Burning sensation in pelvis during pregnancy

Pelvic pain during pregnancy | BabyCenter

About one in four pregnant women have pelvic pain – sharp pain felt most often in the hips or groin. It may start late in the first trimester and can continue for a few months after giving birth, or longer. Treatments such as physical therapy and modifying how you move can help.

What causes pelvic pain in pregnancy?

Experts believe that pelvic pain, also known as pelvic girdle pain, is caused by a variety of factors related to normal pregnancy changes.

Starting as early as 10 weeks, the developing placenta produces increased levels of a hormone called relaxin. This hormone does just what its name implies: It relaxes your ligaments, including the ones that hold the bones of the pelvis together. This makes it easier for your baby's head to pass through during delivery.

Higher levels of estrogen and progesterone during pregnancy may also contribute to this loosening effect.

Relaxed ligaments can hurt if they stretch too far, or when they allow the bones they hold in place to move too easily. These bones can shift and put pressure on nearby muscles, causing pain.

Weight gain and your changing center of gravity can also contribute to pelvic pain. As your belly grows, your pelvis is pushed forward, and the curve of your lower back becomes more pronounced. This can place a lot of strain on the muscles and ligaments in and around the pelvis. In fact, lower back pain and pelvic pain are often related.

What are the symptoms of pelvic pain in pregnancy?

Loosened ligaments in the pelvis can cause soreness, stabbing, stinging, or burning sensations that can occur anywhere from the top of your hip bones down to the fold of your buttocks, either in the front or back.

Some women feel it when lifting, bending, or walking. Going up and down stairs, getting up from a sitting position, and turning over in bed may be especially painful. Some women find the pain is worse at night, especially after a very active day. Some find that their pelvis feels unstable.

What are the different types of pelvic pain in pregnancy?

Symphysis Pubis Dysfunction (SPD) The pubic symphysis is the joint where the two sides of the pelvis meet in the front, right underneath where your pubic hair grows. It's supported by a network of ligaments, and when these ligaments relax, the joint moves too much and causes pain ranging from mild to excruciating.

Diastasis Symphysis Pubis (DSP) This condition occurs when the gap in the pubic symphysis widens too far. The joint normally widens about 2 to 3 millimeters during pregnancy to help your baby pass through your pelvis. In some women, the pubic symphysis widens so much that it becomes unstable.

Sacroiliac joint pain. The sacroiliac joints contain ligaments that connect the sacrum – the structure composed of the last five vertebrae of your spine – to the "wings" of the pelvis on either side. If these ligaments relax too much, it can cause the bones in this area to move, putting pressure on nearby nerves and muscles. With sacroiliac joint pain, one side of your pelvis may hurt more than the other. The pain may radiate down your legs, into the back or front of your thighs. Or you may have a combination of very low back pain and feeling like the bones of your pelvis are unstable.

Round ligament pain. There are two round ligaments that attach your uterus to your pelvis. As your uterus grows up out of the pelvis, the ligaments pull, stretch, and thicken to accommodate and support it. These changes can cause pain which typically lasts just a few seconds as you change position. This pain is concentrated in your groin where your abdomen meets your legs, although occasionally it can shoot down the inside of your thigh.

Who's at risk for pelvic pain in pregnancy?

You may be more likely to develop pelvic pain if you:

• Had pelvic pain in a prior pregnancy.

• Have had multiple pregnancies.

• Have a history of pelvic trauma, like a back injury or pelvic fracture.

• Perform strenuous activities such as lifting, twisting, and bending.

Being overweight or carrying a very large baby (a condition called macrosomia) may also raise your risk for pelvic pain, but evidence is conflicting.

How is pelvic pain diagnosed in pregnancy?

If you're experiencing pain anywhere during pregnancy, it's important to tell your doctor or midwife. They'll want to make sure your pain isn't due to any other health problems, and they'll offer options for relief.

Your healthcare provider will examine you and may have you do certain movement tests to help pinpoint where the pain is coming from. In some cases, you may need to have an ultrasound or magnetic resonance imaging (MRI), which provides pictures of the soft tissue and bones.

How is pelvic pain in pregnancy treated?

There are many treatments available. While you may not get complete relief from pelvic pain during your pregnancy, you can take steps to prevent it from getting worse. Many women use more than one of these techniques to maximize their relief.

