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Posterior Pelvic Pain in Pregnancy

Sacroiliac joint pain commonly seen in the second-third trimester of pregnancy.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Kadın Hastalıkları ve Doğum department. Book Appointment →

What is Posterior Pelvic Pain in Pregnancy?

Posterior pelvic pain in pregnancy (PPGP - posterior pelvic girdle pain) is a musculoskeletal pain syndrome originating from the sacroiliac joint, gluteal region, and posterior superior iliac spine commonly seen in the second-third trimester of pregnancy. It is reported in 50-70% of pregnancies; in 7-25% it is severe enough to interfere with daily activities. It is more common than low back pain.

Etiology: increase in relaxin hormone (10-fold increase in pregnancy) - sacroiliac ligament laxity, posterior shift of center of gravity (lumbar lordosis increase), pelvic ring instability, sacroiliac joint dysfunction, gluteus medius weakness, sacrotuberous ligament strain. Risk factors: previous low back pain history, multiparity, multiple pregnancy, high BMI, hypermobility syndrome, occupational physical activity, history of pelvic trauma.

Clinical: pain in sacroiliac joint, posterior superior iliac spine, gluteal area, may radiate to upper-posterior thigh; pain triggered by long sitting, climbing stairs, walking, turning in bed, getting up from sitting position; relieved by lying-down rest. Differential diagnosis: lumbar disc herniation, symphysis pubis dysfunction, urinary infection, preterm labor, sciatica. Diagnosis is clinical (provocation tests: posterior pelvic pain provocation, FABER, Gaenslen).

Symptoms

Pain over the sacroiliac joint (one or both sides)
Pain in posterior superior iliac spine and gluteal region
Pain radiating to posterior thigh (NOT below the knee)
Pain when getting up from sitting position
Pain triggered by walking, climbing stairs, turning in bed
Pain when standing on one leg (FABER positive)
Reduced walking distance
Difficulty putting on shoes/socks
Pain interfering with sleep
Pelvic instability sensation

Risk Factors

Pregnancy (especially 2nd-3rd trimester)
Multiparity (each pregnancy increases risk by 30%)
Multiple pregnancy (twins, triplets)
Previous low back/pelvic pain history
PPGP history in previous pregnancy (recurrence 85%)
BMI >30
Hypermobility syndrome (Ehlers-Danlos)
Sacroiliac joint trauma history
Occupational heavy physical activity
Sedentary lifestyle, weak abdominal-back muscles

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Severe pain that interferes with daily activities
  • Inability to sleep due to pain at night
  • Persistent pain not responding to bed rest
  • Numbness, weakness in legs (sciatica suspicion)
  • Symphysis pubis pain accompanied by walking inability (SPD)
  • Sudden severe abdominal pain (preterm labor, etc.)
  • Burning urination with low back pain (UTI)
  • Bleeding-discharge accompanying back pain

Treatment Methods

01
Detailed history + physical examination + provocation tests (P4, FABER, Gaenslen, ASLR)
02
Imaging usually not needed (pelvic MRI selected - postpartum)
03
Conservative approach: pelvic stabilization exercises (transverse abdominis, multifidus)
04
Gluteus medius and pelvic floor muscle strengthening
05
Pelvic support belt (sacroiliac belt, between greater trochanters)
06
Physiotherapy + manual therapy (sacroiliac mobilization)
07
Hot-cold compress
08
Acupuncture (proven effective)
09
Aquatic therapy (water-based exercise)
10
Position modification: lying on left side with pillow between knees
11
Avoid heavy lifting, long sitting
12
Acetaminophen (paracetamol) - safe analgesic
13
NSAIDs only contraindicated in 1st trimester and after 32 weeks
14
Severe cases: TENS, lidocaine injection (selected)
15
Resolves spontaneously postpartum (3-6 months 90%)
16
Persistent (>3 months postpartum): physiotherapy, sacroiliac corticosteroid injection
17
Pre-pregnancy preparation: weight, abdominal-back exercise

Which Department to Visit?

You can visit our Kadın Hastalıkları ve Doğum department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Kadın Hastalıkları ve Doğum Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.