When Should I Be Concerned About Pelvic Pain During Pregnancy?

You should be concerned about pelvic pain during pregnancy if you also experience fever or chills, vaginal bleeding, fainting or lightheadedness, severe pain, trouble moving around, fluid leaking from the vagina, the baby moving less, blood in bowel movements, nausea or vomiting, or repeated diarrhea.

Pelvic pain in pregnancy is a common issue for many women. As many as 80% of women report pelvic pain at some point during their pregnancy. Early in your pregnancy, it can be a sign that your body is stretching to make room for your baby. Later in your pregnancy, it can be caused by the ligaments in your abdomen stretching.

It can also be a sign of symphysis pubis dysfunction (SPD) or pelvic girdle pain (PGP), a condition that occurs when the ligaments supporting the pelvic bones relax due to a pregnancy hormone called relaxin.

For most women this pain is mild, but for some it can be severe and even disabling. Talk to your doctor about your symptoms to determine their cause and the best course of treatment.

Some different types of pelvic pain that can be present in pregnancy include:

• Cramping pain similar to menstrual cramps
• Pressure in your pelvic area
• Pain in your pubic area
• Pain in your lower back
• Pain that goes down your thighs
• Clicking sensation in your pelvis

Sometimes the cause of your pelvic pain during pregnancy can be minor. It could be due to cramping, gas and bloating, or constipation. Persistent and serious causes of pelvic pain can vary as your pregnancy progresses:

First trimester

Pelvic pain in the first trimester is normally caused by your body adjusting to and making room for the baby. It may also be related to digestive issues that tend to be worse during pregnancy, such as gastroesophageal reflux disease (GERD).

Pelvic pain in early pregnancy may also be caused by miscarriage. The most serious cause of pelvic pain in early pregnancy is an ectopic pregnancy, which is pregnancy that occurs outside the uterus. Ectopic pregnancies require immediate medical attention.

Second trimester

Round ligament pain is the most common cause of pelvic pain in pregnancy during the second trimester. The round ligaments support the uterus. They stretch during pregnancy to accommodate your growing baby. Round ligament pain is a sharp pain that's felt in the abdomen or in the hip area, on either side. Any sudden movement that makes these ligaments retract quickly can cause this pain. It only lasts for a few seconds and generally gets better in the third trimester.

Third trimester

Pelvic girdle pain (PGP), sometimes called symphysis pubis dysfunction (SPD) can occur at any stage in pregnancy but is more common late in pregnancy. The pain may occur in your pubic bone, at approximately the level of your hips, in either side of your lower back, or in the perineum, which is the area between your vagina and anus. It may spread to your thighs as well. You may also have a grinding or clicking feeling in your pubic area. PGP is not harmful to your baby, but it can be very uncomfortable for you.

If you have any of the following symptoms accompanying your pelvic pain, you should call you doctor right away:

• Fever or chills
• Vaginal bleeding
• Fainting or lightheadedness
• Severe pain
• Trouble moving around
• Fluid leaking from the vagina
• The baby moving less
• Blood in bowel movements
• Nausea or vomiting
• Repeated diarrhea

Your doctor will take a medical history, ask about your symptoms, and do a physical exam. If necessary, your doctor may order an ultrasound or magnetic resonance imaging (MRI) scan to determine the exact cause of your pelvic pain. They may also order some blood or urine tests to check for other issues.

The treatment for your pelvic pain will depend on what is causing it. It may include a combination of home treatments, medication, or therapy.

Normal changes of pregnancy

For pelvic pain that is related to normal pregnancy changes, some helpful options include:

• Don't do any heavy lifting.
• Try sleeping with a pillow between your knees.
• Move more slowly but more often.
• Use a heating pad, but never for more than 10 minutes at a time.
• Rest more often.
• Do Kegel exercises.
• Use a maternity belt for extra support.

Round ligament pain

If your pelvic pain is caused by round ligament pain, try to:

• Get extra rest.
• Move and change positions slowly.
• If you know you need to cough or sneeze, bend and flex your hips.
• Ask your doctor about stretching exercises for persistent pain.

Pelvic girdle pain

Pelvic girdle pain can range from mild to severe. You can try the following options for relief:

• Avoid strenuous activity or heavy lifting.
• Try a heating pad or ice pack on painful areas, but don't use a heating pad for more than 10 minutes at a time.
• Wear a pelvic support belt.
• Do kegel exercises.
• Sleep with a pillow between your legs.
• Talk to your doctor about pain relievers if the pain is severe.
• Talk to your doctor about physical therapy if home measures aren't helping.