Pelvic health · One page to start with
New pelvic, low back, or hip pain in pregnancy is not automatically "just pregnancy". Most of it is pelvic girdle pain, which is mechanical, common, and treatable. But inflammatory disease can cause pain in the same places, and the pelvic girdle pain guideline names axial spondyloarthritis, psoriatic arthritis, rheumatoid arthritis, and lupus among the things that can look the same from the outside. So describe it to the team who knows your disease. That is all that is being asked of you.
Worth mentioning sooner: pain that wakes you in the second half of the night, stiffness in the morning lasting more than about 30 minutes, or pain that feels like your usual disease rather than a new strain.
The pelvic floor is a sling of muscle from the pubic bone to the tailbone. It supports the bladder, bowel, and uterus, and helps you control wind and urine.
The contraction: a gentle squeeze and lift, as if stopping yourself passing wind and urine at the same time. Keep breathing. Do not squeeze your buttocks. Do not pull your tummy in hard.
Then let go completely. The release matters as much as the squeeze. A pelvic floor that never switches off can cause pain and problems of its own, and some people need to learn to relax it rather than strengthen it.
How much? That is deliberately not printed here. The right amount depends on what your pelvic floor is actually doing, and a pelvic health physiotherapist can tell in one appointment what a handout cannot. The illustrated programmes are linked below.
Keep moving, but spread the load. Shorter, more frequent walks beat one long one. Keep your knees together when you turn in bed. Sit down to dress. Take stairs one at a time if it helps. Pace the day rather than doing everything in the good hour. Exercise that hurts should be changed, not pushed through.
The clinical practice guideline reports strong evidence that exercise improves how the pelvic floor, back, and hip muscles perform, and is honest that how much this changes pain day to day is less certain. A pelvic belt, a walking aid, or hands-on treatment can help while you build tolerance.
You are not sure you have found the right muscles. You leak urine or wind. You feel heaviness or dragging. Sex is painful. Pelvic pain is limiting walking, sleep, or work. None of this is something to put up with, and all of it is treatable. Ask your rheumatology team, maternity team, or family doctor about a pelvic health physiotherapist.
Seek prompt medical attention for new numbness or weakness in the legs, new loss of bladder or bowel control, fever with pelvic pain, or a fall or injury.
Free illustrated booklets from Pelvic, Obstetric and Gynaecological Physiotherapy (POGP), a professional network of the UK Chartered Society of Physiotherapy, written by pelvic health physiotherapists and reviewed every three years:
Fit for Pregnancy: https://thepogp.co.uk/_userfiles/pages/files/resources/21xxxxpogpffpregnancy_signed_off.pdf
Fit for the Future (after birth): https://thepogp.co.uk/_userfiles/pages/files/resources/241419pogpfffuture_1.pdf
All booklets: https://thepogp.co.uk/resources/booklets/