Pelvic Girdle Pain (PGP / SPD)

What It Is & Why It Happens

Pelvic Girdle Pain (PGP), historically referred to as Symphysis Pubis Dysfunction (SPD), describes a range of painful sensations caused by joint instability in the pelvis. It is a common skeletal symptom, affecting up to 30% of pregnant individuals.

The primary cause is the hormone relaxin. During pregnancy, the ovaries and placenta produce relaxin to soften and relax the ligaments, joints, and cartilage of the pelvis. This relaxation is necessary to allow the pelvic girdle to expand during childbirth.

However, this increased joint mobility can cause the joints of the pelvis—specifically the symphysis pubis joint at the front and the sacroiliac (SI) joints at the back—to move unevenly or separate slightly. This uneven movement leads to localized inflammation, muscle strain, and pain when weight is shifted asymmetric, such as when walking, standing on one leg, or rolling over.

Typical Timeline

PGP usually begins during the second trimester (around Week 20) and can become progressively more painful during the third trimester (Weeks 28-40) as the weight of the uterus increases and the baby’s head descends into the pelvis. It typically resolves within a few weeks to months postpartum as relaxin levels decrease and pelvic ligaments regain their firm structure.

Safe Comfort Measures

You can protect your pelvic joints and relieve pain safely with these physical techniques:

• Keep Your Pelvis Aligned: Keep your knees together when getting in and out of a car, turning over in bed, or rising from a chair. Imagine you are wearing a tight pencil skirt.
• Distribute Weight Evenly: Avoid standing on one leg. Sit down to put on pants, socks, and shoes. Stand with your weight distributed equally on both feet.
• Wear a Support Belt: A maternity pelvic support band or SI joint belt can help compress the pelvis, stabilization the joints and relieving pressure.
• Sleep with Pillows: Sleep on your side with a firm pillow between your knees and ankles to keep your hips aligned and prevent the top leg from crossing over.
• Apply Cool or Warm Packs: Apply a cool pack or a warm compress to the pubic bone or lower back for 15 minutes to reduce inflammation and muscle tension.
• Consult Your Provider: Talk to your healthcare provider or midwife about your pelvic pain. They can evaluate your joints and refer you to a specialist or prenatal physical therapist if necessary.

When to Call the Doctor (Red Flags)

While pelvic discomfort is standard, severe pain, inability to walk, or signs of preterm labor require immediate clinical evaluation.

Contact your healthcare provider if you experience:

• Severe, sudden, or persistent pelvic pain that makes walking, standing, or bearing weight impossible.
• Pelvic pain accompanied by regular, rhythmic tightening of the uterus (contractions) or low back pain before Week 37.
• Any vaginal bleeding, spotting, or a sudden leak/gush of fluid.
• Numbness or weakness in your legs, groin, or pelvic area, or sudden difficulty controlling your bladder or bowels.
• Clicking, grinding, or popping sensations in the pubic bone accompanied by severe pain.