How to Help Pelvic Pain During Pregnancy (Prenatal Pelvic Floor Physical Therapy Tips)

Authored by Dr. Maryssa Steffen, PT, DPT, Board-Certified Pelvic Health Specialist

Understanding Pelvic Pain During Pregnancy

Pelvic pain during pregnancy is common but not normal.

More than 50% of pregnant people experience some form of musculoskeletal pain during pregnancy, though many can self-manage their symptoms. Everyone’s experience is different. Some people notice mild discomfort, while others experience more intense symptoms.

Having pelvic pain during pregnancy does not mean it will continue to worsen as your pregnancy progresses. When you follow guidance from your healthcare provider or a prenatal pelvic floor physical therapist, symptoms often reduce, improve, or resolve.

If you are experiencing pelvic pain during pregnancy, your body may be asking you to slow down, notice patterns, and reach out for support.

Working with a specialist trained in prenatal pelvic floor physical therapy (prenatal PT) can help you understand what is happening in your body and how to move more comfortably during pregnancy.

Common Causes of Pelvic Pain During Pregnancy

The exact cause of pregnancy-related pelvic pain is complex and varies widely from person to person. Your joints, ligaments, and muscles are adapting quickly as they support your growing baby.

Pelvic pain during pregnancy may be influenced by:

• How the muscles of your spine, pelvis, and hips adapt to support your growing uterus

• Rapid changes to your endocrine, digestive, immune, cardiovascular, and respiratory systems

• Postural changes that increase pressure through the pelvis

• Previous injuries or a history of pelvic or back pain

• Low back or pelvic girdle pain in previous pregnancy

• Constipation or gas caused by slowed digestion

• Increased cortisol levels and nervous system sensitivity to pain

This is one reason pelvic floor PT and prenatal physical therapy can be so helpful. A trained practitioner can evaluate how your body is moving and support your changing biomechanics throughout pregnancy.

Types of Pelvic Pain During Pregnancy

Pelvic pain during pregnancy may show up in several ways:

• Pelvic girdle pain

• Lower abdominal pain

• Groin pain

Pelvic Girdle Pain

Pelvic girdle pain (PGP) describes discomfort around:

• the pubic bone

• the sacroiliac joints

The sacroiliac joints connect the sacrum (base of the spine) to the pelvis.

PGP is different from low back pain, though both can occur during pregnancy. Pain may also travel into the thighs or the back of the legs.

Lower Abdominal Pain

Lower abdominal pain is often related to round ligament pain.

The round ligaments connect the uterus to the pelvic bowl. As the uterus grows, these ligaments stretch and can become irritated. According to the National Institutes of Health, round ligament pain occurs in 10–30% of pregnancies.

Symptoms often improve with rest or changing positions.

Groin Pain

Groin pain may originate from the hip joint, which is a ball-and-socket joint capable of referring pain into the groin.

The round ligaments of the uterus can also create groin discomfort.

When Pelvic Pain Is Most Likely to Occur

Pelvic girdle pain is not harmful to your baby, but it can limit how comfortably you move.

Most people with pelvic girdle pain can still have a vaginal birth.

Symptoms often increase with activities such as:

• Walking

• Going up or down stairs

• Sitting for long periods

• Standing on one leg (such as when getting dressed)

• Turning in bed

• Getting in or out of the car

Important Safety Considerations

Avoid:

• Heating pads or hot tubs

• Medications such as ibuprofen or naproxen unless approved by your OB-GYN

Use the talk test during exercise. If you can comfortably talk while exercising, you are likely working at a safe intensity.

Pregnancy Pelvic Pain Red Flags

Contact your healthcare provider immediately if you experience:

• High blood pressure

• Strong uterine contractions

• Vaginal bleeding

• Dizziness or severe headache

• Numbness or tingling

• Chest pain

• Severe worsening groin pain with walking

• Fluid leakage

• Fever

• Decreased fetal movement later in pregnancy

• Complete loss of bowel or bladder control

Daily Habits That Reduce Pelvic Pain

Exercise Is Medicine

Appropriate movement during pregnancy can:

• Reduce risk of gestational diabetes

• Reduce risk of pre-eclampsia

• Improve cardiovascular health

• Shorten the length of labor

• Support your baby’s heart health

Consistent movement can also:

• Improve stamina

• Support better sleep

• Stabilize mood

• Prepare your body for postpartum recovery

Exercise during pregnancy is generally safe and recommended for both parent and baby.

If you are new to exercise, start gradually and build consistency over time. If you have underlying health conditions, consult your healthcare provider or a prenatal pelvic floor physical therapist before beginning a new routine.

Current guidelines recommend 150 minutes of moderate movement per week, which may look like:

• 30 minutes of movement most days

• 2 rest days

Ideally, this movement includes two mobility and stability sessions per week, such as prenatal yoga, Pilates, or guided pelvic floor PT exercises.

These activities support:

• core stability

• pelvic floor coordination

• overall resilience during pregnancy

Daily Movement Tips

You may find relief by:

• Staying gently active while avoiding movements that increase pain

• Resting when symptoms increase

• Wearing supportive shoes

• Keeping weight evenly distributed between both legs when standing

• Sitting down to get dressed instead of balancing on one leg

• Placing a pillow between your knees in bed for pelvic support

• Keeping your knees together when getting in and out of the car

Try to limit:

• Sitting or standing for long periods

• Frequent stair climbing

• Lifting heavy objects like grocery bags

Research on Exercise and Pelvic Pain

Research shows that exercise plays a meaningful role in managing pregnancy-related pelvic pain.

