Part of Pregnancy back and pelvic pain
What causes pelvic girdle pain in pregnancy, and did you cause it?
Warning signs, and when to get help
What causes pelvic girdle pain in pregnancy?
What causes pelvic girdle pain in pregnancy is not one thing, and it is not settled. The NHS says plainly that the exact cause is not known, and lists what the pain is thought to relate to: earlier damage to the pelvis, the pelvic joints moving unevenly, and the weight or position of the baby. The European guideline on pelvic girdle pain says the cause is multifactorial and may be related to different conditions.
The part everyone agrees on is the background. Ligaments through your body soften and stretch during pregnancy to prepare you for labor, and the NHS says that can strain the joints of your lower back and pelvis. There are three of those joints: one at the front, where the two halves of the pelvis meet at the pubic bone, and one at the back on each side, where the pelvis meets the base of the spine.
What that background does not explain is why one woman with a big bump and a physical job sails through and another is on crutches at 24 weeks. That gap is where the real answer sits, and nobody has filled it yet.
So it is worth separating what has actually been measured from what simply gets repeated.
Hormones, weight and posture: what the evidence actually supports
The relaxin explanation is the one you will have been given. It goes like this: a hormone called relaxin softens the ligaments, the pelvis gets looser, the looser pelvis hurts. It is tidy, and the evidence behind it is thin.
The European guideline does name relaxin, as a hormone that in combination with others affects the laxity of the ligaments of the pelvic girdle, and it suggests increased laxity can cause pain if it is not compensated for by altered neuromotor control. Then it adds the sentence that gets left out: this correlation has not been confirmed by subsequent studies using human relaxin assays. In other words, once researchers could measure relaxin in blood properly, the link stopped showing up.
A systematic review went looking at exactly that. Six studies met its criteria, five case-control and one prospective cohort, four rated high quality. Three of the four high-quality studies found no association between relaxin and pregnancy-related pelvic girdle pain, and the reviewers rated the level of evidence for an association as low, with the remaining uncertainty down to bias in how the pain was assessed and how other risk factors were controlled for (Aldabe and colleagues, 2012).
POGP's booklet does not hedge any of this for patients. It says the old explanation, relaxin loosening the pelvic joints, is now known not to be true, that the pelvis stays strong and stable through pregnancy and birth, and that pain there does not always mean the body or the pelvis has been damaged. Read that as a statement about pelvic girdle pain, which is what the booklet is about. It is not a statement about every pelvic pain in pregnancy, and the uncommon problems it does not cover have their own lines on the warning list at the end of this page.
Posture and weight get repeated in the same confident way, and they deserve a closer look too. The RCOG does say pregnancy puts strain on the pelvic joints through extra weight and changed posture. But the European guideline, reviewing the risk-factor literature, concluded that height, weight and smoking are not risk factors, along with the contraceptive pill, the time since your last pregnancy and most probably age. POGP's booklet goes further on posture specifically and puts postural changes among the factors research has not found associated with this pain. On weight our own sources contradict each other outright, and the next section gives the whole of that rather than picking the version that reads better.
The explanation with the best support is not hormonal at all. A second review by the same team looked at pelvic movement, loading and motor control: 10 studies, 7 case-control and 3 prospective cohorts, 7 rated high quality. Six of those seven found an association between pregnancy-related pelvic girdle pain and altered pelvic motor control and mobility, and the reviewers rated that evidence as moderate (Aldabe and colleagues, 2012).
Read the limits with it, because they matter. Those were observational studies, so they show altered movement and pain turning up in the same women, not one causing the other. A pelvis that is being controlled differently may be the reason it hurts, or it may be what a person does when it hurts. Nobody has untangled that, and anyone who tells you otherwise is guessing.
Why it happens to some women and not others
The risk-factor list is worth having with its sources attached, because the version that circulates is usually attributed to nobody.
The European guideline's own conclusion is narrow. The risk factors it rates as most probable are a history of previous low back pain, with odds ratios of 1.8 to 2.2, and previous trauma to the pelvis, with an odds ratio of 2.8. That is it, at that level of confidence.
The patient guidance casts a wider net. The NHS names a history of back or pelvic girdle pain, a previous injury to the pelvis, pelvic girdle pain in an earlier pregnancy, a physically demanding job, and being overweight. POGP names a physical job, a large weight gain in pregnancy, and pelvic girdle pain or back pain in a previous pregnancy, and separately lists uneven movement of the lower back or pelvic joints, weakness in the tummy, buttock, inner thigh and pelvic floor muscles, a previous injury, occasionally the baby's position, and hormonal changes in a small number of women. The RCOG adds a past back problem, a past pelvic injury and hypermobility syndrome.
