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Aches and pains are an expected part of pregnancy, but pelvic pain that keeps you from walking, working, or sleeping is not something you have to endure. In a recent episode of the Healthful Woman podcast, Dr. Nathan Fox spoke with Dr. Jaclyn Bonder, a physiatrist specializing in women’s health, about why this pain happens and how effectively it can be treated. As Dr. Bonder put it, “pregnancy is nine months — you don’t want to be uncomfortable for that long.”

What is Pelvic Girdle Pain?

Pelvic girdle pain refers to pain anywhere between the top of your hip bones and the bottom of your buttocks. It can involve several structures at once: the sacroiliac joints in the back of the pelvis, the hip joints, the lower spine, and the pubic symphysis in the front.

The pelvis works as a connected ring — two C-shaped halves that meet in the middle at the pubic symphysis. That front joint is normally stable and not built to move much, and the same is true of the sacroiliac joints in the back.

Why It Happens During Pregnancy

The main driver is hormonal. During pregnancy your body releases relaxin, which loosens ligaments throughout the pelvis in preparation for delivery. As Dr. Bonder describes it, everything becomes “a little bit more loosey-goosey.”

That looseness sets off a chain reaction. Joints that were designed to be stable become less so, and the surrounding muscles have to work much harder to hold everything in place. If those muscles fatigue or aren’t strong enough for the job, more stress lands on the joints, which leads to inflammation and pain — and painful joints in turn cause muscles to strain further.

Two things raise your risk: a history of hypermobility or being “double-jointed,” and having had pelvic girdle pain in a previous pregnancy, which is the strongest predictor of all. Fitness, though, is not destiny in either direction. Women who train five days a week can develop significant pain, and women who have never set foot in a gym may sail through — it reflects how an individual body handles pregnancy more than how strong that body was going in.

Symptoms and When to Seek Care

Pelvic girdle pain shows up as discomfort in the lower back, hips, sacroiliac area, or directly over the pubic bone. Patients often describe strange sensations — a feeling that a leg is going to fall off, or that the hips are shifting in odd directions. Pain typically worsens with walking, standing for long periods, or rolling over and getting out of bed, and it can radiate down the legs. Severity ranges from a mild nuisance to pain severe enough that a patient needs a walker.

Reach out to your provider if pain is interfering with daily activities like working, grocery shopping, or showering; if it is progressively worsening; or if you notice neurologic symptoms such as weakness, numbness, or tingling.

Diagnosis and Treatment

Diagnosis begins with a detailed history and a physical exam that assesses pelvic alignment and evaluates the hips, sacroiliac joints, and pubic symphysis, along with muscle strength and tightness. If conservative treatment isn’t working or the picture is unclear, MRI and X-ray are both safe in pregnancy; CT scans are generally avoided because of radiation exposure.

Treatment is non-operative and focused on restoring function:

Physical therapy is usually the first line of treatment. “Exercise is medicine,” Dr. Bonder notes — a low-risk treatment that helps a great many patients.

Support bracing with a pregnancy-specific belt can improve pelvic or lumbar stability, depending on where the pain is.

Medications, always chosen in consultation with your OB, may include acetaminophen or muscle relaxants, with other options reserved for specific circumstances.

Complementary care such as acupuncture, massage, or chiropractic treatment can help, provided the practitioner is experienced with pregnant patients.

Recovery Postpartum

In some cases the pubic symphysis actually separates, which more often becomes apparent after delivery — sometimes in women who had no pain during pregnancy. Assisted deliveries and very rapid labors are associated with this injury.

Recovery is managed with early rest, anti-inflammatory medication at therapeutic doses, supportive bracing, and a gradual, pain-guided return to physical therapy. The prognosis is generally good: most patients are walking a mile comfortably before three months and back to their regular routines, including the gym, within three to six months.

Listen to the Healthful Woman Podcast

Dr. Bonder sums up the larger lesson simply: most of this pain gets better when it is treated correctly, and pregnancy is too long to spend in avoidable discomfort. To hear the complete conversation, including why a C-section is usually not the answer for pelvic pain and how to prepare your body before a future pregnancy, listen to “Pelvic and Pubic Symphysis Pain in Pregnancy and Postpartum” on the Healthful Woman podcast.

If you have questions about pelvic pain during pregnancy or are struggling to recover postpartum, schedule an appointment with our team. We are here to help you navigate these decisions with clear, individualized guidance.

Carnegie Imaging for Women blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!