Pregnancy girdles, bands, and belts. These work by applying gentle pressure to the pelvis to give you more stability. They can be effective when combined with gentle exercise.

Sleep positioning. Pregnancy pillows that support your belly and hips can ease the strain on your pelvic ligaments and allow you to get a good night's sleep. You may need to experiment to find one that's right for you. Women's hips are wider than their knees, especially in pregnancy. Sleep with a pillow between your knees to keep your hips in a neutral position and avoid extra stress on your hips and lower back. Read more about how to be comfortable in bed during pregnancy.

Physical therapy. Studies show that certain exercises – especially in water – can be helpful in reducing pelvic pain. Ask your doctor or midwife for a referral to a physical therapist who specializes in pregnancy. (Your insurance may pay for part or all of the cost.) You'll learn stretches to relieve your pain and exercises to strengthen your core, pelvic floor, and back to provide your pelvis with more stability. A physical therapist can also teach you how to avoid pain when getting out of bed and doing daily tasks.

Acupuncture. Some women find that acupuncture helps with pelvic pain. When performed by a licensed practitioner, acupuncture is considered safe for expecting moms.

Pain relievers. Acetaminophen (such as Tylenol) is an over-the-counter medication that has a long history of safety during pregnancy. Avoid ibuprofen (Advil, Motrin) and other nonsteroidal anti-inflammatory drugs, like Aleve and aspirin.

What else can I do to ease my pelvic pain during pregnancy?

In addition to the treatments that your doctor or midwife recommends, there are ways you can reduce pain as you go through your day:

Avoid painful activities. Limit activities that cause discomfort, such as heavy lifting and carrying, standing or walking for long periods, and strenuous exercise. Find new ways to do the things that cause you pain. For instance, instead of getting out of bed by sitting straight up, try rolling to your side first and pushing up from that position.

Take frequent breaks. Try to rest a few minutes in a comfortable position as often, and as regularly, as possible.

Exercise gently. Try mild to moderate exercise, such as gentle abdominal strengthening exercises, Kegels, prenatal yoga, and walking. Don't overdo it, and avoid exercises that require squatting or spreading your legs, which can aggravate hip pain.

Practice good posture. Keep your back straight and aligned. Try not to slump, especially when seated.

Apply ice or heat. Try using an ice pack or rubbing an ice cube on the areas where it hurts. (For low back pain, get one of those flat ice packs that go in lunch bags and tuck it into your waist band.) Ice helps tame inflammation. If you're also experiencing low back pain, a heating pad can be soothing – but use it only on your back (for about 20 minutes at a time), not in the front where your uterus and baby are.

Will pelvic pain affect my labor and delivery?

Here are a few things you may need to consider:

• As you approach your due date, make sure your healthcare provider has reevaluated your condition and tested your pain level and range of motion, especially if you plan to get an epidural. This information helps determine if any special accommodations need to be made for you during labor and delivery.

• Depending on your mobility, here are some alternative positions for giving birth: kneeling while someone supports you from behind, lying on your side with someone holding your leg, or delivering your baby on all fours.

• If you choose epidural or spinal anesthesia, you could overstretch your already sensitive ligaments while you're numb. Discuss this possibility with your practitioner so you can plan to avoid this problem.

Will I still have pelvic pain after my baby is born?

Most women feel complete relief within about 3 months of giving birth. A small number have residual pain, which may need further treatment, such as pain-relievers or immobilization devices like belts or girdles. Many women benefit from physical therapy to strengthen the muscles of the abdomen and lower back and rebuild strength and coordination in the pelvic floor.

In very rare cases in which the pubic symphysis has separated, surgery may be needed to stabilize the pelvis.

Learn more about pelvic organ prolapse.

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Pelvic pain in pregnancy - NHS

Some women may develop pelvic pain in pregnancy. This is sometimes called pregnancy-related pelvic girdle pain (PGP) or symphysis pubis dysfunction (SPD).

PGP is a collection of uncomfortable symptoms caused by a stiffness of your pelvic joints or the joints moving unevenly at either the back or front of your pelvis.

Symptoms of PGP

PGP is not harmful to your baby, but it can be painful and make it hard to get around.

Women with PGP may feel pain:

over the pubic bone at the front in the centre, roughly level with your hips
across 1 or both sides of your lower back
in the area between your vagina and anus (perineum)
spreading to your thighs

Some women may feel or hear a clicking or grinding in the pelvic area.