A 2023 review in the Journal of Women’s Health & Pelvic Health Physical Therapy analyzed 22 studies examining exercise and pregnancy-related back and pelvic pain.

The researchers found that pregnant people who exercised regularly reported significantly less pain than those who did not exercise. Non-exercisers were 30% more likely to experience severe pain during pregnancy.

Another 2023 study published in Cureus examined pelvic girdle pain during pregnancy. Both active and sedentary individuals experienced pelvic girdle pain. However, those who exercised maintained greater mobility and daily function.

Exercise may not eliminate pelvic pain entirely, but it helps the body stay stronger, more mobile, and more resilient.

If you are unsure where to start, a prenatal pelvic floor physical therapist or prenatal PT specialist can help guide safe and effective exercises.

Pelvic Floor Exercises During Pregnancy

Pelvic floor exercises can provide many benefits during pregnancy.

They can:

• Support effective labor contractions

• Assist with optimal baby positioning

• Reduce risk of postpartum issues such as urinary incontinence or prolapse

Pelvic floor training also allows the muscles to move through their full range of motion, improving blood flow and muscle health.

As pregnancy progresses, the growing uterus increases pressure on the pelvic floor. This can lead to symptoms such as:

• leaking with coughing, sneezing, or laughing

• sudden urinary urgency

People who become pregnant in their late 30s or beyond may have a slightly higher likelihood of pelvic floor symptoms due to changes in estrogen levels that influence pelvic tissue strength.

Safe Stretches and Exercises

Breathing

Practice breathing into the rib cage rather than only the front belly. Your diaphragm sits under the ribs and helps regulate pelvic floor mobility, strength, power, and endurance.

Stretching

Helpful stretches include:

• Modified child’s pose

• Happy baby

• Yogi squat (deep squat)

• Hip internal rotation stretches

• Supported butterfly

• Seated straddle

• Chest openers and upper back rotations in seated

These movements can help create space for your baby.

Posture

Check in with your posture during lifting or loading tasks. Try to keep your ribcage aligned with your pelvis, contract your pelvic floor muscles, and breathe. Ask for help if it is heavy!

Hip Exercises

• High bear

• Water-based exercise

• Bird dog and fire hydrants

Pelvic Floor Training

Practice gently bringing your sit bones, tailbone, and pubic bone toward one another to activate the pelvic floor.

Hold for 10 seconds
Relax for 10 seconds
10 repetitions
2 sets
2 times per day

Continue pelvic floor exercises until the last week before your due date. Prioritize relaxation during your last week before delivery.

Support Belts and Physical Support Options

Physical support can make daily activities more comfortable.

Options include:

• Wrapping a long scarf around the hips and belly

• Using a non-elastic sacroiliac joint belt

• A pregnancy pillow for sleep

• Wrist brace for sleep

When sleeping on your side, place a pillow between your knees to keep the hips aligned and reduce pelvic pain.

Some complementary therapies, such as acupuncture, may also help. A 2022 review found acupuncture improved pain, disability, and quality of life for pregnant people with pelvic girdle pain.

Digestive Health and Constipation

Constipation affects about 40% of pregnancies.

As the uterus grows, it places pressure on the intestines and slows digestion.

Helpful strategies include:

• Eating a fiber-rich diet (about 35 g per day)

• Regular gentle exercise

• Drinking 1.5–2 liters of water daily (up to 3 liters if exercising or in hot weather)

• Avoiding straining on the toilet

• Using a foot stool to elevate the knees

• Practicing slow breathing to relax the pelvic floor

Improving Sleep During Pregnancy

If sleep has been difficult, small changes can help.

Try:

• Limiting caffeine

• Keeping a consistent sleep schedule

• Reducing light exposure before bed

• Keeping your bedroom cool, dark, and quiet

• Writing down thoughts if your mind is racing

• Waiting about an hour after eating before lying down

• Getting out of bed briefly if you cannot fall back asleep

• Practicing relaxation or breathing techniques

Other Musculoskeletal Conditions During Pregnancy

Other conditions associated with pregnancy may include:

• Carpal tunnel syndrome

• Diastasis rectus abdominis (DRA)

A prenatal pelvic floor physical therapist can help evaluate and manage these concerns as well.

When to Seek Professional Help

Prenatal pelvic floor physical therapy focuses on:

• Reducing pain

• Improving muscle coordination

• Supporting pelvic joint stability

Treatment may include:

• Targeted exercises for the pelvic floor, abdominal muscles, hips, and back

• Movement retraining

• Prenatal massage

Pregnancy-related pelvic pain often improves after birth. However, prenatal PT and pelvic floor PT can significantly improve comfort, mobility, and daily function throughout pregnancy.

If you are experiencing pelvic pain during pregnancy, working with a pelvic floor physical therapist trained in prenatal PT can help you move more comfortably and feel more supported throughout your pregnancy journey.

Reference

https://www.nth.nhs.uk/resources/pregnancy-related-pelvic-girdle-pain-prpgp/