POGP's 2023 booklet gives a different list again, drawn from research rather than from clinic habit: a history of low back pain or pelvic girdle pain, a high body mass index, smoking, depression or anxiety, a heavy workload in pregnancy, not being satisfied with work, and a belief that the pain will not improve. The last three need reading carefully. They are things found alongside the pain in research, not proof that any of them produced it, and the practical use of them is that help for low mood and for a heavy or unhappy workload belongs in the treatment, which the same booklet asks you to request.
Weight is where our sources genuinely disagree, so here is the whole of it. The NHS names being overweight, POGP's booklet names a high body mass index, and POGP's patient page names a large weight gain during this pregnancy. The European guideline, which reviewed the risk-factor research rather than summarizing practice, concluded that weight and height are not risk factors at all. We cannot settle that for you, and nothing follows from it either way, because the NHS is explicit that if you are obese and pregnant you should not try to lose weight during the pregnancy, since it will not reduce the chance of complications and may not be safe. If weight is on your mind, that is a conversation with your midwife, now and after the birth, rather than something to act on this week.
The same booklet also lists what the research has not found associated with this pain, and that list is worth reading twice: breastfeeding, the time since your last pregnancy, age and height, the contraceptive pill, a vaginal birth, pelvic joint changes and postural changes. One of those sits against the other sources on this page. The NHS says pelvic girdle pain is caused by stiffness of the pelvic joints or by the joints moving unevenly, POGP's own patient page lists uneven movement of the joints of the lower back or pelvis among what may be happening, and the RCOG goes furthest of the three, saying the pain is usually caused by the joints moving unevenly. We are not going to tidy that away, because three of our four patient sources say it and the fourth says the research has not found it.
The measurement studies do let you sort the two halves of that argument, which is as near a resolution as the evidence gets. How much the joints have changed or loosened is the half with nothing behind it: average sacroiliac joint laxity at 36 weeks was no higher in the women with moderate or severe pelvic pain than in the women with none or mild pain (Damen and colleagues, 2001), and the relaxin evidence is rated low. Unevenness and control is the half with something behind it: in the same study, laxity that differed between left and right was present in 37 percent of the women with moderate or severe pain and 4 percent of those with none or mild pain, and the review of pelvic movement and motor control rates that evidence moderate (Aldabe and colleagues, 2012). So it is reasonable to say your joints may be working unevenly, and nothing in those measurements supports the idea that your pelvis has loosened or gone slack. What nobody can tell you is which of the two came first.
Two limits belong with that reassurance, because this is the page you came to in order to find out what your pain is. The laxity in that study was measured at the sacroiliac joints, the two at the back, and not at the joint at the front, so it says nothing about the pubic bone. And every woman in it had pain that came on the ordinary way, over weeks. A pelvis that has genuinely separated is a different event with a different story: a single moment of onset, often a crack, pop or tearing feeling over the pubic bone, and legs that will not take your weight afterwards. If that is your story, the warning line at the end of this page is the one to read rather than this paragraph.
One factor on POGP's patient page deserves its own paragraph, because it is the one most easily turned into blame. Muscle weakness around the pelvis appears on a patient information list as something that can add strain to the joints. It is not the same as a finding that your muscles were weak and that is why this happened, and the measurement studies describe altered motor control rather than weakness. If somebody has told you this is because your core is weak, that is further than the evidence goes.
What runs through all five lists is history rather than anything you chose. A pelvis or a back that has been hurt or sore before is the one factor that appears on every one of them, from the European guideline to the RCOG.
Is pelvic girdle pain normal in pregnancy?
Common, yes. The NHS estimates that pelvic girdle pain affects up to 1 in 5 pregnant women to some degree, the RCOG gives 1 in 5, and POGP says about 1 in 5 for pelvic girdle pain and about half of pregnant women for lower back and back-of-pelvis pain.
Normal is a different word, and it does more damage than people realize. Being told your pain is normal in pregnancy is how women end up on crutches at 36 weeks having never been referred. POGP's booklet draws the line in one sentence, that this pain is common but is not normal or expected in pregnancy, and the RCOG is just as direct: pelvic girdle pain is not something you just have to put up with until the baby is born, and early diagnosis and treatment should stop symptoms getting worse for most women. POGP says to speak to your midwife or GP if the advice is not helping, or if the pain is affecting your sleep or daily activities, and that you should be referred to a specialist pelvic health physiotherapist.
So the useful answer is that the pain is common, that it responds to treatment, and that commonness is not a reason to wait. Nor is it a reason to skip the phone call: the NHS treats new back pain in the second or third trimester as a possible sign of early labor, so the warning list matters more here than any explanation of the mechanism.
