Medicines for Pelvic girdle pain in pregnancy

What it is

Pelvic girdle pain (PGP), sometimes called symphysis pubis dysfunction, is pain in the joints of the pelvis that is common during pregnancy. The pelvis is made up of bones connected by joints at the front (the pubic symphysis) and back (the sacroiliac joints), and in pregnancy these joints and their ligaments become more relaxed and mobile (partly due to pregnancy hormones and the changing load), which, in some women, leads to pain and reduced stability. The pain is typically felt over the pubic area at the front, and/or the lower back and buttocks, and can spread to the thighs; it is often worse with activities that involve moving the legs apart or shifting weight from one leg to the other — such as walking, climbing stairs, turning over in bed, getting in and out of a car, or standing on one leg to dress. It can range from mild to quite disabling, affecting mobility and sleep. Importantly, PGP is common, is not harmful to the baby, and does not mean anything is seriously wrong — and, reassuringly, it usually improves after the birth. It is also treatable during pregnancy, so women should not feel they have to simply put up with it.

How it is treated

PGP is usually managed effectively with a conservative approach, and it is well worth seeking help rather than enduring it. Physiotherapy is the mainstay — a physiotherapist (ideally one experienced in women's health) can assess the pelvis, provide exercises to strengthen the muscles that support and stabilise the pelvis and improve movement, offer manual therapy, and advise on posture and activity; this helps many women significantly. Practical measures and advice help day to day: pacing activities and avoiding those that worsen the pain where possible (such as keeping the knees together when turning in bed or getting in and out of a car), taking stairs one at a time, avoiding standing on one leg (for example sitting to dress), and getting help with heavy or awkward tasks. A pelvic support belt can help some women by supporting the pelvis, and equipment or aids are provided where needed. Simple pain relief that is safe in pregnancy can be used, guided by a midwife or doctor. Support with daily life, work and sleep, and reassurance that it is common and usually improves after birth, are important. The reassuring message is that pelvic girdle pain is common, not harmful to the baby, and usually improves with physiotherapy, supportive measures and activity modification — and after the birth — so women should seek help early.