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Pelvic girdle pain

Also known as Symphysis pubis dysfunction (SPD), Pregnancy-related pelvic girdle pain, PGP. Any trimester, most often the second half; usually eases after birth.

Pelvic girdle pain, once called symphysis pubis dysfunction, is aching or sharp pain in the joints of your pelvis: the pubic bone at the front and the sacroiliac joints at the back. It shows up in about 1 in 5 pregnancies as your ligaments soften and your baby's growing weight changes how you move. It can genuinely wear you down, making it hard to walk, climb stairs, or turn over in bed. Here is the reassuring part: it does not harm your baby, it rarely changes how you give birth, and it usually eases once your baby arrives. This page covers what helps most, starting with pelvic-health physiotherapy, and the few warning signs that point to something other than ordinary PGP.

Know the warning signs When to call a provider
How common
About 1 in 5 pregnancies
Roughly 20%; some sources cite as many as 1 in 4.
When
Any trimester
Often the second half of pregnancy, and it usually eases after birth.
Urgency
Routine
Uncomfortable but not dangerous, and it does not harm your baby.
Outlook
Usually resolves
Most improve after birth; about 1 in 10 have lingering pain.

Understanding it

What is pelvic girdle pain?

Pelvic girdle pain (PGP) is discomfort in the joints that make up your pelvis, mainly the pubic symphysis at the front and the two sacroiliac joints at the back. It affects about 1 in 5 pregnancies, and you may still hear its older name, symphysis pubis dysfunction or SPD, which really describes pain focused at the front joint.

It is a mechanical problem, not a disease. Pregnancy hormones, especially relaxin, loosen the ligaments that normally hold your pelvic joints firmly together, so the joints move more and sometimes unevenly. Add your baby's growing weight and a shifting center of gravity, and the pelvis takes more strain than it is used to.

The result is pain over the pubic bone, groin, lower back, hips, or the area between the legs, often with a clicking or grinding feeling. It typically flares with the movements of daily life, walking, stairs, standing on one leg, turning in bed, or getting out of a car, and it can range from a mild niggle to something that seriously limits how you get around.

None of this harms your baby, and most people can still have a normal vaginal birth. PGP responds well to pelvic-health physiotherapy, a support belt, and small changes to how you move, and for the large majority it improves after delivery. The goal is to keep you comfortable and moving until then.

Symptoms

What are the symptoms?

The hallmark is pain around the pelvis, at the front, the back, or both, that gets worse with everyday movements like walking, stairs, and turning over in bed. The pattern is usually clear enough to recognize; the signs below help tell it apart from problems that need different care.

Early signs

  • Pain over the pubic bone at the front, roughly level with your hips
  • Pain across one or both sides of your lower back or over the buttocks
  • Pain spreading into the groin, hips, thighs, or the area between the vagina and anus (perineum)
  • Pain that worsens when walking, climbing stairs, standing on one leg, turning over in bed, or getting in and out of a car
  • A clicking or grinding feeling or sound in the pelvis
  • Finding it harder to walk, or walking with a waddle, especially by the end of the day

Emergency signs — call 911

  • Severe pain that is constant and does not ease at all with rest or a change of position
  • Fever, chills, or feeling generally unwell, which can point to an infection rather than PGP
  • Numbness, pins and needles, or weakness in one or both legs, or new trouble controlling your bladder or bowels
  • Regular tightening or cramping, low back pressure, or leaking fluid before 37 weeks, which can signal early labor
  • Burning when you pass urine or blood in your urine, since a urine infection can also cause pelvic pain

Why it matters

Risks to you and baby

No harm to your baby

PGP is a problem with your joints, not your pregnancy. It does not affect your baby's health, growth, or wellbeing, however painful it feels for you.

Reduced mobility and daily life

The real toll is on you: pain with walking, stairs, standing, and rolling over in bed can disrupt work, exercise, sleep, and simply getting around. This is the main reason to treat it rather than endure it.

