Pregnancy related Pelvic pain

                        Pregnancy and Pelvic girdle pain

Pregnancy Related Pelvic Pain: Words Can Hurt

Pregnancy related Pelvic pain can create great challenges. Imagine you are 32 weeks pregnant with your first child and you start to have pain in the low back and pubic area when you change position. Pregnancy related pelvic pain can happen when you sit, stand for longer periods or when you walk. The pain makes it very difficult for you to function. As a result, you may worry about whether you can continue to work and manage your household.

Pregnancy Related Pelvic Girdle Pain: Words Can Hurt

Now imagine you have seen your health care provider and have been told that your pelvis is separating. They tell you this is because of the hormone Relaxin. Then you are told that you may need to put up with this until after you have your baby .

In addition, you are told, “it will probably get better afterwards”. “Be careful” “If it hurts, don’t do it”, “Your pubic bone is splitting”, “Your pelvis is unstable”. These are common words of advice or explanations pregnant women with pelvic girdle pain (PGP) receive from their healthcare providers. (From the Canadian Physiotherapy Association – Pain Science Division)

What is Pregnancy related pelvic girdle pain?

Pregnancy related Pelvic pain is characterized by pain around the pubic and sacroiliac joints. It can present as pain in the inner groin and adductor area, the buttocks or the sides of the hips. As a result, it is aggravated most commonly by maintaining sustained postures or changing position.

This Pelvic pain affects approximately 16-25% (Kanakaris 2011) of pregnant women, although it is very likely under reported and dismissed as a normal consequence of pregnancy.

Prognosis for Pregnancy related pelvic pain

The prognosis for pregnancy related pelvic girdle pain is very good. The majority of women improve within a few months after delivery. Only approximately 5-8.5% (Kanakaris 2011) go on to have persistent symptoms. Understanding this issue is the role of your Physiotherapist. Physiotherapists can help!

How does Breast feeding affect pregnancy related pelvic girdle pain?

Urban myths regarding breastfeeding being associated with laxity-related musculoskeletal pain should be put to rest. Suggestions to “be careful” (suggesting fragility), restrict function (reinforcing disability), to rest more and avoid activity (usually makes symptoms worse) should be set aside.

Too many women have weaned their babies early. They have done this in hopes this would alleviate their Pelvic girdle pain. This decision is based upon “helpful” advice, often from their Health Care Provider, despite the fact that there is no evidence to support this. As a result, many women are sadly advised not to lift their babies for several weeks after delivery. They are told to avoid doing this in order to avoid aggravating their Pregnancy related Pelvic girdle pain.

The good News!

The good news is that Pregnancy related Pelvic girdle pain can be managed very successfully! You can be shown effective self management programs which allow you to take control of your own care. This will allow you to become more confident, comfortable and active during your pregnancies.

Good strategies can be integrated into daily activities. As a result, it is possible to manage work, daily activities and child/baby care independently during pregnancy and postpartum.

Studies have also shown that vaginal deliveries are not only safe for women with Pregnancy related Pelvic Girdle pain, they are even preferable. Bjelland (2012) found a 2-3 fold increased risk of severe Pregnancy related Pelvic girdle pain (PGP) postpartum in women with PGP after a planned Cesarean Section.

Pregnancy related Pelvic Girdle pain Leads to a significant decrease in Quality of Life

Pregnancy related Pelvic Girdle pain Leads to a Significant Decrease in Quality of Life:

Five main categories emerged:

1. Pelvic girdle pain affects the ability to cope with every day life a) Postpartum depression- 3x more prevalent in this group of women (Gutke 2007)

2. Coping with motherhood and changing roles a) 20% avoid future pregnancies because of fear of Low Back pain and Pregnancy related pelvic girdle pain (Brynhildsen 1998)

3. Relationship between partners often reached the breaking point

4. Questioning one’s identity as defined by profession and work

5. Lack of acknowledgement of pain and disability Elden H. et al: Life’s pregnant pause of pain: Pregnant women’s experiences of pelvic girdle pain related to daily life: A Swedish Interview Study. Sexual & Reproductive Healthcare. (2013) Engeset J. et al. Pelvic girdle pain affects the whole life—a qualitative interview study in Norway on women’s experiences with pelvic girdle pain after delivery. BMC Res Notes. (2014) 7: 686.

How Can Physiotherapy help with Pregnancy related pelvic girdle Pain?

We at PhysioNow believe that Physiotherapists have a privileged role in helping to shape the experience of pregnant women with Pelvic girdle pain. Physiotherapists are in the ideal position to calm anxiety and correct misconceptions. We are happy to educate you about your condition. We explain it in a way that decreases the threat of your pain and gives you permission to move.

Physical activity is now seen as a critical part of a healthy pregnancy. Pregnant women should accumulate at least 150 minutes of moderate-intensity physical activity each week over a minimum of three days per week. However, being active every day is encouraged. Following the 2019 Guideline for Physical Activity throughout Pregnancy can reduce their risk of pregnancy-related illnesses such as gestational diabetes, high blood pressure and preeclampsia by 25 percent. (https://csepguidelines.ca/guidelines-for-pregnancy/)

Pain Management in Pregnancy: Joint SOGC/CSEP Clinical Practice Guidelines Nov 2018 P

1. Muscle training for the pelvic floor (e.g., Kegel exercises) may be performed on a daily basis to reduce the risk of urinary incontinence. Physiotherapist Instruction in proper technique is recommended to obtain optimal benefits.

2. Pelvic floor muscle training with a Physiotherapist is recommended to prevent urinary incontinence during pregnancy and after delivery

3. Core stability training with a Physiotherapist is recommended to prevent and treat back and pelvic pain during and following pregnancy.

4. Pregnant women who experience lightheadedness, nausea, or feel unwell when they exercise flat on their back should modify their exercise position to avoid this position.

Supervised antenatal and postnatal pelvic floor muscle training has been shown to be protective against Urinary Incontinence(UI), particularly in high risk groups Boyle et al 2012, Stafne et al 2012, Reilly et al 2002. 

If you or someone you know suffers from Pregnancy related pelvic girdle pain, we can help! We have highly trained Physiotherapists ready to help you with this very unpleasant condition. Please call PhysioNow today to get started!