Posterior Pelvic Pain (Sacroiliac Joint Pain) in Pregnant Women

Posterior pelvic pain (PPP) is pain felt at or near the sacroiliac joints of your pelvis as a result of sacroiliac joint dysfunction.
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These are joints located at the 2 dimples of the lower back. The pain often feels deep within your lower back and can occur on one or both sides of your back. In some cases, pain radiates down to the buttock and the back of the thigh.

While pain may begin at any time during pregnancy, PPP on average begins in the 18th week of pregnancy and becomes more intense as the pregnancy progresses. The pain usually spontaneously resolves within 3 months post delivery. But in some cases it can become chronic and disabling.

What are the Sacroiliac joints?

The sacroiliac joints (SIJ) are formed between the sacrum, a triangular-shaped bone in the lower portion of the spine, and the right and left ilium of the pelvis. The SIJ is a strong and stable weight-bearing joint that permits very little movement due to its natural structure. The main role of the SIJ is to allow forces to be transmitted effectively through the body, absorbing impact from the legs to the spine during activities such as walking, running and jumping.

The SIJ is kept stable through two mechanisms:

  1. Firstly, the rough, groove-like connecting surfaces of the sacrum and ilium interlock and help stabilise the joint, like two pieces of Lego together.
  2. Secondly, the SIJ is further strengthened by a complex mesh of ligaments and muscles such as the core stabilizers. These core muscles, such as the transversus abdominis and multifidus which surround the SIJ, act as active stabilizers by actively contracting to create a compressive force over the SIJ, gripping the joint firmly together. They act as a natural corset by providing that compression around the lower back and pelvic region -much like wrapping your fingers around the two Lego pieces, keeping them firm and tight.

Posterior pelvic pain arises from sacroiliac joint dysfunction, in other words, when the stability of SIJ is compromised.

Why does it happen?

During pregnancy, mechanisms stabilising the SIJ is affected. This instability allows for increased motion, stressing the SIJ.

  1. Hormones released during pregnancy relax the ligaments of the body to allow the pelvis to enlarge, in preparation for childbirth
  2. Due to the growing uterus, some of the core muscles around the pelvis get ‘stretched’ and weakened.

Moreover, the additional weight and altered walking pattern associated with pregnancy can cause significant mechanical strain on the sacroiliac joints, which may result in SIJ inflammation, giving a deep ache in the posterior pelvis.

What are the symptoms?

Of all the back pains experienced during pregnancy, posterior pelvic pain is the most common – you are four times more likely to experience PPP than lumbar pain.

You may have posterior pelvic pain / sacroiliac joint dysfunction if you have:

  • Deep, boring pain in the back of the pelvis (around the sacroiliac joints)
  • Pain may occasionally radiate to the groin and thighs.
  • The pain is typically worse with standing, walking, climbing stairs, resting on one leg, getting in and out of a low chair, rolling over and twisting in bed, and lifting. The pain improved when lying down.
  • If there is inflammation and arthritis in the SI joint, you may experience stiffness and a burning sensation in the pelvis.

Diagnosing Sacroiliac Joint Dysfunction in pregnancy

Your doctor and/or physiotherapist will conduct a thorough history and physical examination to determine the underlying disorders for your pain. That includes your description of symptoms, a series of tests designed to look at the stability, movement, and pain in the sacroiliac joints and surrounding structures. Imaging, such as computed tomography (CT) scan and X-ray may also help in the diagnosis. Another reliable diagnostic method involves injecting an anesthetic agent into the SI joint, guided by an X-ray machine, numbing the irritated area, thereby identifying the pain source. However, due to the concerns of fetal exposure to radiation, diagnostic procedures involving radiation is generally avoided.