Did you cause it?
No. This is the question under the question, and it usually goes unasked.
Take the risk factors above and look at what is on them. Previous low back pain. A previous injury to the pelvis. Pelvic girdle pain in an earlier pregnancy. Hypermobility. A physically demanding job. None of those is a choice you made in the last few months, and the guideline that has looked hardest at the question rules out several of the things women blame themselves for, naming height, weight, smoking, the contraceptive pill, the interval since the last pregnancy and most probably age as things the evidence does not support as risk factors.
Three things we get asked in clinic, with what the sources actually say.
Did lifting my toddler do it? Nothing in the guidance names lifting as a cause. It does name a physically demanding job as something that makes pain more likely, so heavy work can be part of the picture, and pacing it is worth doing. That is different from having caused the condition.
Was it because I stopped exercising, or because I did not do my pelvic floor exercises? Nothing we can cite says either of those brought this on. Two of our sources do make a forward-looking claim, and it is a different claim: the RCOG says being as fit and healthy as possible before a future pregnancy, including strengthening the tummy and pelvic floor muscles, may make pelvic girdle pain less likely next time, and POGP's booklet says getting the pelvic floor working well will help in labor and reduce pelvic girdle pain after the birth. Neither is evidence that you caused this episode, and neither comes with a trial behind it. The exercise evidence during pregnancy is about reducing pain once it is there, and it is modest.
Was it the way I sit, or my posture? The guideline that reviewed the risk factors did not find posture among them, and the movement research describes altered control rather than a wrong position. If it were posture, correcting it would reliably fix it, and it does not.
What you can change is the load going through those joints day to day, and that is a reasonable thing to spend effort on. It is not the same as having caused the problem.
What sets the pain off day to day
This is the distinction that makes the question useful. What made the joint sensitive is one question, and largely unanswered. What sets the pain off on a given Tuesday is a different question, and much better understood.
The NHS lists the movements: walking, going up and down stairs, standing on one leg while you dress, turning over in bed, and moving your legs apart, for instance getting out of a car. Some women notice clicking or grinding in the pelvis, which POGP's booklet says you may hear or feel but which is not harmful in itself. One exception is worth stating, because clicking at the front also appears in the list of signs of a separated joint (Stolarczyk and colleagues, 2021): a click that arrived in the same moment as a sudden pubic pain, or that comes with not being able to stand on one leg, belongs with the warning line at the end of this page rather than with the reassurance here. POGP and the NHS both advise avoiding whichever of those makes your own pain worse, because the list is not the same for everybody.
They have one thing in common, and spotting it changes how you handle a job nobody has written advice for: your two legs are doing different things. The pattern behind which movements hurt is set out in full on the main program, and what to avoid with pelvic girdle pain takes it through the day. If your pain sits mostly on one side, which is the usual way this presents, one sided pelvic girdle pain explains why and what to do about the sore side.
Pain that builds through the day is the pattern most women describe, and it is why POGP's advice is about breaking jobs into shorter spells rather than choosing between doing everything and doing nothing. The same movement genuinely does cost more at 8pm than it did at 8am.
If you were given the name SPD rather than pelvic girdle pain, pelvic girdle pain and SPD covers what changed and whether it changes anything for you.
Why it can carry on after the birth
The cause question does not stop at delivery, because for some women neither does the pain.
The RCOG says pelvic girdle pain usually improves after birth, and that around 1 in 10 women have ongoing pain. POGP notes that the pain can carry on after the baby is born, and adds something the cause lists leave out: long spells of feeding, lifting and carrying put their own strain on the back and pelvis. So the thing that keeps it going afterwards may not be the thing that started it.
One measurement does reach across the birth, and it is the unevenness again rather than the looseness. The same Rotterdam group followed women up and found that among those with moderate or severe pelvic pain in pregnancy, sacroiliac laxity that differed between left and right at 36 weeks went with pain that persisted after the birth in 77 percent of them, about three times the risk carried by even laxity (Damen and colleagues, 2002). Read that as a prediction and not as a cause, and as nothing you can act on, because the laxity was measured with research equipment you will not meet in a clinic. It is worth one line because it is the only thing on this page suggesting that something present during the pregnancy carries on through it.
The RCOG also says one episode of pelvic girdle pain raises the chance of it returning in a later pregnancy, which loops back to the risk-factor list: a history of this pain is one of the strongest predictors of having it again. Practically, that is a reason to ask for help early next time rather than at 30 weeks.