The pain can be worse when you're:

walking
going up or down stairs
standing on 1 leg (for example, when you're getting dressed)
turning over in bed
moving your legs apart (for example, when you get out of a car)

Most women with PGP can have a vaginal birth.

Non-urgent advice: Call your midwife or GP if you have pelvic pain and:

it's hard for you to move around
it hurts to get out of a car or turn over in bed
it's painful going up or down stairs

These can be signs of pregnancy-related pelvic girdle pain.

Treatments for PGP

Getting diagnosed as early as possible can help keep pain to a minimum and avoid long-term discomfort.

You may be referred to a physiotherapy service that specialises in obstetric pelvic joint problems.

Physiotherapy aims to relieve or ease pain, improve muscle function, and improve your pelvic joint position and stability.

This may include:

exercises to strengthen your pelvic floor, stomach, back and hip muscles
equipment, if necessary, such as crutches or pelvic support belts

These problems tend not to get completely better until the baby is born, but treatment from an experienced practitioner can improve the symptoms during pregnancy.

Coping with pelvic pain in pregnancy

Your physiotherapist may recommend a pelvic support belt to help ease your pain, or crutches to help you get around.

It can help to plan your day so you avoid activities that cause you pain. For example, do not go up or down stairs more often than you have to.

The Pelvic, Obstetric & Gynaecological Physiotherapy (POGP) network also offers this advice:

be as active as possible within your pain limits, and avoid activities that make the pain worse
rest when you can
ask your family, friends or partner, if you have one, to help with everyday activities
wear flat, supportive shoes
sit down to get dressed – for example, do not stand on 1 leg when putting on jeans
keep your knees together when getting in and out of the car – a plastic bag on the seat can help you swivel
sleep in a comfortable position – for example, on your side with a pillow between your legs
try different ways of turning over in bed – for example, turning over with your knees together and squeezing your buttocks
take the stairs 1 at a time, or go upstairs backwards or on your bottom
if you're using crutches, have a small backpack to carry things in
if you want to have sex, consider different positions, such as kneeling on all fours

POGP suggests that you avoid:

standing on 1 leg
bending and twisting to lift, or carrying a baby on 1 hip
crossing your legs
sitting on the floor, or sitting twisted
sitting or standing for long periods
lifting heavy weights, such as shopping bags, wet washing or a toddler
vacuuming
pushing heavy objects, such as a supermarket trolley
carrying anything in only 1 hand (try using a small backpack)

The physiotherapist should be able to provide advice on coping with the emotional impact of living with chronic pain, such as using relaxation techniques. If your pain is causing you considerable distress, then you should let your GP or midwife know. You may require additional treatment.

Find out more on the Pelvic, Obstetric & Gynaecological Physiotherapy (POGP) website.

Labour and birth with pelvic pain

Many women with pelvic pain in pregnancy can have a normal vaginal birth.

Plan ahead and talk about your birth plan with your birth partner and midwife.

Write in your birth plan that you have PGP, so the people supporting you during labour and birth will be aware of your condition.

Think about birth positions that are the most comfortable for you, and write them in your birth plan.

Being in water can take the weight off your joints and allow you to move more easily, so you might want to think about having a water birth. You can discuss this with your midwife.

Who gets pelvic pain in pregnancy?

It's estimated that PGP affects up to 1 in 5 pregnant women to some degree.

It's not known exactly why pelvic pain affects some women, but it's thought to be linked to a number of issues, including previous damage to the pelvis, pelvic joints moving unevenly, and the weight or position of the baby.

Factors that may make a woman more likely to develop PGP include:

a history of lower back or pelvic girdle pain
previous injury to the pelvis (for example, from a fall or accident)
having PGP in a previous pregnancy
a physically demanding job
being overweight

Further information

Find support and advice from other women with PGP at the Pelvic Partnership.

Listen to women’s experiences of pain and discomfort in pregnancy, including PGP, on healthtalk.org.

Read more about coping with common health problems in pregnancy, including nausea, heartburn, tiredness and constipation.

Find maternity services or physiotherapy services near you.

Community content from HealthUnlocked

Pelvic pain in early pregnancy | Symptoms

Ectopic pregnancy
Signs: Abdominal or pelvic pain that is often sudden and persistent (not crampy), localized, and may or may not be accompanied by vaginal bleeding. If an ectopic pregnancy is terminated, fainting, dizziness, or palpitations may occur.

