Prenatal Care Part 1: The reproductive system, hormonal changes and pelvic girdle pain.
Updated: Jun 3, 2019
Written by physiotherapist Amanda McDonald.
I’ve seen many pregnant women prepare for a physiotherapy appointment saying that ‘It is normal to get pain during pregnancy due to everything changing, right?’ or ‘There is nothing I can do because I am pregnant’. The thing is you don’t have to live with pain, and you can do something about it. Sure, as pregnancy progresses you are going to grow bigger, your body will change and you’ll experience things you haven’t yet experienced.
Seeking assistance from a health professional who knows what they are talking about, who can give you strategies to assist with your pain and take you through pelvic floor safe exercises is your first step to looking after your body during pregnancy.
Before I go into the pains of pregnancy, lets talk about the reproductive system and pelvic anatomy and the changes during pregnancy.
The Reproductive System:
The upper reproductive tract consists of:
2 x ovaries – main role is egg maturation and hormonal secretion during the menstrual cycle (oestrogen and progesterone)
2 x fallopian tubes
Uterus – protects and provides nutrition and removal of waste for developing embryo/fetus. The muscular wall creates contractions to eject the fetus at the time of birth.
The lower reproductive tract consists of:
Looking closer at the Uterus
During pregnancy the uterus expands up to ~1000 times its size by the end of pregnancy. The weight of the uterus is carried by the pelvic floor.
Its 3 layers all serve a unique function and it normally sits anteverted (resting on superior section of bladder), but can be retroverted (during pregnancy uterus flips forward).
Oestrogen and progesterone are the two main hormones produced by ovaries and placenta during pregnancy. Oestrogen is responsible for the stimulation of the uterus and breast growth.
Progesterone promotes gestation and aids in implantation of embryo. Other functions include.
Relaxing the uterus smooth muscle to prevent miscarriage
Relaxes bowel to help prevent constipation
Increases body temperature
Dilates blood vessels
The pelvis is a stable structure with attachment sites for 35 muscles. It is responsible for transmitting forces between the spine and lower limbs and housing organs. In fact , ~60% of forces are transferred from the sacral base S1 from L5.
Pregnancy related pelvic girdle pain (PRPGP) – What is it?
Low back and pelvic pain is common in pregnancy. Back pain affects 48-90% of pregnant women. Common areas treated include the pelvis (pubic symphysis and pelvic girdle), lumbar (low back) and thoracic (upper back) spine. It may commence at any point in pregnancy, but is more common in the second half of pregnancy, and may also be more common in second and subsequent pregnancies. It may present from a small niggle to severe pain.
It is caused by inflammation and increased joint laxity of one or more of the pelvic joints, the pubic symphysis which is the bony joint at the front of your pelvis and/or sacroiliac joints (located at the back near the dimples above the bottom). When you are pregnant you experience hormonal changes including the release of a softening hormone called relaxin. This creates softening of the pelvic ligaments. If the muscles around the pelvis and low back (think pelvic floor, abdominals, spinal, glutes and leg muscles) fail to keep up with these hormonal changes and rapid changes in posture then you may experience pelvic girdle pain.
It may present as the following:
Pain over the pubic bone (deep into groin and vagina),
Pain in the butt/lower back on one or both sides, often with referral down the thigh,
Pain whilst walking, up stairs, getting in and out of car, standing up from a chair, rolling in bed or standing on one leg
Whilst pelvic girdle pain is common in pregnancy, you can do things to help – you don’t have to suffer in silence. It is important to realise that all women present differently and need individualised treatment to address the cause of their pain. Your physiotherapist will spend time thoroughly understanding your symptoms and medical history as well as conducting a full assessment on your pelvis which may include the use of real–time ultrasound or an internal assessment to assess the pelvic floor muscles. This will ensure you receive treatment that is tailored to your body.
A physiotherapist can provide helpful treatment, advice and exercise therapy – and it is the combination of these things that usually provide the most benefit and relief of pain.
Hands-on physiotherapy treatment, including joint mobilisation, soft tissue massage and dry needling, can provide some relief temporarily, but should always be used in conjunction with other treatments, such as Pilates based exercises.
RICE: Rest! Spend some time laying down and taking the load off the joints. Apply a cool compress for 10-15 minutes every 1-2 hours. Wear tubigrip or a sacroiliac joint belt, which can help stabilise the pelvic joints and make day-to-day activities more comfortable.
Clinical Pilates exercise. These exercises can be specifically tailored to pregnant women. Specific areas include deep core stabilisation exercises, gluteal and postural exercises. See our Women’s Health page for more details.
Appropriate general exercise including swimming (more arms and gentle kicking), cycling and weights sitting on a swiss ball.
Support: Keep your legs together when moving in bed, out of the car and from sit to stand. Log roll in bed and put a pillow between your legs for sleeping. Engage your core muscles (deep abdominals and pelvic floor) to provide support when during daily activities.
Try to avoid:
Asymmetrical loading activities – anything involving placing more load through one leg more than the other. For example, leaning to one hip, lunges, stairs, standing on one leg to put clothes on.
High impact activities, such as running and contact sports.
If you have pelvic girdle pain already, avoid excessive walking and standing.
Lifting and carrying – including your toddler!
Certain exercises: Breaststroke swimming can sometimes flare back and pelvic pain in pregnancy. Stick to pelvic friendly poses in yoga and avoid wide leg stance and single leg loaded poses.
It is important to recognise that if you are not getting better, no matter how much advice and treatment you receive, if you don’t modify your exercise or activity level, you may not improve. Really stop and take it easy and reassess what you are doing - especially when there is housework to do, work to be done, and a toddler to look after!
Contact the clinic for more information and to book in with one of our physiotherapists.