If you are reading this after the birth, the postnatal core and pelvic floor program is the one written for that stage. What makes the pelvic floor weak and how to tell if your pelvic floor is tight or weak deal with a question that often sits alongside this one, and diastasis recti covers the tummy muscle gap. If the pain settled into your lower back rather than your pelvis, the low back pain program is the better fit.
When a new pain needs your midwife, not an explanation
Explanations are for pain that has already been checked. A new or changed back or pelvic pain in pregnancy gets reported first, and the reason is that several things that are not pelvic girdle pain start out looking exactly like it.
Some of those are not joint problems at all, and an explanation of the joints is exactly what hides them. A pubic joint that gives way in a single moment is not the gradual condition described above. A temporary weakening of the bone at the top of the thighbone gives one sided hip or groin pain that is worse on weight bearing, and it gets read as pelvic girdle pain for weeks before anyone scans it.
A lump in the groin needs examining rather than explaining. Severe or worsening pain low in the tummy or pelvis, particularly if the area hurts to touch or to move, is its own emergency. Each of those has a line below with its own timeframe and with what to do while you wait, and none of them is settled by how much it hurts.
The NHS asks you to contact your GP or midwife urgently if you have back pain in the second or third trimester, because it can be a sign of early labor, and urgently too if back pain comes with a fever, vaginal bleeding, pain when you pee, or pain in one or more sides under your ribs. Urgently is the NHS's own word, not ours. Before 37 weeks, regular tightenings, period-type pains or backache that is not usual for you go to your midwife or maternity unit straight away. Reduced or changed baby movements go the same way, at any hour.
Beyond that, the NHS asks you to call your midwife or GP about pelvic girdle pain itself if it is hard to move around, if it hurts to get out of a car or turn over in bed, or if stairs are painful, and POGP asks you to get help if the pain is not improving with the advice or is affecting your sleep and daily activities. A pelvic health physio or physical therapist can work out which movements set off your pain and tailor the program to it, which the general advice cannot do.
Every line on the warning list below carries its own timeframe, and red flags in physiotherapy explains how to read it.
Related exercise programs
- Pregnancy back and pelvic pain
- Postnatal core and pelvic floor
- Pelvic floor weakness
- Diastasis recti
- Low back pain
Warning signs
Get emergency help now
- Emergency: anything that looks life threatening, at any stage of pregnancy. Call emergency services without stopping to work out which line below fits: 999 in the UK, 112 in the UK and anywhere in Europe, 911 in the United States and Canada, 000 in Australia, 111 in New Zealand. Say how many weeks pregnant you are, and say it again to each new person you speak to (NHS).
- Emergency: heavy bleeding from your vagina, for example soaking a pad soon after you put it on, or any bleeding with severe pain in your tummy, pain in your shoulder, or feeling sick, faint or dizzy. Call emergency services straight away.
- Emergency: a very high or a very low temperature, shivering you cannot control, breathing very fast or finding it hard to breathe, being confused or slurring your speech, skin, lips or a tongue that look blue, gray, pale or blotchy (on brown or black skin this can be easier to see on the palms of the hands or soles of the feet), or a rash that does not fade when you press it. Call emergency services, as this can be sepsis.
- Emergency: pelvic or pubic pain that has suddenly left you unable to stand, walk or put weight on one or both legs. Call emergency services if you cannot stand or walk at all, or you cannot get to a hospital safely. Until help reaches you, stay where you are rather than trying to get yourself up: lie on your side with your knees together and a pillow between them, and do not stand on one leg or let your legs come apart.
- Emergency: hip or groin pain on one side that suddenly becomes much worse, or a leg that will not take your weight at all. Go to an emergency department straight away, and say you are pregnant and that the top of the thighbone may be involved, because pregnancy can weaken the bone there and weakened bone can crack. Call emergency services if you cannot stand or walk at all, or cannot get there safely.
- Emergency: you suddenly become short of breath, you get chest pain or pain in your upper back that may be worse when you breathe in, you cough up blood, your heart is beating very fast, or you faint. Call emergency services straight away, even if your leg looks normal. These can be signs of a blood clot in the lungs (pulmonary embolism).
- Emergency: numbness, tingling or altered feeling around or under your genitals, between your inner thighs, or around your bottom (anus), for example it feels different when you wipe after using the toilet. Call emergency services or go to an emergency department straight away. This can be a sign of pressure on the bundle of nerves at the base of the spine (cauda equina syndrome), which needs emergency treatment.
- Emergency: you find it hard to start peeing, cannot pee, cannot feel yourself peeing or cannot control when you pee, or you do not notice when you need to poo or cannot control when you poo, and this is not normal for you. The same applies to a new change in how your genitals feel during sex, or new trouble getting an erection or ejaculating. Call emergency services or go to an emergency department straight away. These can also be signs of cauda equina syndrome.
