How to Relieve Pelvic Pain in the Third Trimester, According to a Physical Therapist

During your third trimester, you’re probably experiencing a lot of feelings – from excitement over being so close to the finish line to frustration from the aches and pains that can often come with pregnancy. And while some symptoms are unavoidable (like lightning crotch), others can be treated with small changes.

Pelvic pain, for example, is one of those symptoms you can actually address – or at least try to manage. If you’re having pelvic pain during pregnancy in your third trimester, particularly in the front and/or the back of your pelvis, you’re probably experiencing symphysis pubis dysfunction (SPD). It’s a common form of pelvic girdle pain that sometimes radiates from the lower back down into the thighs and typically happens around 36 to 38 weeks.

Ahead, Kandis Daroski, PT, DPT, pelvic health physical therapist at Hinge Health, breaks down pelvic girdle pain and SPD, what causes these third-trimester symptoms, and how to relieve pelvic pressure during pregnancy in the third trimester.

What Is Symphysis Pubis Dysfunction?

Symphysis pubis dysfunction (SPD) is a type of PGP that is most prevalent during pregnancy and affects about 30 percent of pregnant people, according to Cleveland Clinic. PGP can affect the sacroiliac joints (SI joints), which are located in the lower back where the spine and pelvis connect, or occur in the symphysis pubis, which is in front of the pelvis at the center of the pubic bone.

“The pubic symphysis joint is comprised of the two pubic bones and a cartilage disc that sits in between the two pubic bones,” Dr. Daroski explains. “During pregnancy, the ligaments that normally keep those two pelvic bones aligned can become too relaxed and stretchy, causing pain and discomfort. This is called symphysis pubis dysfunction.”

This type of third-trimester pain is typically categorized as “sudden, shooting pain coming from the front or back of your pelvis” or “steady pain that radiates throughout your lower abdomen, back, groin, perineum (the space between your anus and vulva), thigh and leg,” per Cleveland Clinic. The pain also tends to get worse with certain movement. Dr. Daroski adds that pregnant people with SPD often describe difficulty when walking due to pain that feels like “their pubic bones are tearing apart.”

What Causes Pelvic Pain in Pregnancy?

The pelvis consists of the two hip bones, the sacrum and the coccyx, and ligaments help to keep the pelvis aligned. “During pregnancy, your body releases more of a hormone called relaxin,” Dr. Daroski explains. “This hormone is responsible for relaxing the ligaments in the pelvis in order to make room for a growing baby.”

Relaxin production is highest at the end of the first trimester and then starts to decline until it peaks once again to prepare for the big event of delivery (36-38 weeks). “While this is great for preparing for delivery, it can cause excessive movement at the joints of the pelvis and cause discomfort,” she adds. “And as your baby grows in the womb, the extra weight and the change in the way you sit or stand will put more strain on your pelvis.”

What Can Help Alleviate Pelvic Girdle Pain?

Dr. Daroski says staying active can make a big difference in pain management. “While exercise won’t combat the effects of relaxin on your ligaments, strengthening your abdominal, pelvic floor, and hip muscles is critical for ensuring the pelvis and spine are stable and supported,” she says. “In addition, exercise is a great way to improve your balance and posture, which can also result in pregnancy-related pain.” Also, consider the use of a support belt. “Worn further down around your hips, these belts provide compressive support to help pelvic girdle pain,” she says. They support your joints as compared to the belly bands, which support your belly. Belts are more snug and best used underneath your clothes.

But even with a support belt, certain activities such as walking, standing on one leg or raising a leg, going up or down stairs, and getting in and out of the car can place increased stress on the joints of the pelvis. Avoid activities that aggravate your pain, and make small adjustments to your daily movements to keep moving. Dr. Daroski shares her tips for specific pain points:

• Pain When Using the Stairs. If walking up and down stairs is painful, do one stair at a time, or consider going up sideways.
• Pain When Getting Out of the Car. To get out of the car, pivot your hips toward the door and keep your legs together before getting up.
• Pain When Standing. Don’t stand for long periods without taking frequent breaks to sit. During instances where you would normally stand on one leg, like putting on pants, instead, get dressed sitting in a chair or on the bed.
• Pain When You Wake Up. Rethink the way you’re sleeping. Add a pillow between your knees or a full-length body pillow for extra support. When getting in and out of bed, try to keep your knees together and turn slowly onto your side or back.
• Pain When Sitting. When sitting in a chair, sit with both feet flat on the floor. Avoid crossing your legs, which can put more strain on your joints.

She also suggests working with a pelvic health physical therapist, who are experts in musculoskeletal care and focus on supporting individuals with pelvic-related conditions before, during, and beyond pregnancy.

Does Pelvic Girdle Pain Go Away Postpartum?

While it’s incredibly uncomfortable (and sometimes debilitating), pelvic pain during pregnancy is pretty common and will typically go away on its own after birth. Once your body stops producing relaxin, your ligaments tighten back up, causing less movement at the joint. Dr. Daroski says this is often when symptoms of PGP resolve.

But for some people, pelvic pain can become a lingering issue that can contribute to other pelvic symptoms such as urinary urgency, urinary leakage, pelvic organ prolapse, pain with intercourse, and diastasis recti (when the ab muscles separate during pregnancy from being stretched). A study out of Poland showed that nearly 10 percent of people were diagnosed with PGP during the first days postpartum, and almost 16 percent reported similar symptoms six weeks later.

If pain lingers, talk to your doctor for specific treatment recommendations, like exercise therapy, Dr. Daroski says. “The fourth trimester [or postpartum] is hard enough, and you should not suffer in pain and discomfort!”