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Pelvic pain radiating down leg 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 girdle pain in pregnancy

Pelvic girdle pain in pregnancy | Pregnancy Birth and Baby beginning of content

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Key facts

  • Pelvic girdle pain refers to pain or discomfort in your lower back, pelvis, hips, or thighs during pregnancy.
  • This pain can be mild or severe, and you may find you have difficulty sitting, standing and walking.
  • • Pelvic pain is common in pregnancy, but you are more likely to have it if you had back or pelvic pain before you were pregnant, had an injury to the area, your work is physically demanding, you are overweight or you smoke.
  • Your GP, obstetrician and physiotherapist can help you to manage your pelvic pain in pregnancy.
  • Depending on your circumstances, your health team may recommend that you modify your daily activities, wear a pelvic support garment, or they may refer you to physiotherapy and exercise programs.

What is pelvic girdle pain?

Pelvic girdle pain (PGP) refers to pain or discomfort in the lower back or pelvis during pregnancy. The pain may also extend to your upper thighs and perineum. During pregnancy your pelvic ligaments relax, and other joints become more mobile. This can result in pain in the pelvic area. Pelvic girdle pain usually goes away without treatment after birth, though symptoms may return in future pregnancies.

What are the symptoms of pelvic girdle pain in pregnancy?

If you have PGP, you may only have mild discomfort in your pelvis or back. Alternatively, you may have severe pain making it difficult for you to sit, stand, walk and move around. Each person has a different levels of pain or discomfort.

Who gets pelvic pain in pregnancy?

Some people are more likely to have PGP than others. If you had back or pelvic pain before your pregnancy or had PGP in a previous pregnancy, you are more likely to have PGP in your current pregnancy. If you have had a back or pelvic injury, you are also more likely to develop PGP. Other risk factors for PGP include the number of times you’ve been pregnant, physically demanding work, being overweight, emotional distress, or smoking.

Who can help with pelvic pain?

If you are experiencing back, pelvic, or hip pain during pregnancy, you should see your doctor. Your doctor will ask you about your medical history and do a physical examination. It is important to see a doctor so you can be sure that your pain is because of PGP.

Your doctor may suggest that you see a physiotherapist. A physiotherapist can teach you exercises to help you to manage your pain.

If your pain is severe and you are not improving with standard care, you may be referred to a specialist pain service.

How is pelvic girdle pain treated?

There are several strategies that you can use to help you manage and control pelvic girdle pain. First, you can try and identify what daily activities cause you pain and try to adjust or avoid those activities. For example, you can avoid wearing high heeled shoes and standing on one leg. You can also reduce weight-bearing activities like climbing stairs or walking and standing for long periods of time. You can also try to avoid activities that involve straining your hip, like getting in and out of a car or bath, or squatting.

Wearing a pelvic support garment can also help to reduce pain. Pelvic support garments can help to stabilise your pelvic girdle and improve symptoms if the garment is fitted correctly and used for short periods of time. Ask your physiotherapist for more information about pelvic support garments.

You can also ask your doctor or pharmacist about medicines that can help you to manage your pain so you can continue with your daily activities. This may include taking medicines like paracetamol.

Physiotherapy and exercise programs can help to reduce pain too. They may also help to correct the problem causing the pain.

How can I relieve pelvic girdle pain at home?

Many of these pain-relieving techniques can be done at home. Ask your physiotherapist to suggest a home exercise program to help you when you first start to feel a pelvic-pain episode. If your pain stops you from doing essential daily activities, you can take a pain-relief medicine like paracetamol. Taking pain relief may mean that you’re better able to do the exercises that your physiotherapist has recommended. If you have a pelvic support garment, you can put that on.

Applying heat to painful areas and sitting or lying down may help you control your pain. Extended bedrest without the guidance of a doctor is not recommended, so speak to your doctor if you feel you need to lie down for extended periods of time while you’re pregnant.

Will pelvic girdle pain affect labour and birth?

In most cases, people with PGP can have a normal vaginal labour and birth. Your doctor may recommend that during labour you position yourself in a way that puts less stress and strain on your pelvis and hips. For example, you might find it less painful to go through labour on your side or in the 'all fours' position. Usually inducing labour early or having a caesarean section are not recommended. These options may occasionally be suggested in severe cases.

Will I have pelvic girdle pain in future pregnancies?

Not every person with PGP during pregnancy will have pelvic pain again in future pregnancies. However, recurrence is very common. Nearly 7 out of 10 people with PGP during pregnancy have it again in future pregnancies. Unfortunately, your pain may also be worse during future pregnancies.

If you’ve had PGP in a previous pregnancy, speak with your health team to develop a strategy to manage your pelvic pain early. Managing your pelvic girdle pain early can help to avoid pain from worsening as your pregnancy progresses.

Speak to a maternal child health nurse

Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available 7am to midnight (AET), 7 days a week.

Sources:
Department of Health (Pelvic girdle pain), AJGP (Pelvic girdle pain in pregnancy), National Center for Biotechnology Information (Pregnancy-related pelvic girdle pain: an update), Royal Women's Hospital Victoria (Pregnancy related girdle pain fact sheet)

Learn more here about the development and quality assurance of healthdirect content.

Last reviewed: October 2022


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  • Exercising during pregnancy
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