- Emergency: sciatica in both legs, or pain, tingling, numbness or weakness in both legs. The same applies if you lose feeling in one leg. Call emergency services or go to an emergency department straight away.
- Emergency: you have had cancer, now or in the past, and your back or neck pain feels like a tight band around your body, or comes with pain spreading down an arm or leg, weakness, numbness or pins and needles in your arms or legs, trouble walking, or trouble controlling your bladder or bowels. Call your cancer team's emergency number straight away, or go to an emergency department if you do not have one or cannot get through. This can be cancer pressing on the spinal cord (metastatic spinal cord compression), which needs treatment straight away.
- Emergency: pain in your lower tummy or pelvis that is severe, is getting worse, or hurts when you move or touch the area, or that comes with feeling faint, dizzy or lightheaded, passing out, pain at the tip of your shoulder, trouble breathing, heavy bleeding from the vagina, or sudden confusion. Call emergency services or go to an emergency department straight away. Tell them if there is any chance you are pregnant.
- Emergency: you have a lump in your groin and the pain in it is severe or came on suddenly, you cannot poo or pass wind at all, you are vomiting blood or your vomit looks like coffee grounds, or you have suddenly become confused. Call emergency services or go to an emergency department straight away, and do not try to push the lump back in yourself. A hernia that has become trapped can block the bowel or cut off the blood supply to whatever is caught in it (NHS).
- Emergency: you have thoughts of ending your life or of harming yourself or your baby and feel you might act on them, you have already harmed yourself, or you do not feel you can keep yourself or your baby safe. Call emergency services or go to an emergency department straight away.
Get help now, day or night
- Who to call for every line below that says to contact your midwife or maternity unit: call them straight away, day or night, on the number in your maternity notes. In the first 12 weeks, before your first midwife appointment, the NHS routes these calls to a GP surgery or an early pregnancy unit, and from 12 to 19 weeks to a midwife or an early pregnancy unit, so you do not need a maternity unit of your own yet to be seen. Outside the UK, call your obstetrician, or the maternity or labor and delivery unit where your birth is booked. If you cannot reach anyone and you are worried, call NHS 111 in the UK, and anywhere, go to your maternity unit or an emergency department rather than waiting at home (NHS).
- Any bleeding or spotting from your vagina, even if it is light and you have no pain. Contact your midwife or maternity unit straight away.
- Your waters break, or you have a gush or trickle of fluid from your vagina, at any stage of pregnancy. Contact your midwife or maternity unit straight away.
- Before 37 weeks, you have regular tightenings or contractions, period-type pains, or backache that is not usual for you. Contact your midwife or maternity unit straight away, as this can be a sign of early (premature) labor.
- New back pain in the second or third trimester (from 13 weeks), even if you think it is PGP or ordinary backache. Contact your midwife or maternity unit straight away, as it can be a sign of early labor. Once they have checked it, follow their advice about when to call again.
- Your baby is moving less than usual, you cannot feel your baby moving anymore, or the usual pattern of movements has changed. Contact your midwife or maternity unit straight away, even in the middle of the night. Do not wait until the next day, and do not use a home heartbeat monitor to check.
- A severe headache that does not go away with simple painkillers, problems with your vision such as blurring or flashing lights, pain just below your ribs, sudden swelling of your face, hands or feet, being sick (vomiting), heartburn that does not go away with heartburn medicines, or feeling very unwell. Contact your maternity unit straight away, as these can be signs of pre-eclampsia, which needs checking and treating quickly. The same applies to a headache after an epidural or spinal anesthetic that gets worse when you sit or stand up and eases when you lie down. Call emergency services if you have a fit (seizure), or a headache that came on suddenly and is very severe. Call emergency services too if you have a headache with a stiff neck and either a high temperature or bright light hurting your eyes, as this can be meningitis.
- Tummy pain that does not go away after you have rested for 30 to 60 minutes, or that comes with lower back pain, vaginal discharge that is unusual for you, regular cramping or tightenings, pain when you pee, or needing to pee suddenly or more often than usual (NHS). The same applies to back or pelvic pain that comes on suddenly, is getting worse quickly or is much worse than your usual pain. Contact your maternity unit straight away. Call emergency services if the tummy pain is severe, any pain comes with bleeding from your vagina, or tummy pain comes with pain in your shoulder or feeling sick, faint or dizzy.
