Skip to main content

Pregnancy fitness: Pelvic pain

When you decided to have a baby, you knew you were going to experience some discomfort. You might have morning sickness or lower back pain. What you weren't prepared for was severe pelvic pain that your midwife or doctor would dismiss as “just one of those things” even though it was so bad, you weren't sure you were going to be able walk to your next appointment.

Pain on that level is never inconsequential, and it is certainly nothing that should be ignored in the hopes birth will resolve it. Here, we discuss what causes pelvic/pubic as well as symptoms, tips on how to prevent pelvic pain from worsening, and therapies to discuss with your doctor or midwife.

To easily understand the structure of your pelvis, imagine a ring of joints supported by ligaments. Any pressure on this ring or changes to any part of the ring affect the whole structure. The pubic symphysis joint is located at the front of the pelvis.

During pregnancy, the hormone relaxin is present at ten times its normal concentration in the female body. While it serves a very important function during pregnancy and labor – to relax the joints in the pelvis so baby can come through the birth canal - too much relaxin too soon can cause something called Pubic Symphysis Dysfunction (PSD)

PSD is frequently overlooked and under-diagnosed in pregnancy. Many caregivers have never even heard of it as it is more commonly associated with repetitive stress in sports like swimming or cycling, or blunt trauma such as a slip and fall accident.

Symptoms can be as mild as inner leg discomfort to as severe as unresolved abdominal and pelvic pain. The pubic bone is tender to the touch and basic examinations of the abdomen will result in an increase of pain. Any activity requiring full leg movement – stair-climbing, sit-to-stand, getting in and out of vehicles, bending or lifting, walking – can be difficult or downright painful. You may also feel like a hip is out of place or you may find that you are waddling when you walk. You may also have sciatica (pain radiating from the buttock down the leg) or bladder dysfunction.

If your doctor or midwife is not familiar with PSD, request a referral to a physical therapist who specializes in pregnancy-related conditions for a complete evaluation. You will want to rule out spinal or muscular conditions. Once you have confirmed your pelvic pain as PSD, you can act to treat and eventually resolve this condition. The root cause of this pain is usually too many hormones, a misaligned pelvis, or some combination of the two. With physical therapy and some changes in your daily routine, you can minimize and hopefully resolve the effects of PSD. Once your hormone levels return to normal, you can then be re-evaluated to decide if further therapy is required.

Careful therapy combined with a combination of therapies can alleviate PSD symptoms and help mother stay in shape to have a safe and healthy natural birth. As always, consult with your care provider before engaging in any home therapies.

  • Maternity support belt

  • Chiropractic treatments to realign pelvic, back, and affected areas

  • Osteopathic manipulation

  • TENS (Transcutaneous Electronic Nerve Stimulation)

Traditional therapies usually include bedrest and anti-inflammatories, but many mothers find that light activity and simple changes in their routine ease many symptoms until they can treat the root cause of their PSD with more aggressive therapy.

  • Use a pillow between your legs and under your 'baby bump' when sleeping

  • Keep your legs and hips as parallel/symmetrical as possible when moving or turning in bed

  • Deep water aerobics or deep water running may be helpful as well (there are flotation devices to help you stay afloat easily during this; you do not need to know how to swim in order to do this)

  • Keep your legs close together and move symmetrically when standing or moving

  • Sit down to get dressed, especially when putting on underwear or pants

  • Avoid movements that require your legs to spread wider than shoulder width

  • Swing your legs together as a unit when getting in and out of cars

  • Apply ice to soothe and help reduce inflammation in the pubic area

  • Sciatica may be helped by stretching the hamstring muscles

  • Back pain can often be helped by resting backwards over a large gymnastic or 'birth' ball (see resources)