Pelvic Pain During Pregnancy: Causes and Symptoms

By OBGYN Dr. Kenosha Gleaton

As the body grows and changes to accommodate a pregnancy, it’s common to experience a range of different symptoms, aches, and pains. Many of us have heard of common pregnancy symptoms like morning sickness, fatigue, and frequent urination. Another symptom that can arise during pregnancy is pain or discomfort in the pelvic area. There are many different reasons for someone to experience pelvic pain, including infections, injury, or hormone and pregnancy-related causes. Let’s talk a little more about the causes and symptoms of pelvic pain during pregnancy.

The Pelvis

Before we dive in, it’s important to have a better understanding of the pelvis and its importance. The pelvis is a group of fused bones that support movement, protect important organs, and transfer body weight when standing or walking. [1] The pelvis protects the bladder, rectum, urethra, and uterus. The pelvis is generally broad and shallow in people assigned female at birth (AFAB) in order to provide ample room for childbirth. [1] 

What Causes Pelvic Pain During Pregnancy?

There are many potential causes of pelvic pain during pregnancy, including infections, injury to the pelvis or surrounding ligaments and joints, underlying conditions, and others. It’s estimated that about 30% of pregnant people will experience pelvic pain that is categorized as pregnancy-related pelvic girdle pain (PGP) or symphysis pubis dysfunction (SPD). [2-3] PGP is defined as a group of uncomfortable symptoms caused by stiffness of the pelvic joins or the uneven movement of joints close to the pelvis. [2] SPD is defined as the symptoms felt when the joint between the left and right pelvic bones allows for more movement than usual. [3] 

Symphysis Pubis Dysfunction

SPD occurs when the pubic symphysis joint allows for more movement than usual. During pregnancy, the body increases the production of a hormone called relaxin that allows the ligaments to loosen and the joints to become more flexible or relaxed. [3] This loosening can be very helpful for allowing the pelvic bones to widen in time for childbirth but can cause some pain or discomfort when there is additional movement in the pelvis that you aren’t used to. [3] 

Symptoms of SPD

The pain or discomfort someone feels can be dependent on their weight, movement, or other factors. Some common signs of SPD include [3]:

• Mild discomfort in the pelvic area
• Sudden, shooting pain coming from the front or back of the pelvis
• Steady pain through the lower abdomen, back, groin, perineum, thigh, and leg. 
• Worsening pain or discomfort when walking, bending forward, taking the stairs, standing on or raising one leg, etc.
• Difficulty using the bathroom
• Feeling fatigued
• Hearing a clicking or grinding sound coming from the pelvis
• It’s also been suggested that SPD pain can contribute to postpartum depression symptoms after delivery. 

Diagnosing SPD

In order to be diagnosed with SPD, you will need to visit your healthcare provider. There are a few different ways for a provider to determine if you are experiencing symphysis pubis dysfunction or another condition. First, they will address your medical history and inquire about any potential injuries to the pelvic area. [3] They may also complete a physical exam to check for tenderness, pain, swelling, and mobility. In some cases, your provider may take a closer look at the joint using imaging tests such as an ultrasound or CT scan. [3] 

Pelvic Inflammatory Disease

Another potential cause of pelvic pain or discomfort is pelvic inflammatory disease (PID). PID is an infection of one or more of the reproductive organs, such as the uterus, fallopian tubes, and ovaries. [4] In some cases, PID develops when STIs are left untreated for a long period of time. PID can lead to chronic pelvic pain, infertility, and other complications. [4] Although PID can cause pelvic pain during pregnancy, fortunately, PID during pregnancy is really quite rare since the pregnancy itself acts as a barrier preventing most bacteria and STI’s from reaching the upper reproductive tract.

Symptoms of PID

The symptoms of PID can be difficult to recognize. Some people may not have any symptoms, which can lead to the progression or worsening of the condition. Others may notice symptoms like [4]:

• Mild to severe pain in the lower abdomen and pelvis
• Unusual or heavy vaginal discharge
• Unpleasant vaginal odor
• Painful sex
• Fever or chills
• Painful, difficult, or frequent urination
• Abnormal vaginal bleeding

Diagnosing PID

Diagnosing PID can’t be done with one test but with a combination of findings from imaging tests, symptoms, lab testing, and more. [4] Your healthcare provider will likely begin by asking about your medical history, including STI history and testing. They will also perform a pelvic exam to check for tenderness, swelling, and to take fluid samples. Blood and urine tests can also be performed to test for various infections or viruses. Additional testing may include an ultrasound, laparoscopy, and endometrial biopsy in the nonpregnant state. [4] 

Injury and Underlying Conditions

In addition to PID and SPD, some people may experience pelvic pain as a result of an injury or underlying condition. If someone jams or dislocates the pelvic bones, they are likely to experience severe pain or discomfort in the pelvic area. [3] Underlying conditions that can lead to pelvic pain include osteoarthritis, osteitis pubis, and others. [3] Osteoarthritis refers to the cartilage in a joint wearing down over time, while osteitis pubis is an inflammatory condition that can cause harm to the joints. Learn about pregnancy osteoporosis → 

Symptoms of Osteoarthritis and Osteitis Pubis

Symptoms of underlying conditions impacting the pelvis and related joints or bones can vary depending on the severity of the condition, age, and more. Some people with osteoarthritis will notice pain gradually increases over months or years, and may worsen with activities such as running or prolonged walking. In some, a sensation of crunching or grinding may be present in the affected joints. 

Those with osteitis pubis may notice the following [5]:

• Pain in the groin or lower abdomen
• Pain in the inner thigh
• Pain in or near the genitals
• Swelling
• A feeling of tightness or pressure above the pelvis
• Difficulty walking

Osteitis pubis may be present during pregnancy or after pregnancy, so be sure to monitor your symptoms closely and always speak to your healthcare provider if you have questions or concerns. 

How Long Does Pelvic Pain Last?

If you are experiencing some uncomfortable pain during pregnancy, you should speak to a healthcare provider immediately to discover the root of the problem and to find a treatment that works well for you. Depending on the cause of the pelvic pain, symptoms may last for a few hours or could be long-lasting. [2-3] If you are experiencing pain that is related to SPD, pain typically resolves a few months after giving birth. Once the body stops producing relaxin, your ligaments will tighten again and you will have less movement in the joints. [3] Read my article on Pelvic Pain Treatment for more information. 

Support Bone Health and Nutrition During Pregnancy

If you are pregnant and concerned about any uncomfortable symptoms, your first step should be to speak with your healthcare provider. In addition to following your provider’s recommendations, you may be able to support bone health and a  healthy pregnancy overall with products like Natalist Magnesium Plus, formulated with vitamin D and calcium to support bone health, ease tension, and relaxation, Vitamin D3 Gummies, or Prenatal Daily Packets to support pregnancy nutrition. 

References:

1. Burgess MD, Lui F. Anatomy, Bony Pelvis and Lower Limb: Pelvic Bones. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551580/
2. Pelvic pain in pregnancy. National Health Service. December 2022. URL. 
3. Symphysis Pubis Dysfunction. Cleveland Clinic. November 2021. URL. 
4. Pelvic Inflammatory Disease (PID). Mayo Clinic. April 2022. URL. 
5. Osteitis Pubis. Cleveland Clinic. December 2022. URL.