Treatment and Management

The first-line treatment of pregnancy-related sacroiliac joint dysfunction is physiotherapy and exercises that focuses on core stability of the trunk and pelvic girdle. Sometimes, a sacro-iliac belt is prescribed to complement the core stability exercises and to give quick pain relief. Exercises will form a large part of the treatment and in some cases, mobilisation (a gentler form of manipulation) of your hip, back or pelvis may be used to correct any underlying movement dysfunction. Other manual techniques include muscle energy technique (MET) and myofascial release. It is vital to engage a physiotherapist who is skilled in treating pregnancy-related pain as she is aware of the studies that support the use of specific stabilizing exercises and other treatment techniques, thereby preventing the dysfunction from escalating into a chronic condition.
Other alternative treatments include anesthetic and steroidal injections into the SIJ that can help in pain relief, which lasts from one day or much more long-term. Oral anti-inflammatory medications are often effective in pain relief as well. However, these two treatments may be contra-indicated during pregnancy.

Posterior Pelvic Pain Home Advice

Here are some tips for expectant women with posterior pelvic pain..

Lying down

  • Avoid lying on your back for long periods of time, particularly after the 19th week of your pregnancy.
  • Try lying on your side (preferably your left) with a pillow placed between your knees and another under your tummy.
  • If your waist sags down into the bed, try placing a small rolled up towel under your waist.

Turning over in bed

  • To turn to your right while lying on your back, arch your lower back, tighten your pelvic floor muscles and lower abdominal muscles and bend both knees one by one.
  • Turn your head to the right and take your left arm over to the right of your body. Hold onto the side of your bed if you can.
  • To turn, pull with your left hand and take both knees over to the right so that you roll to the right. As soon as possible, bend your knees up as high as they will go – this helps to lock out your pelvis and lessen pain.
  • Reverse this to turn to the left.

Getting out of bed

  • Roll onto your side with your knees bent up, move your feet over the edge of the bed and push yourself up sideways with your arms.
  • Reverse the process when you lie down.

Standing from a sitting position.

  • Sit on the edge of the chair.
  • Keeping your knees apart slightly and lean forwards till your head is directly over your knees, keeping your back straight.
  • Stand up by pushing up with your arms, with your back straight and tummy tucked in. This helps to hold your pelvic joints in their most stable position and may reduce your pain significantly.


Reference:

  1. Fitzgerald CM and Le J. Back pain in pregnancy requires practitioner creativity. Biomechanics. 2007 November 
  2. Ostgaard HC, Andersson GB, Karlsson K. Prevalence of back pain in pregnancy. Spine. 1991; 16:549-552.
  3. Ostgaard HC, Zetherstrom G, Roos-Hansson E, Svanberg B. Reduction of back and posterior pelvic pain in pregnancy. Spine. 1994; 19:894-900.
  4. http://www.sidysfunction.com/articles/lumbarbackandposteriorpelvicpain.html

     

 

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Comments

  • Pingback: Posterior Pelvic Pain (Sacroiliac Joint Pain) in Pregnant Women

  • sumathimuralee

    hi, i want know about recent techniques in physiotherapy, and some tips in tamil words.

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  • hoppppyyy

    thank you for this information it was very helpful for me to help my friend stay out of pain :)

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  • afinn

    I developed Posterior Pelvic Pain at 32 weeks. Three things were successful for me. First, stretching my hamstring muscles by doing gentle, modified yoga (i.e. downward dog but with my hands on the back of the sofa, not the ground. Two, a Bella Band for general support (a pregnancy band most women buy so they can wear their pants unbuttoned for a few extra months at the beginning of pregnancy). Third, a Maternity Support Belt (google this for images). nnSo, daily stretches, Bella Band all day and the Support Belt for standing (even while making dinner, etc.) was the cure for me.

  • Han

    I am just 9 weeks pregnant and i have this pain, is that normle or am i just very unlucky??

