TENS (transcutaneous electrical nerve stimulation) machine, which is considered safe during pregnancy when used on the back or pelvis (but should not be placed on the abdomen).

What Exercises Help Pelvic Girdle Pain?

The most effective exercises for pelvic girdle pain include pelvic floor exercises (Kegels), deep abdominal muscle activation, gentle pelvic tilts, bridging exercises, and swimming or water-based exercise. These strengthen the muscles that stabilize the pelvis and compensate for loosened ligaments. Always work within your pain-free range and consult a physiotherapist for a personalized program.

Exercise is a cornerstone of PGP management, but it must be the right type of exercise performed correctly. The goal is to strengthen the muscles that provide stability to the pelvis, particularly the pelvic floor muscles, the deep abdominal muscles (transversus abdominis), the gluteal muscles, and the deep muscles of the hip. A Cochrane systematic review found that structured exercise programs designed specifically for pregnancy-related pelvic pain can reduce pain intensity and improve function, especially when started early.

The pelvic floor muscles form a hammock-like structure at the base of the pelvis and play a critical role in stabilizing the pelvic joints from below. Strengthening these muscles helps compensate for the ligamentous laxity caused by relaxin. To perform pelvic floor exercises, contract the muscles as if you are trying to stop the flow of urine mid-stream. Hold for 5-10 seconds, then release slowly. Aim for 10 repetitions, three times daily. It is important to also practice quick, strong contractions (flicks) to train the fast-twitch muscle fibers that activate during sudden movements like coughing or sneezing.

The transversus abdominis is the deepest abdominal muscle and acts like a natural corset, providing essential support to the pelvis and lower back. To activate it, lie on your side or sit upright and gently draw your lower abdomen inward, as if pulling your belly button toward your spine. Hold for 10 seconds while breathing normally. This is a subtle movement, not a forceful contraction. When performed correctly, you should feel a gentle tightening deep in your lower abdomen without any movement of your pelvis or spine. Practice this activation throughout the day, especially before any activity that might trigger pain.

Swimming and water-based exercise are often recommended as the ideal forms of cardiovascular exercise for women with PGP. The buoyancy of water supports your body weight, reducing the load on the pelvic joints while allowing you to exercise the stabilizing muscles. Water aerobics classes designed for pregnant women can be particularly beneficial. Avoid breaststroke kick, as the wide leg movement can aggravate symphysis pain. Instead, use a front crawl or backstroke kick, keeping your legs relatively close together.

Stationary cycling is another well-tolerated activity, as the seated position removes weight from the pelvis while allowing the legs to move in a symmetric pattern. Adjust the seat height so that your legs do not extend fully at the bottom of the pedal stroke, and keep the resistance light to moderate. Walking can also be continued if tolerated, but keep the distance short, wear supportive shoes, and walk on flat, even surfaces.

Exercises to Avoid

Certain exercises can worsen pelvic girdle pain and should be avoided or modified. High-impact activities such as running, jumping, and step aerobics place excessive force through the pelvic joints. Exercises that involve wide leg movements, such as lunges, squats with wide stance, and breaststroke swimming, can strain the pubic symphysis. Heavy weightlifting and exercises that involve standing on one leg should also be avoided. If any exercise causes pain during or after the activity, stop and consult your physiotherapist for an alternative.

How Is Pelvic Girdle Pain Treated?

Treatment for pelvic girdle pain typically involves physiotherapy with manual therapy and exercise, a pelvic support belt for external stability, pain-safe positioning strategies, and, when necessary, acetaminophen (paracetamol) for pain relief. Acupuncture has shown moderate evidence of effectiveness. In severe cases, crutches or a walking frame may be needed.

The management of pelvic girdle pain during pregnancy follows a multi-modal approach that combines physical therapy, lifestyle modifications, supportive devices, and, when necessary, medication. The overarching goal is to reduce pain, improve function, and maintain quality of life while ensuring the safety of both the mother and baby. Early intervention is key: research consistently shows that women who begin treatment soon after symptom onset have better outcomes than those who delay seeking help.

Physiotherapy is the first-line treatment and the most evidence-based intervention for PGP. A physiotherapist specializing in women's health or musculoskeletal pregnancy care can perform a thorough assessment to identify which pelvic joints are affected, evaluate muscle strength and coordination, and develop an individualized treatment plan. Treatment typically includes manual therapy techniques such as soft tissue massage, joint mobilization, and myofascial release to address muscle imbalances and joint dysfunction. The physiotherapist will also teach you a tailored exercise program and movement strategies for daily activities.

A pelvic support belt (also called a sacroiliac belt or trochanteric belt) is a simple but effective device that provides external compression and stability to the pelvic joints. The belt is worn around the hips, below the belly, at the level of the greater trochanters (the bony prominences on the outside of the hips). When fitted correctly, it helps hold the pelvic joints together, reducing the excessive movement that causes pain. Studies published in the Journal of Clinical Nursing have shown that pelvic support belts can reduce pain and improve function, particularly when used in combination with exercise.

Pain medication during pregnancy requires careful consideration. Acetaminophen (paracetamol) is generally considered the safest option for pain relief during pregnancy and can be used at standard doses for short-term symptom management. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen should generally be avoided during pregnancy, particularly in the third trimester, as they can affect fetal kidney function and the closure of the ductus arteriosus. Always consult your healthcare provider before taking any medication during pregnancy.

Acupuncture has shown moderate evidence of effectiveness for pregnancy-related pelvic pain in several clinical studies, including a randomized controlled trial published in the British Medical Journal. When performed by a qualified practitioner experienced in treating pregnant women, acupuncture appears to be safe and may provide meaningful pain relief. It can be used alongside other treatments as part of a comprehensive management plan.

