Parveen notices that a customer, Alison, is looking a little under the weather and discreetly asks if her pregnancy is going ok...

“Everything is fine with the baby, thanks,” replies Alison, “but I’m not feeling so good myself. I keep getting this pain in my private regions, and it seems to get worse when I’m pushing my son Ben’s pram or going upstairs. I didn’t have anything like this when I was pregnant with Ben, but it seems to be getting worse. Shall I mention it at my next scan or do you think I need to make an appointment sooner?”

Answer

Rather than waiting for her 20-week scan appointment, Alison should arrange to see her midwife or GP as soon as she can, as she sounds to be suffering from pregnancy-related pelvic girdle pain (PPGP), which is sometimes referred to as symphysis pubis dysfunction.

Pain – which may be over the pubic bone or affect the back or perineum and radiate to the upper legs – results from one of the pelvic joints becoming stiff, causing the other pelvic joints and surrounding muscles to compensate.

The pain is usually worse when walking, standing on one leg, moving the legs apart (e.g. when getting out of bed or a car) and pushing heavy items (such as a shopping trolley, pram or vacuum cleaner). Prompt management can help relieve pain and improve muscle function and pelvic stability.

Measures that may be used include physiotherapy, strengthening exercises, assistive devices such as a pelvic support belt or crutches, and analgesics.

Wearing flat, supportive footwear, avoiding activities that exacerbate the pain, and being aware of distributing weight evenly across the body, for example, by using a rucksack rather than a shoulder or hand bag, can also help.

The bigger picture

The Pelvic Partnership charity estimates that up to one in four pregnant women experience PPGP, with risk factors including being overweight or obese, a history of lower back pain, previous injury to the pelvis, having a highly physical job or lifestyle, and having experienced the condition in a previous pregnancy.

Although PPGP does not normally affect whether a women can have a vaginal birth, it is important that she works out her pain-free range of movement (the distance the legs can be opened without pain being felt) and a note of this is made in her pregnancy notes and birth plan to reduce the risk of further joint damage occurring during labour.

In severe cases of PPGP, early induction of labour may be considered appropriate.
In the past, PPGP was widely regarded as resolving once the baby had been born, but now it is generally accepted that symptoms can continue for months or even years after childbirth, and treatment may well be required.

Extend your learning

• Find out how PPGP sufferers can manage the condition at nct.org.uk/pregnancy/pelvic-girdle-pain-pregnancy as well as some of the circumstances likely to trigger PPGP symptoms after childbirth at pelvicpartnership.org.uk/pgp-longterm/pgp-longterm.