- Back pain with a high temperature (38C or above), feeling hotter than usual or shivery, pain or burning when you pee, pee that looks cloudy, pink, red or brown, or pain in one or both sides of your back just under the ribs. Contact your midwife, maternity unit or doctor straight away, as this can be a urine or kidney infection, which is usually treated easily once someone has seen you (NHS). Call emergency services instead if you have any of the signs of sepsis in the emergency warnings above.
- Pelvic or pubic pain that came on in a single moment, for example during the birth, a fall or a wide step, with a crack, pop or tearing feeling over your pubic bone. Contact your maternity unit straight away, and ask them to check the joint at the front of your pelvis. While you wait, keep off it rather than walking it off: lie on your side with your knees together and a pillow between them, get help to move if there is someone with you, and do not stand on one leg or let your legs come apart. If you cannot stand or walk at all, or you cannot get to a hospital safely, call emergency services. Separation of that joint (pubic symphysis diastasis) is uncommon, is not the same as the pelvic girdle pain this page is about, is confirmed on a scan rather than by how much it hurts, and is first treated with a pelvic support belt and side lying, so ask about a belt at that appointment (Stolarczyk 2021). Pain that has built up over days or weeks, even when it is severe, is the usual pattern of pelvic girdle pain.
- A calf or thigh that is newly swollen or getting more swollen, warm, tender, red or darker than usual, has swollen veins that are sore to touch, or has a throbbing or cramping pain that does not fit your injury or condition, or that feels different from normal muscle soreness after exercise. This can be a sign of a blood clot (deep vein thrombosis), especially after surgery, an injury, time in a cast or boot, a long trip or a spell of being much less mobile than usual. Get medical advice the same day. If you are also short of breath or have chest pain, call emergency services. Pregnancy and the first 6 weeks after giving birth also make a clot more likely, so if you are pregnant or gave birth in the last 6 weeks, contact your maternity unit, midwife or GP straight away.
- You fall, or your bump is knocked or hit, for example in a car accident, even if you feel fine. Contact your maternity unit straight away so you and your baby can be checked.
- Lower tummy or pelvic pain and you are pregnant or think you might be. Contact your midwife or maternity unit straight away if you are pregnant, or get medical advice the same day if you might be. Pain low in the tummy early in pregnancy needs checking, because a pregnancy can grow outside the womb (ectopic pregnancy).
- You are out of breath when you lie down, or breathlessness comes with dizziness. Contact your maternity unit straight away. If you are severely short of breath when you are resting, or so breathless that you are gasping or cannot get your words out, call emergency services. Feeling a little more out of breath as your baby grows is common, but this pattern needs checking.
Get help today
- Same day: a leg or foot that is getting weaker, for example your foot drags, catches on the ground or slaps down when you walk (foot drop). Get medical advice the same day. If the weakness is getting worse by the hour, go to an emergency department.
- Same day: new back pain and you have had cancer, now or in the past. Get medical advice the same day and mention your cancer history. If you are being treated for cancer now, contact your cancer team the same day.
- Same day: a lump in your groin that becomes painful, hard or red, that you cannot push back in, or that comes with a bloated tummy, feeling or being sick, constipation or a high temperature. Get medical help the same day, in person rather than by phone, for example at urgent care or an emergency department, as these can mean a hernia has become trapped (NHS). Do not try to push the lump back in yourself.
- Same day: dizziness, lightheadedness or feeling faint while you are exercising, or the room seems to spin. Stop, and sit down or lie on your side until it passes. Contact your midwife or maternity unit the same day, and do not exercise again until you have been checked, as dizziness is one of the signs to stop exercising in pregnancy. If you faint, it does not settle within a few minutes of keeping still, or you cannot stand or walk steadily, call emergency services.
- Thoughts of suicide or of harming yourself or your baby, even if you do not plan to act on them. Get urgent help the same day from your GP, midwife or health visitor, or NHS 111 in the UK. In the UK, you can also talk to Samaritans on 116 123.
Book an appointment
- Within a few days: hip or groin pain, usually on one side, that is worse when you put weight on that leg, that makes you limp or need a stick or crutch, or that has not eased with position changes and pacing. Ask your midwife or doctor for a review, and say the pain is in your hip rather than only your pelvis. While you wait, take the weight off that leg where you can: lean on a crutch, a stick, a shopping cart or a stroller, use the rail and one step at a time on stairs, sit down for jobs you would do standing on one leg, and do not push through pain you have to limp on. Pregnancy and the weeks after the birth can cause a temporary weakening of the bone at the top of the thighbone, which is uncommon, is often read as pelvic girdle pain for weeks, and shows up on an MRI scan, which is the test to ask about when hip pain has no other explanation (Morton 2024). If the pain suddenly becomes much worse, or that leg will not take your weight at all, do not wait for the review: go to an emergency department straight away, as the emergency warnings above say.