Miscarriage (threatened miscarriage or ongoing spontaneous abortion)
Signs: Spasmodic pain in the pelvic area, often radiating to the abdominal cavity. Often vaginal bleeding, sometimes with the release of fragments of fetal tissue.

Septic abortion (infection of the contents of the uterus before, during or after a miscarriage)
Signs: Usually in women who have already had an abortion (usually performed by an inexperienced doctor or by the women themselves). Fever and chills, persistent abdominal or pelvic pain, and pus-filled vaginal discharge. nine0006

Normal changes during pregnancy (includes distension and growth of the uterus in early pregnancy)
Signs: Cramping or burning sensation in the lower abdomen, pelvis and/or lower back.

Uterine fibroma degeneration
Signs: Pain in the pelvic area that starts suddenly and is usually accompanied by nausea, vomiting, and fever. Sometimes vaginal bleeding.

Torsion (twisting) of the epididymis
Signs: Pain in the pelvic area that starts suddenly, may be with colic, which is often mild if the ovary uncoils on its own, often with nausea or vomiting.

Rupture of the corpus luteum cyst (forms in the ovary from which the egg is released after ovulation)
Signs: Abdominal or pelvic pain that originates in a specific area, sometimes resembling pain due to ovarian torsion; nine0005 usually occurs suddenly. Vaginal bleeding.

Pelvic inflammatory disease
Signs: Pain in the pelvic area that lasts a long time, usually develops gradually, as a rule, is felt on both sides.
Vaginal discharge containing pus. Sometimes fever or chills. It is more common in women who have sex with new partners and do not use condoms or diaphragms. nine0006

Appendicitis
Signs: As a rule, continuous pain and tenderness in the lower abdomen on the right. There may be pain in a different place (higher in the abdomen) or a different nature of pain (weaker and more crampy) compared to non-pregnant women.

Urinary tract infections
Signs: Discomfort that is felt just above the pubic bone. Often burning during urination, frequent urge to urinate, and the need to urinate immediately. Sometimes blood in the urine. nine0006

Inflammatory bowel disease (Crohn's disease, ulcerative colitis)
Signs: Pain, which may be spasmodic or continuous, may occur in multiple locations. Often diarrhea, sometimes with mucus or blood. As a rule, in women who have already been diagnosed with this disease.

Intestinal obstruction (intestinal obstruction)
Signs: Spasmodic pain that recurs periodically, vomiting. Lack of bowel movements or gas (flatulence), bloating. As a rule, in women who have undergone surgery in the abdominal cavity. nine0006

Gastroenteritis
Signs: Usually vomiting and diarrhea.

Pain in the pubic region during pregnancy

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The pubic bone is one of the three bones that make up the pelvic bone. Two pubic bones, forming the pubic articulation (symphysis), form the anterior wall of the pelvis. The pubic bone in women with a regular physique has the form of a roller about the thickness of the thumb, which is curved and forms a pubic eminence. This bone hangs in a kind of arch over the entrance to the vagina.

The main cause of pain in the pubic bone is the divergence and increased mobility of the pubic symphysis. To refer to pathological changes in the pubic symphysis of the pelvis during pregnancy and after childbirth, the following terms are used: symphysiopathy, symphysitis, arthropathy of pregnant women, divergence and rupture of the pubic symphysis, dysfunction of the pubic symphysis. The most commonly used terms are "symphysitis" or "symphysiopathy". nine0006

So, symphysiopathy is a disease associated with a pronounced softening of the pubic joint under the influence of the hormone relaxin, which is produced during pregnancy. The process of softening the interosseous joints is natural, it helps the child to pass more easily through the bone pelvis during childbirth. The diagnosis of "symphysiopathy" is made when severe pain appears, the pubic joint swells, greatly stretches, becomes mobile, and the pubic bones diverge excessively. One of the striking, characteristic symptoms of this pathology is that it is impossible to raise the leg in the prone position. In addition to acute pain in the pubis, there are difficulties when walking up the stairs, it becomes difficult to turn from side to side on the bed and get up from the sofa, and the gait changes and becomes like a "duck". According to most doctors, the cause of symphysiopathy is a lack of calcium, an increased concentration of the hormone relaxin, and increased physical activity on the bones of the pelvic region. In addition, the development of symphysiopathy can be provoked by a serious sports injury or a fracture of the pelvic bones. nine0006

At what stage of pregnancy do they occur?

