Is Pelvic Pain During Pregnancy in the Second Trimester Normal?
Pelvic pain is expected as your body adapts to the changes of a growing baby. The second trimester of pregnancy is when weight gain increases rapidly due to the baby's growth. This affects the demand on the hips, lower back, and pelvic floor.
Pain that should be referred to a medical provider: sharp/shooting pain in the pelvis, bleeding, severe cramping, or contractions with predictable timing.
In this blog, we will go over what is considered pelvic pain during pregnancy in the second trimester, how to relieve the pain, and how pelvic floor PT can help.
Pelvic pain may be common, but that does not mean it’s something you have to struggle through.
What Causes Pelvic Pain During Pregnancy?
This question is quite difficult to answer because of how much change happens during the second trimester. The best part of our job is getting to spend time learning your history and testing muscles and alignment to figure out how to help you feel better. We have outlined some of our most common symptoms or struggles that come into the clinic everyday, but it’s usually a unique combination of things for each person.
1. Postural changes
A growing belly shifts the body's center of mass forward, which changes what muscles are working and how long they have to work. We usually see 2 main impairments here:
Changes in how the hips, pelvis, and spine distribute loads.
Increased demands on the abdominal, gluteal, and pelvic floor muscles.
2. Hormone fluxes
Although relaxin is commonly blamed for hormonal changes that cause pain in pregnancy, there are more hormone and soft tissue influences that are responsible.
We know from the newest research that relaxin in isolation isn't necessarily responsible for pelvic pain. It may influence, but not cause pelvic pain during pregnancy.
Your ligaments, joints, and muscles have to adapt and react to the mobility necessary to grow a baby. This can influence irritation in the pelvis and cause pelvic pain during pregnancy in second trimester.
3. Lightning Crotch (also known as Pubic Symphysis Pain)
You probably already know if you have lightning crotch, but here are the common symptoms:
Pain that feels like a sharp or shooting pain in your crotch (or front of pelvis) bone.
May worsen with putting on pants, getting in and out of a car, or longer walks.
Asymmetrical movements may be aggravating to it such as: lunges, running, or walking.
4. Sacroiliac Joint and Posterior Pelvic Pain
Your sacroiliac (SI) joint is often involved in pelvic pain as it is a large joint that connects both sections of your bony pelvis. This is a common place where improving muscle coordination and tension can quickly lead to relief.
Typically, SI pain is described as:
Pain that feels like a deep ache, sharp or shooting pain into the buttock, or general lower back pain in the back of the pelvis.
Pain that is irritated by longer walks, prolonged sitting, or movements like lunges or single leg deadlifts may irritate the sacroiliac joint due to deep hip, pelvic floor, and muscular instability or fatigue.
5. Pelvic Floor Muscle Dysfunction
The pelvic floor muscles may have difficulty relaxing, contracting, or coordinating with the increased demands due to added weight and pressure from baby. The pelvic floor coordinates with the hips, lower back, abs, and diaphragm. When one area is tight or underperforming, the other areas have to pick up the slack. (Think of a group project in school where one person always ended up doing more work - Sorry if that was you.)
Symptoms may include:
Pain with sex
Pelvic pressure or heaviness
Tailbone pain
Deep hip pain that doesn’t resolve with stretching
What Does Second Trimester Pelvic Pain Feel Like?
Here is a list of common pelvic pain that can be improved in pregnancy:
Sharp or shooting crotch bone pain
Aching or shooting into the labias, inner thighs, or groin.
Pain present with rolling in bed.
Pain with everyday activities such as workouts, walking, or running.
Pain around the lower back, SI joint, or tailbone
Sensations of vaginal heaviness or pressure
The location of pelvic pain during pregnancy can help guide treatment. Knowing where the pain is can be helpful when developing your specific treatment plan.
When Should You Be Concerned About Pelvic Pain During Pregnancy?
