About Pelvic Instability
Pelvic Instability is a condition that causes pain around the joints of the pelvis (pelvic girdle) during and after pregnancy.
In normal pregnancy a hormone called Relaxin softens the ligaments around the joints of the pelvis. This is a natural process which assists childbirth and does not usually cause lasting discomfort.
For some women this natural process seems to go wrong, causing the joints of the pelvis to loosen too much. This can result in the pelvis becoming unstable or out of alignment.
Pregnancy can also put strain on muscles of the back, stomach, pelvic floor, hips and pelvic girdle which may lead to the pelvic joints becoming less stable.
Pelvic instability can also occur due to a previous fall or injury to the pelvis and in rare cases by complications in labour or postnatally.
Pain or instability can occur at any of the three pelvic joints: pubic symphysis at the front of the pelvis and left and right sacroiliac joints at the back. The pain can make it difficult for women to walk or attend to activities of daily living.
Pelvic Instability has been recognised as an important women’s health issue in the UK and Europe for around 20 years. It is also referred to as Symphysis Pubis Dysfunction (SPD) or Pelvic Girdle Pain (PGP).
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The Pelvic Instability Association recognises that the
new preferred term for Pelvic Instability is Pelvic Girdle Pain.
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What are the symptoms of Pelvic Instability?
Every woman's experience of Pelvic Instability will be individual. Women may experience only some of the symptoms below.
- Pain in the front or back of the pelvis, groin, buttocks, thighs, hips or lower back.
- Difficulty walking or a waddling gait.
- Pain felt when standing on one leg: getting dressed; climbing stairs; getting in and out of the bath.
- Pain felt when turning, twisting or bending: getting out of bed; out of the car; pushing a shopping trolley; day to day activities.
- Women may feel and/or hear a clicking, clunking or grinding sensation in their pelvis.
- Some women find it difficult to part their legs without severe pain.
- Pain and difficulty with sexual intercourse.
- Women with Pelvic Instability can also suffer with incontinence and/or bowel problems.
Symptoms of Pelvic Instability can be mild, moderate or severe. Symptoms can improve, stay the same or progress as the pregnancy progresses. It can start as early as the first trimester or sometimes not until after the baby is born. It can return in future pregnancies.
It is important to get Pelvic Instability recognised and managed as early as possible in your pregnancy. This can help improve recovery and reduce the pain.
How many women have Pelvic Instability?
One in five pregnant women will experience some level of Pelvic Instability. Of the women who have Pelvic Instability, about 5 to 8% will have severe problems with pain and disability. Serious pelvic instability occurs in about 7% of women after birth.
What causes Pelvic Instability?
The exact cause for Pelvic Instability is not fully understood. It can occur when there is a combination of different factors in the pregnancy. These may include:
- Pregnancy hormone effects on ligaments supporting the pelvis
- Changes in weight and posture in pregnancy
- The pelvis moving out of alignment or unevenly
- Changes occurring to muscles around the pelvis, such as the stomach, back, pelvic floor and hips making it difficult for them to hold the pelvis in alignment
- On occasion the baby's position may produce symptoms related to the Pelvic Instability
Further risk factors, which may play a part in Pelvic Instability in some women are:
- A previous injury to the pelvis area, or having had previous low back or pelvis pain
- Having had Pelvic Instability in a previous pregnancy
- Having a heavy physical job or workload, or working in awkward postures
- Being overweight before or during your pregnancy
- Having increased mobility in other joints (ie. hypermobility syndrome)
Research has shown that breastfeeding, time between pregnancies and contraception use is not associated with Pelvic Instability.
Diagnosis
Unfortunately Pelvic Instability is sometimes misdiagnosed as “aches & pains of pregnancy” and women can miss out on the help they need. If you think that you may have Pelvic Instability, and the symptoms don't improve after a few days of rest, you should see your doctor and arrange an appointment with a physiotherapist.
Accurate diagnoses is usually made by symptoms and clinical tests. Physiotherapists who have experience treating this condition are usually able to assess whether you are experiencing Pelvic Instability. Imaging tests can be used in diagnosis, especially after the pregnancy. Unfortunately, imaging tests sometimes do not give a clear picture of the amount of pain or symptoms a woman may be experiencing.
Pelvic Instability has historically been known by many different names. In Europe it is most commonly known as Pelvic Girdle Pain (PGP) or Symphysis Pubis Dysfunction (SPD). It is also known by the medical profession as: Pregnancy-related pelvic joint pain; Posterior pelvic pain in pregnancy; Peri partum pelvic pain; Pelvic girdle relaxation; Pelvic girdle syndrome; Pelvic insufficiency; Pelvic dysfunction; Pelvic arthropathy; Pelvic osteoarthropathy; Pubic symphysis instability; Symphysiolysis; Sacroiliac joint syndrome or Sacroiliac joint dysfunction.
Early assessment & intervention can improve the long-term outcome and reduce the pain.
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