CONSULTATION DRAFT
6.4 Pelvic girdle pain
The severity of pelvic girdle pain (symphysis pubis dysfunction) during pregnancy varies widely. Advice
should be aimed towards minimising pain.
6.4.1
Background
Pelvic girdle pain has been described as a collection of signs and symptoms of discomfort and pain in
the pelvis and lower back (lumbopelvic) area, including musculoskeletal pain radiating to the upper
thighs and perineum. Symptoms occur due to relaxation of the pelvic ligament and increased joint
mobility in pregnancy. Symptoms vary from mild discomfort to severe and debilitating pain that can
hinder mobility. Other causes of pain in the pelvic area (eg urinary tract infection, preterm labour)
should be excluded (Kanakaris et al 2011). Pelvic girdle pain usually resolves spontaneously after the birth
(Elden et al 2008), although symptoms may recur during subsequent pregnancies (Leadbetter et al 2004).
Incidence in pregnancy
•
The true incidence of pelvic girdle pain in pregnancy is unknown and estimates from low-level
evidence are contradictory, ranging from approximately 4% to 84% (Bastiaanssen et al 2005; Morgren &
Pohjanen 2005; Robinson et al 2006; 2010). The wide variation can be attributed to various factors
including the absence of a precise definition and diagnostic criteria, differences in study design
and selection of the study population.
•
The incidence of pelvic girdle pain has been found to be higher in late pregnancy (Gutke et al 2006;
Leadbetter 2006; Van de Pol et al 2007; Robinson et al 2010; Kovacs et al 2012) and among women with a
higher BMI (Kovacs et al 2012).
•
There is currently no evidence regarding the incidence of pelvic pain in specific population groups.
Factors influencing pelvic girdle pain
Low-level evidence indicates that (Morgren 2005; Albert et al 2006; Eberhard-Gran & Eskild 2008; Biering 2010):
•
pelvic pain is more common in women with a previous history of low back pain (Albert 2006; Bjelland
et al 2010) or trauma of the back or pelvis (Albert 2006);
•
risk factors for developing pelvic pain include: increased number of previous pregnancies (Albert
2006; Bjelland et al 2010; Robinson et al 2010); physically demanding work (Morgren 2005; Bjelland et al
2010); high BMI (Albert 2006; Eberhard-Gran & Eskild 2008; Bjelland et al 2010); emotional distress (Bjelland et
al 2010); and smoking (Albert 2006; Biering et al 2010).
The evidence on age as a risk factor for pelvic pain in pregnancy is inconsistent (Eberhard-Gran & Eskild
2008; Bjelland et al 2010).
6.4.2
DIscussing pelvic girdle pain
Summary of the evidence
NICE (2008) found little evidence on which to base clinical practice. Subsequent evidence is limited by
the heterogeneity and low quality of studies and the inconsistency of findings.
Treatments for pelvic pain
Systematic reviews into interventions for women with pelvic girdle pain have found low-level evidence:
•
women receiving acupuncture or physiotherapy reported less intense pain in the morning or
evening than women receiving usual antenatal care and acupuncture was more effective in
reducing evening pain than physiotherapy (Pennick & Young 2007);
•
acupuncture was more effective than standard treatment, physiotherapy, or stabilising exercises
(Ee et al 2008);
CONSULTATION DRAFT
•
exercise, pelvic support garments and acupuncture improved functional outcomes (Richards et al
2012); and
•
exercise during pregnancy may decrease pelvic girdle pain (Schiff Boissonnault et al 2012).
RCTs have found benefits from a multimodal approach (manual therapy, stabilisation exercises, patient
education) (George et al 2012) and no reduction of pain with exercise (Eggen et al 2012; Stafne et al 2012).
Lower level evidence supports acupuncture as an effective intervention (Ekdahl & Petersson 2010). No
serious adverse effects were reported (minor side effects included bruising, pain on needle insertion,
bleeding, haematoma and fainting).
Recommendation 11
Grade C
Advise women experiencing pelvic girdle pain that pregnancy-specific exercises, physiotherapy,
acupuncture or using a support garment may provide some pain relief.
Advice on managing pelvic girdle pain
There is consensus from low-level evidence and clinical reviews about providing advice on minimising
pain, including (Vleeming et al 2008; Leadbetter et al 2004; Aslan & Fynes 2007):
•
wearing low-heeled shoes;
•
seeking advice from a physiotherapist regarding exercise and posture;
•
reducing non-essential weight-bearing activities (eg climbing stairs, standing/walking for long
periods of time);
•
avoiding standing on one leg (eg by sitting down to get dressed);
•
avoiding movements involving hip abduction (eg getting in/out of cars, baths or squatting); and
•
applying heat to painful areas.
6.4.3
Practice summary: pelvic girdle pain
When: A woman has pelvic girdle pain.
Who: Midwife; GP; obstetrician; Aboriginal and Torres Strait Islander Health Practitioner; Aboriginal and
Torres Strait Islander Health Worker; multicultural health worker, physiotherapist.
Provide advice: Reassure the woman that pelvic girdle pain will not harm her or her unborn child, and
is likely to resolve after the birth. Advise the woman about steps she can take to minimise pain.
Take a holistic approach: Consider possible barriers to women being able to make changes to
minimise their pain (eg work requirements, cultural attitudes to exercise, costs of allied health
services).
6.4.4
Resources
Common discomforts in pregnancy. In: Minymaku Kutju Tjukurpa Women’s Business Manual, 4th edition. Congress
Alukura, Nganampa Health Council Inc and Centre for Remote Health.
http://www.remotephcmanuals.com.au
6.4.5
References
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Aslan E & Fynes M (2007) Symphysial pelvic dysfunction. Current Opinion in Obstetrics and Gynecology 19(2): 133139.
Bastiaanssen JM, de Bie RA, Bastiaenen CHG et al (2005) Etiology and prognosis of pregnancy-related pelvic girdle
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Biering K, Aagaard Nohr E, Olsen J et al (2010) Smoking and pregnancy-related pelvic pain. BJOG 117( 8): 1019–26.
Bjelland E, Eskild A, Johansen R et al (2010) Pelvic girdle pain in pregnancy: the impact of parity. Am J Obstet
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