Most often pregnancy-related pain is from our pelvic bones, muscles, and nerves, but it is recommended to contact your OB/GYN or midwife for new, persistent, or worsening pain, particularly if accompanied by:
Fluid leakage (that isn’t urine) or bleeding
Fever
Burning or itching with urination
Consistent contractions or sensations of cramping
Severe pelvic pain or deep abdominal pain
A medical evaluation would be warranted if you are experiencing any of these issues.
5 Ways to Relieve Pelvic Pain During Pregnancy in the Second Trimester
Here are some specific things to try to relieve your pelvic pain during pregnancy:
1. Modify Activities That Aggravate Your Symptoms
Keep your pelvis stacked underneath you instead of jutted forward
Lean on a wall or sit down to put on your pants
Try symmetrical workouts if lunges or running tend to increase your pain
These can include: squats, deadlifts, or anything that generally has both legs performing the same motion at the same time.
Sit on an exercise ball at home rather than a deep couch for added pelvis and abdominal support
2. Strengthen Your Hips and Glutes
Pregnancy is a marathon and requires training! Consider a strengthening program to maintain strength throughout your pregnancy.
This can include: squats, deadlifts, heavy carries, and single leg work to improve balance and coordination
Strength in your hips can improve pelvic floor overactivity and can help maintain core support as your bodily demands increase throughout pregnancy.
3. Improve Core and Pelvic Floor Coordination
The pelvic floor and core should work as a team. We want to be able to contract the abs as the pelvic floor lifts, and relax the pelvic floor and abs together as well.
The pelvic floor is intended to contract and relax. Just doing Kegels may be contributing to your pelvic pain. Try: diaphragmatic breathing to truly get pelvic floor length.
4. External support can help
A supportive belt may give you the external relief you need
We love brands like Love Steady for pelvic floor support or a Serola belt for SI joint pain.
Support garments like the ones above may help give support with everyday activities and provide relief.
Although external support garments can be a great tool, they are most effective with an individualized plan for movement based on your specific needs in pregnancy.
5. Work With a Pelvic Floor Physical Therapist
A full assessment geared toward your needs is the most direct way to resolve your pelvic pain during pregnancy in the second trimester
A pelvic floor PT can find the root cause by assessing pregnancy-related changes such as: the ribs, the core system, pelvic floor coordination.
Every evaluation at Revive Rehab includes an individualized movement program that is targeted toward your pain and will help prepare you for birth and postpartum. Our goal is always to maintain exercise and movement throughout pregnancy.
How Can Pelvic Floor Physical Therapy Help With Pregnancy-Related Pelvic Pain?
Pelvic PT can drastically improve pregnancy-related pelvic pain.
In pregnancy, patients can expect treatment to look like:
A detailed evaluation with a movement assessment, core and pelvic floor assessment, and a specific plan for your needs.
An individualized mobility and strengthening program focused on pregnancy
Hands-on manual work for pain relief
Birth prep education and movements to prioritize in second and third trimesters
Partner-assisted techniques for pain-relief in labor
Pushing preparation for delivery
Every individual is different, just like every pregnancy is different. You deserve a plan that is specific to you and your needs and goals.
Find Relief From Pelvic Pain During Pregnancy in Second Trimester With Revive Rehab
If you’re wondering if “pelvic pain during pregnancy in the second trimester” can be resolved, you are definitely not alone.
Pelvic floor physical therapy can help you get back to the things you love without pain throughout pregnancy.
Revive Rehab in Columbia, Missouri, is a pelvic health practice that specializes in pregnancy and postpartum care.
If you are in the Columbia, Jefferson City, Fulton, Boonville, or mid-Missouri area, we’d love to work with you! Click here to learn more about our in-person services.
We offer hour-long, one-on-one, individualized appointments with a physical therapist to get to the root cause of your concerns. We provide a holistic approach for your care. Click the link below if you’d like to book an appointment with us, we’d love to help support you!
Written by: Dr. Sarah Miller, PT, DPT
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