When to Consider Additional Help

If standard physiotherapy and self-management strategies are not providing adequate relief, or if your symptoms are severe and worsening, ask your healthcare provider about referral to a specialist. Options include a multidisciplinary pain team, an orthopedic specialist with experience in pelvic conditions, or a specialized women's health physiotherapist. In some cases, occupational therapy can help with practical strategies for managing daily tasks, work modifications, and assistive devices.

When Should You See a Doctor for Pelvic Pain in Pregnancy?

See your healthcare provider if pelvic pain is affecting your ability to walk, work, or sleep, or if symptoms are worsening despite self-care measures. Seek urgent medical attention if you experience sudden severe pelvic pain, vaginal bleeding, fever, or pain accompanied by contractions, as these may indicate a different condition requiring immediate evaluation.

While pelvic girdle pain is a common and generally benign condition during pregnancy, it is important to know when to seek medical attention. You should contact your midwife or doctor for an initial assessment as soon as you notice persistent pelvic pain, even if it is mild. Early diagnosis and treatment are associated with better outcomes and can prevent symptoms from escalating. Many women delay seeking help because they believe pelvic pain is just a normal part of pregnancy that must be endured, but this is not the case. Effective treatments are available and can make a significant difference to your comfort and mobility.

Make an appointment to see your healthcare provider if you experience any of the following: pelvic pain that interferes with walking, sleeping, or daily activities; pain that requires you to change how you move or limits what you can do; pain that is progressively getting worse; difficulty climbing stairs or getting in and out of a car; or if you are struggling emotionally due to the impact of pain on your quality of life. Your provider can refer you to a physiotherapist, prescribe appropriate pain relief, and arrange additional support if needed.

In some cases, pelvic pain during pregnancy may have causes other than PGP that require different management. Conditions such as urinary tract infections, round ligament pain, preterm labor, and placental abruption can all cause pelvic pain and need to be ruled out, particularly if the pain pattern is unusual or if it is accompanied by other symptoms.

Getting the Right Diagnosis

Diagnosis of PGP is primarily clinical, based on your symptoms and a physical examination. Your healthcare provider or physiotherapist will ask about the location, timing, and triggers of your pain, and may perform specific tests to identify which pelvic joints are involved. The active straight leg raise test is a commonly used clinical test where you lie on your back and lift one leg, and the examiner assesses whether this provokes pelvic pain or a sensation of heaviness. Imaging such as X-rays is generally avoided during pregnancy, but ultrasound of the pubic symphysis can sometimes be used to measure the degree of separation if symptomatic diastasis is suspected.

How Does Pelvic Girdle Pain Affect Birth and Recovery?

Pelvic girdle pain does not prevent vaginal delivery but requires planning for comfortable birth positions. Measure your pain-free range of hip abduction before labor. Most women recover within 1-3 months after delivery, but 7-10% may have symptoms lasting 6 months or longer. Continued physiotherapy postpartum accelerates recovery.

Many women with pelvic girdle pain worry about how the condition will affect their labor and delivery. The good news is that PGP does not prevent vaginal birth in the vast majority of cases. However, it does require some advance planning to ensure that labor and delivery are managed in a way that is comfortable and safe for your pelvis. The most important step is to measure your pain-free range of hip abduction before you go into labor. This means determining how far apart you can comfortably open your legs without triggering pain. Record this measurement and share it with your birth team so they know your limits.

During labor, certain positions may be more comfortable than others for women with PGP. Side-lying positions are often well tolerated and allow the pelvis to remain in a neutral, supported position. Kneeling, all-fours, and standing with support are other options that keep weight off the pubic symphysis while allowing gravity to assist the birthing process. The traditional lithotomy position (lying on your back with legs in stirrups spread wide apart) should generally be avoided as it places maximum strain on the pelvic joints. If stirrups are necessary for medical reasons, ensure that your legs are not opened beyond your measured pain-free range.

An epidural can be beneficial for women with severe PGP during labor, as it provides pain relief that allows the pelvic muscles to relax. However, it is important that the birth team remains aware of your pelvic limits even when you cannot feel pain, as overstretching the pelvis under anesthesia could potentially cause injury. Discuss your PGP and birth preferences with your midwife or obstetrician well before your due date so that a plan can be documented in your birth notes.

After delivery, most women experience a gradual improvement in PGP symptoms as hormone levels normalize and the pelvic joints begin to tighten and stabilize. The timeline for recovery varies: many women notice significant improvement within the first few weeks, with most recovering fully within 1-3 months. However, approximately 7-10% of women continue to have symptoms 6 months or more after delivery. Factors that increase the risk of prolonged symptoms include severe pain during pregnancy, late onset of treatment, high BMI, and low physical activity levels postpartum.

Continuing physiotherapy after delivery is important for women with persistent symptoms. Postpartum rehabilitation focuses on rebuilding pelvic floor strength, retraining the deep abdominal muscles, gradually increasing activity levels, and restoring normal movement patterns. Women who experienced severe PGP during pregnancy should receive a postnatal physiotherapy assessment to guide their recovery, even if symptoms have improved.

Planning for Future Pregnancies

If you had PGP in one pregnancy, the risk of recurrence in a subsequent pregnancy is approximately 40-70%. However, this does not mean the condition will necessarily be as severe. Strengthening your pelvic floor and core muscles before becoming pregnant again, maintaining a healthy weight, and seeking early physiotherapy as soon as symptoms appear can all help manage PGP more effectively in future pregnancies. Discuss your history of PGP with your healthcare provider at the beginning of any future pregnancy so that a proactive management plan can be put in place.

Frequently Asked Questions About Pelvic Girdle Pain