- Within a few days: a new lump or swelling in your groin, especially one that gets bigger when you cough, sneeze or stand and smaller when you lie down. Tell your midwife or doctor, because a lump there needs examining rather than explaining, and an ultrasound scan is what separates swollen veins alongside the round ligament from a hernia (Yeo 2021). Do not try to push the lump back in yourself, and use the same day line above instead if the lump becomes painful, hard or red or you cannot push it back in.
- Low mood, anxiety or stress that is affecting your day to day life, or pain that is causing you considerable distress. Tell your midwife or doctor and ask what support is available, because this is part of what gets treated rather than something to put up with (NHS; RCOG; POGP).
Common questions
What causes pelvic girdle pain in pregnancy?
More than one thing, and the sources are open about not knowing. The NHS says the exact cause is not known and names earlier damage to the pelvis, pelvic joints moving unevenly, and the weight or position of the baby. The European guideline on pelvic girdle pain calls the cause multifactorial. The ligaments of the body soften and stretch in pregnancy to prepare you for labor, which the NHS says can strain the joints of the lower back and pelvis. What has actually been measured is more interesting than the usual explanation: a review of six studies found only low-level evidence that relaxin is involved, while a companion review found moderate evidence that pelvic motor control and mobility are altered in women with this pain.
Is pelvic girdle pain normal during pregnancy?
It is common. The NHS estimates that pelvic girdle pain affects up to 1 in 5 pregnant women to some degree, the RCOG gives the same figure, and POGP puts lower back and back-of-pelvis pain at about half of pregnant women. Common is not the same as something to put up with, which is the RCOG's own point: it says PGP is not something you just have to live with until the birth, and that early treatment should stop it getting worse for most women. Any new back or pelvic pain goes to your midwife first, because several things that are not PGP start the same way.
Did I cause my pelvic girdle pain?
No. The two risk factors the European guideline rates as most probable are a history of previous low back pain and previous trauma to the pelvis, and it specifically lists height, weight, smoking, the contraceptive pill, the time since your last pregnancy and most probably age as things that are not risk factors. Our sources do not agree on weight: the NHS names being overweight, POGP's booklet names a high body mass index, and the European guideline's review found weight was not a risk factor. Nothing follows from that for you now, because the NHS says that if you are obese and pregnant you should not try to lose weight during the pregnancy, as it will not reduce the chance of complications and may not be safe. Nothing in any of the lists points at how you have moved, sat or exercised during this pregnancy.
Why am I having pelvic pain while pregnant?
Pelvic girdle pain is the commonest reason, and it has a recognizable pattern: pain over the pubic bone, across one or both sides of the lower back, between the vagina and anus, or spreading into the thighs, worse on walking, stairs, standing on one leg, turning in bed and moving the legs apart. Pelvic pain in pregnancy also has causes that are nothing to do with joints, including a urine infection, early labor and, low down on one side early in pregnancy, a pregnancy growing outside the womb. A small number are structural without being pelvic girdle pain, such as a pubic joint that separates in one moment, a temporary weakening of the bone at the top of the thighbone, or a lump in the groin, and each of those has its own line on this page's warning list. That is why the answer to this question comes from your midwife or maternity unit and not from a website.
Can pelvic girdle pain harm my baby?
No. The NHS says PGP is not harmful to your baby, although it can be painful and make it hard to get around, and the RCOG says the same. The main pregnancy back and pelvic pain program covers that in full. Pain from something other than PGP is a different question, which is why the warning signs on this page matter more than the explanation does.