The disease begins gradually or suddenly during pregnancy, childbirth or after childbirth. Most often, women begin to feel pain in the area of the pubic joint in the third trimester of pregnancy. This is due to the fact that the places of adhesions of the pubic bones, their ligaments and cartilage, soften under the influence of the hormone relaxin. This pregnancy hormone naturally softens the bony joints, which is necessary to facilitate the passage of the baby through the bone pelvis and birth canal at the time of childbirth. nine0006

Some women begin to complain of pain in the pelvic bones some time after giving birth. This may be the result of traumatic childbirth (imposition of obstetrical forceps, shoulder dystocia, excessive separation of the hips during childbirth, etc.) or physical exertion (lifting a heavy baby stroller up the stairs, prolonged motion sickness in the arms of a well-fed baby, etc. ). It is recommended to limit physical activity, wear an orthopedic bandage, consult a traumatologist. Complaints usually recur after the next pregnancy. In a small proportion of patients, pain persists for a long time. nine0006

When can this be considered the norm, and when not?

Obstetricians-gynecologists do not consider a slight soreness of the pubic joint to be a pathology, but if the pain is acute, restricting the movements of the pregnant woman, accompanied by edema, then we can talk about pathology. Pain can be quite strong and especially manifest itself while walking, turning the body to the right and left in a sitting position and even lying down. In this case, you need to urgently consult a doctor and undergo an ultrasound diagnosis (ultrasound) to determine the size of the divergence of the pubic bones. Magnetic resonance imaging (MRI) is also used, which allows assessing the state of the symphysis, the state of the bone tissue, as well as soft tissues. nine0006

With ultrasound, the degree of divergence (diastasis) of the pubic bones is determined. The severity of the clinical picture largely depends on the degree of divergence of the pubic bones, and therefore there are three degrees of divergence of the pubic branches: in the first degree - by 6-9 mm, in the second - by 10-20 mm, in the third - more than 20 mm. The severity of the symptoms of the disease varies from mild discomfort to unbearable pain.

How can pain be relieved? nine0086

There are some recommendations that will help reduce bone pain during pregnancy, if the cause of its occurrence is the divergence of the pubic bones. Be sure to wear a bandage, especially in later pregnancy. The bandage takes on most of the load, thereby releasing pressure from the pubic joint. Limitation of heavy physical exertion is indicated for any manifestations of pain, lying down more often, walking less and being in a sitting position for no longer than 30-40 minutes. In severe cases, before and sometimes after childbirth, a woman may be shown strict bed rest. Moreover, the bed should not be hard and flat. nine0006

Since the appearance of symphysiopathy is associated not only with a large production of the hormone relaxin, but also with a lack of calcium in the body, the expectant mother is prescribed calcium preparations and complex vitamins for pregnant women, which contain all the necessary vitamins and trace elements in the right amount and proportions. There is evidence that pain is reduced during acupuncture and physiotherapy.

In especially severe cases of symphysiopathy, the pregnant woman is hospitalized. nine0006

What is the danger of this condition?

The occurrence of symphysiopathy is due to several reasons. This is a lack of calcium in the body of the future mother, and an excess amount of the hormone relaxin, and the individual structural features of the woman's body, and possible hereditary or acquired problems of the musculoskeletal system.

With an unexpressed clinical picture of the disease, with an expansion of the pubic fissure up to 10 mm, normal pelvic sizes, a small fetus, childbirth can be carried out through the birth canal, avoiding the use of physical force, such as the Christeller maneuver. With a pronounced stretching of the pubic symphysis, pain syndrome, especially with anatomical narrowing of the pelvis, a large fetus, there is a danger of rupture of the pubic symphysis, and the method of choice in this case is caesarean section. This is due to the fact that during natural delivery, the bones can disperse even more and the woman subsequently will not be able to walk at all. nine0006

Prevention

The body of a healthy woman is able to independently cope with all the difficulties of the pregnancy period. First of all, the expectant mother should include enough foods containing calcium in her diet, as well as take vitamins for pregnant women.

For the prevention of symphysiopathy, the use of a prenatal bandage is recommended, which supports the abdomen and prevents excessive stretching of the ligaments and muscles.