Sleep and mood

Weeks of pain and broken sleep can wear on your mood, and PGP is linked with more low mood and anxiety. That is a real part of the condition and worth raising with your team, not something to tough out.

It rarely dictates how you give birth

Most people with PGP have a normal vaginal birth, and a cesarean is not usually needed for it. Your team can plan comfortable positions and note how far your legs can comfortably part.

Occasionally, pain that lingers after birth

For most people PGP eases within weeks to a few months of delivery. Around 1 in 10 have pain that persists longer and does well with continued pelvic-health physiotherapy.

How it's found

How is it diagnosed?

PGP is a clinical diagnosis. There is no scan or blood test for it; a midwife, doctor, or pelvic-health physiotherapist recognizes it from your description and a simple examination, while making sure nothing else is causing the pain.

History and pain pattern

Where the pain sits and what sets it off, such as stairs, turning in bed, or standing on one leg, is often enough to point clearly to the pelvic joints.

Physical examination

Gentle checks of the pelvic joints for tenderness and movement. Simple provocation tests, such as the active straight leg raise, the thigh-thrust (P4), and Patrick's FABER test, help confirm the pain is coming from the pelvic joints.

Ruling out other causes

Making sure the pain is not from something needing different treatment, such as a urine infection, sciatica or other nerve pain, or, near term, early labor.

Imaging is usually not needed

X-rays, CT, and other scans are not recommended to diagnose PGP and are generally avoided in pregnancy; the diagnosis is made from your history and examination.

As soon as pelvic pain starts to affect walking, sleep, or daily life. Ask to be referred to a pelvic-health physiotherapist early rather than waiting it out; earlier treatment tends to work better.

Treatment

How is it managed?

PGP is very treatable, and the aim is simple: keep you comfortable and moving until it settles after birth. Pelvic-health physiotherapy is the cornerstone, supported by a belt, activity tweaks, and safe pain relief.

Treatment paths

The mainstay is pelvic-health (women's health) physiotherapy: tailored exercises to strengthen your tummy, back, hip, and pelvic-floor muscles, hands-on manual therapy, and practical advice. A pelvic support belt can steady the joints and ease pain while walking and standing. Day to day, keep gently active within your comfort but avoid what clearly worsens the pain; move symmetrically, keep your knees together when turning in bed or getting out of a car, sit down to dress rather than standing on one leg, avoid heavy lifting and long periods of standing, rest when you can, and try a pillow between your knees at night. Crutches or other aids can help if walking is hard.

Medication

Acetaminophen (paracetamol) is the first-choice pain reliever and is considered safe in pregnancy, taken at the lowest effective dose for the shortest time needed. Check with your provider before taking any other painkiller, since some are not recommended in pregnancy.

Monitoring

Most PGP is simply followed by your physiotherapist and midwife, with the plan adjusted as your pregnancy progresses. Toward the end, you can plan birth positions that keep your legs from being pushed too far apart, and note your comfortable range so your team can support you in labor.

Can it recur?

It commonly returns in a future pregnancy, and a previous episode is one of the strongest predictors, so if you have had PGP before, arrange physiotherapy early next time. After birth it usually eases within weeks to a few months; around 1 in 10 have longer-lasting pain that benefits from continued physiotherapy.

What you can do

Can it be prevented?

  • Build strength and stay active

    Going into pregnancy fit, with strong core, hip, and pelvic-floor muscles, and staying gently active during it, may lower your risk and ease the severity. A physiotherapist can tailor safe exercises to you.

  • Get a pelvic-health physiotherapist early

    If pain starts, or if you had PGP before, ask for a referral promptly. Early exercises and a support belt can stop a mild niggle from becoming disabling.

  • Move to protect your pelvis

    Keep movements smooth and symmetrical: knees together when turning in bed or leaving a car, sit down to put on trousers, avoid standing on one leg, and skip heavy lifting and long stretches of standing.