References
- NHS. Pelvic pain in pregnancy. Page last reviewed 12 December 2022. https://www.nhs.uk/pregnancy/common-symptoms/pelvic-pain/
- NHS. Back pain in pregnancy. Page last reviewed 10 January 2024. https://www.nhs.uk/pregnancy/common-symptoms/back-pain/
- Royal College of Obstetricians and Gynaecologists (RCOG). Pelvic girdle pain and pregnancy. Patient information leaflet. June 2015. https://www.rcog.org.uk/for-the-public/browse-our-patient-information/pelvic-girdle-pain-and-pregnancy/
- Pelvic, Obstetric and Gynaecological Physiotherapy (POGP). Pregnancy related pelvic girdle pain and low back pain during pregnancy and after having a baby. https://thepogp.co.uk/patient_information/womens_health/pregnancy_pgp_lbp.aspx
- Pelvic, Obstetric and Gynaecological Physiotherapy (POGP). Pregnancy related pelvic girdle pain and other common conditions in pregnancy. Booklet. 23 March 2023. https://thepogp.co.uk/Resources/112/pregnancy_related_pelvic_girdle_pain_and_other_common_conditions_in_pregnancy/
- NHS. Overweight and pregnant. Page last reviewed 17 February 2023. https://www.nhs.uk/pregnancy/keeping-well/overweight/
- Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. European Spine Journal. 2008;17(6):794-819. https://doi.org/10.1007/s00586-008-0602-4
- Aldabe D, Ribeiro DC, Milosavljevic S, Bussey MD. Pregnancy-related pelvic girdle pain and its relationship with relaxin levels during pregnancy: a systematic review. European Spine Journal. 2012;21(9):1769-1776. https://doi.org/10.1007/s00586-012-2162-x
- Aldabe D, Milosavljevic S, Bussey MD. Is pregnancy related pelvic girdle pain associated with altered kinematic, kinetic and motor control of the pelvis? A systematic review. European Spine Journal. 2012;21(9):1777-1787. https://doi.org/10.1007/s00586-012-2401-1
- NHS. Pregnancy symptoms you need to get help for. Page last reviewed 24 June 2026. https://www.nhs.uk/pregnancy/common-symptoms/pregnancy-symptoms-you-need-to-get-help-for/
- NHS. Premature labour and birth. Page last reviewed 10 January 2024. https://www.nhs.uk/pregnancy/labour-and-birth/premature-labour-and-birth/
- NHS. Vaginal bleeding in pregnancy. Page last reviewed 17 February 2026. https://www.nhs.uk/pregnancy/common-symptoms/vaginal-bleeding/
- NHS. Your baby's movements. Page last reviewed 8 July 2024. https://www.nhs.uk/pregnancy/keeping-well/your-babys-movements/
- NHS. Pre-eclampsia. Page last reviewed 23 March 2026. https://www.nhs.uk/conditions/pre-eclampsia/
- NHS. Stomach pain in pregnancy. Page last reviewed 18 November 2024. https://www.nhs.uk/pregnancy/common-symptoms/stomach-pain/
- NHS. Ectopic pregnancy. Page last reviewed 23 August 2022. https://www.nhs.uk/conditions/ectopic-pregnancy/
- NHS. Urinary tract infections (UTIs). Page last reviewed 11 July 2025. https://www.nhs.uk/conditions/urinary-tract-infections-utis/
- NHS. Sepsis. Page last reviewed 14 May 2026. https://www.nhs.uk/conditions/sepsis/
- NHS. DVT (deep vein thrombosis). Page last reviewed 30 April 2026. https://www.nhs.uk/conditions/deep-vein-thrombosis-dvt/
- NHS. Pulmonary embolism. Page last reviewed 25 May 2023. https://www.nhs.uk/conditions/pulmonary-embolism/
- Stolarczyk A, Stepinski P, Sasinowski L, Czarnocki T, Debinski M, Maciag B. Peripartum pubic symphysis diastasis, practical guidelines. Journal of Clinical Medicine. 2021;10(11):2443. https://doi.org/10.3390/jcm10112443
- Morton A, Savard-Heppel J. Transient osteoporosis of the hip in pregnancy. Obstetric Medicine. 2024;17(4):188-193. https://doi.org/10.1177/1753495X241236222
- NHS. Hernia. Page last reviewed 19 May 2026. https://www.nhs.uk/conditions/hernia/
- NHS. Inguinal hernia repair. Page last reviewed 28 February 2025. https://www.nhs.uk/tests-and-treatments/inguinal-hernia-repair/
- Yeo JHL, Tashi S. A rare but noteworthy diagnosis for lumps in the groin during pregnancy: round ligament varices. American Journal of Case Reports. 2021;22:e934313. https://doi.org/10.12659/AJCR.934313
- Damen L, Buyruk HM, Guler-Uysal F, Lotgering FK, Snijders CJ, Stam HJ. Pelvic pain during pregnancy is associated with asymmetric laxity of the sacroiliac joints. Acta Obstetricia et Gynecologica Scandinavica. 2001;80(11):1019-1024. https://doi.org/10.1034/j.1600-0412.2001.801109.x
- Damen L, Buyruk HM, Guler-Uysal F, Lotgering FK, Snijders CJ, Stam HJ. The prognostic value of asymmetric laxity of the sacroiliac joints in pregnancy-related pelvic pain. Spine. 2002;27(24):2820-2824. https://doi.org/10.1097/00007632-200212150-00018
Written and checked by the PocketPhysio editorial team. Last updated 2026-10-23.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.