  • Beachbug09

    I got this pain around 9 weeks as well! Horrible pain, i never knew about it until now :(

  • mkenn

    I had this during my first pregnancy and the doctor thought it was ONLY related to being pregnant. However, I suffered with sacroiliac joint pain for many years afterwards and finally was diagnosed with Ankylosing  Spondylitis.  This is very common for it to take years for a doctor to figure out you have AS.  If you have lingering, prolonged pain in your SI joints after pregnancy, please ask your doctor (internist or family practitioner, not OB doctor) to work you up for AS.  If he isn’t familiar with AS, then see a rheumatologist.

  • guest

    i am 10 weeks pregnant as of today & my pain started like a month ago. so i was probably 6weeks when it started. it totally sucks.. but this is my second child & i think b/c of the fact that i’ve been pregnant before may have made the symptoms show up faster. however, i never had this problem with my first child. weird.

  • mkenn

    It is “sort of” normal as being one of the side effects, for lack of better terminology, of being pregnant. Some women get it, some don’t.  Just like some are very sick and nauseous, some have no nausea.  A friend of mine had it during her pregnancy and her’s went away after her delivery.  Her’s turned out to be totally related to pregnancy.  Mine turned out to be something permanent, although it has dormant stages and stages where it flares up.  My friend’s doctor gave her some exercises to do using a medium size ball placed between her legs and while standing, doing pelvic  tilts/glute contractions holding the ball with her legs.  I also believe a yoga instructor who is trained to work with pregnant women could show you some stretches to do that would help ease the pain.

  • babylove

    I am 2o weeks pregnant and have severe pain in my tailbone area and buttocks….it worsens specially when I am trying to stand up

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  • Ali

     hi, just wanted t ask a question i have been dignosed with Ankylosing  Spondylitis, I have had 4years si joint pain, this is my 3rd child just found out pregnant dont know if i will be as bad as last twopregnancy or worse and what treatmeant did you receive and where can i get more advise or help. will be gratefull for advise

  • Tiffanyshell

    I have the exact pain that all of you are speaking of and my doctor did not even supect it could be PPP, which is suprising to me. I have had this pain for about 3 weeks and I am now 12 weeks so it seems like women are getting this earlier than the 18th week. At least i know i am not alone. Thanks :)

  • Debhuber33

    I am 19 weeks, this started for me at about 17 weeks. I was at work when I felt a horrific pop in the back of my pelvis on the right. Since then I’ve been in physical therapy and seeing a chiropractor (4 total weeks), and have reached a plateau of improvement. it also seems both therapy practitioners are reluctant to say “sacroiliac dysfunction”. I am currently 19 weeks and have come to accept that birth is my most probable cure. I have pains that vary from the right to the left, worsens with sitting, and grabs suddenly with unpredictable movements. only occasionally do the pains radiate down the buttocks. Most of the time there is a dull ache with occasional sharp stabs that occur unpredictably. looking forward to some relief, however birth is still a long way off.

  • junebugmom

    I have had this pain since about 5weeks pregnant, i am now 7 and its in both buttocks… and it is VERY painful!!!! I always just thought it was sciatica… i had no idea! I have a 19 month old son and i also had this with him very very early in pregnancy too.

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  • Lizamerica5

    Hi I’m 23 weeks pregnant and I started with this pain since 9-10 weeks it comes and goes but it hurts more when I spend a lot of time sitting down and when it hurts is when I’m going to stand up plus I have a pain on the pelvic upper right side went to doctors and he said I have an infection this is my 3rd time I have a Bacterial vaginosis has someone had same problem I’m just worry that baby could catch the infection and worry of having a premature baby

  • RockysMom

    Thank you so much! I got this pain around 9 weeks and could not figure out what it was. Super helpful

  • Katie Brooke Callahan

    hi my name is katie. i am miserable at five weeks with intense pain from buttocks down left leg. i am pretty much on my right side in a high up bed all the time or walking with a cane around my house. i hope this gets better. email me if you want id love to hear how you dealt with your pain kbcfaces@gmail.com thank you kindly!