Who is more at risk

Risk factors

A previous episode of PGP or ongoing low back pain
Having had pelvic girdle pain or long-standing low back pain, in or outside pregnancy, is among the strongest predictors of PGP and of it returning next time.
One of the strongest predictors of PGP
A past injury to the pelvis
A previous fracture or significant injury to the pelvis can leave the joints more vulnerable to pregnancy-related pain.
Naturally flexible (hypermobile) joints
If your joints stretch more than usual, they may be more affected by the ligament loosening of pregnancy, particularly alongside a higher body weight.
Physically demanding work or loading
Strenuous or physically heavy work, and repeated uneven loading of the pelvis, are linked with a higher chance of PGP.
Higher body weight and previous pregnancies
A higher pre-pregnancy weight adds load to the pelvic joints, and having had children before is also associated with PGP, including in the weeks after birth.

Do not wait

When to call your provider or 911

  • Tell your midwife or provider as soon as pelvic pain starts to limit walking, sleep, or daily life, and ask for a referral to a pelvic-health physiotherapist.
  • Call if the pain is severe, constant, or not eased by rest, changing position, or acetaminophen.
  • Call promptly for a fever, chills, feeling unwell, or burning when you pass urine, since an infection can cause pelvic pain and needs different treatment.
  • Seek urgent care for numbness, pins and needles, or weakness in your legs, or any new difficulty controlling your bladder or bowels.
  • Before 37 weeks, get checked for regular tightening or cramping, low back pressure, or leaking fluid, which can be signs of early labor rather than PGP.

Talking to your team

Questions to ask your provider

  • Can you refer me to a pelvic-health (women's health) physiotherapist?
  • Would a pelvic support belt help me, and how do I choose and wear one?
  • Which exercises are safe for me, and which movements or positions should I avoid?
  • How much acetaminophen is safe, and is any other pain relief okay in my case?
  • What can I change to sleep, work, and get around more comfortably?
  • Do I need any equipment, such as crutches, or extra help at home or work?
  • What positions are best for labor and birth, and can I still plan a vaginal delivery?

Keep reading

More on pelvic girdle pain

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Good to Know

Pelvic girdle pain FAQs

Common questions about pelvic girdle pain, answered.

Is pelvic girdle pain harmful to my baby?

No. It is pain in your pelvic joints, not a problem with the pregnancy, and it will not harm your baby's health or growth, even though it can be very uncomfortable for you.

Will it go away after I give birth?

For most people, yes. Symptoms usually ease soon after delivery and settle over a few weeks to months. Around 1 in 10 have pain that lingers longer, which does well with continued physiotherapy.

Can I still have a vaginal birth?

Usually yes. Most people with PGP have a normal vaginal birth, and a cesarean is not normally needed for it. The main thing is to avoid positions that push your legs too far apart, which your team can help you plan.

Is it safe to keep moving and exercising?

Yes, keep gently active within your comfort, but ease off anything that clearly makes the pain worse, like long walks on uneven ground, standing on one leg, or wide leg movements. A physiotherapist can give you safe, targeted exercises.

What painkiller can I take?

Acetaminophen (paracetamol) is the usual first choice and is considered safe in pregnancy at the lowest dose for the shortest time. Check with your provider before taking anything stronger or any other painkiller.

Does a pelvic support belt actually help?

Many people find a support belt eases pain by gently compressing and steadying the pelvic joints while walking and standing. A physiotherapist can help you choose the right one and fit it correctly.

Is this the same thing as SPD?

Yes. Symphysis pubis dysfunction (SPD) is an older name for pain focused at the pubic joint at the front. Pelvic girdle pain is the current umbrella term, since the pain can involve the front, the back (sacroiliac) joints, or both.

Why does it hurt so much to turn over in bed or climb stairs?

These movements load one side of the pelvis at a time or shift the joints unevenly, which loosened, less-stable joints feel sharply. Keeping your knees together and moving smoothly and symmetrically usually helps.

Medically Reviewed · Updated

Reviewed by Dr. Grace Lin, MD, FACOG · OB-GYN

Obstetrician-gynecologist focused on reproductive and sexual health for women: pregnancy, BV, yeast, trichomoniasis and HPV/cervical screening. Our editorial guidelines →

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