Causes of Pelvic Pain in Pregnancy

Pelvic pain or discomfort in pregnancy may vary in intensity and duration. It can be triggered by a number of factors or occur spontaneously for no known reason. However, it is important to note the nature of the pain, aggravating factors and duration in order to assist your doctor with a diagnosis.

Pelvic pain includes pain or discomfort in the lower abdomen and pelvis, as well as pain in the pubic area, groin, lower back or hips. The causes of the pain may not always be related to the pregnant state (non-obstetric). It is also not uncommon for mild pain or discomfort to have no identifiable cause in pregnancy. In this instance, it will often pass on its own without complicating the pregnancy or affecting the mother’s health in any way.

Causes of Pelvic Pain in Pregnancy

Some of the obstetric causes of pelvic pain has been discussed under abdominal pain in pregnancy. This includes :

  • Ectopic pregnancy
  • Spontaneous abortion (miscarriage)
  • Abruptio placentae
  • Placenta previa
  • Preterm labor
  • Normal labor pains
  • Round ligament pain
  • Torsion of the pregnant uterus

Other obstetric and non-obstetric causes of pelvic pain in pregnancy includes :

Pregnancy Pains

  • Pain due to implantation of the embryo
    • A dull, menstrual-like pain may be felt deep in the pelvis or lower abdomen for a day or two around the time of the first missed period. Implantation of the embryo into the uterus is thought to be the cause.
  • Normal changes of pregnancy
    • This is a result of growth and enlargement of the uterus. It is usually felt as a cramping pain in the lower abdomen, pelvis or lower back.

Ovary Pains

  • Ruptured hemorrhagic corpus luteum cyst
    • May cause pelvic pain and severe vaginal bleeding, which may lead to hemorrhagic shock.
  • Adnexal (ovarian) torsion
    • A sudden, colicky pelvic pain, often accompanied by nausea and vomiting. The torsion normally resolves on its own, with relief of symptoms.

Uterus Pains

  • Red degeneration of myoma (fibroid)
  • It may present as sudden onset of pelvic pain with nausea, vomiting, fever, and vaginal bleeding occasionally.
  • Torsion of pedunculated myoma
  • Chorioamnionitis
    • Bacterial infection of the chorion and amnion (the membranes surrounding the fetus) and the amniotic fluid.

Urinary Pains

  • Acute urinary retention
    • This is due to a retroverted gravid uterus, meaning a pregnant uterus that is tilted or tipped backwards).

Pelvic Cavity Pains

  • Pelvic inflammatory disease (PID)
    • Not very common during pregnancy.
  • Scar tissues or adhesions
    • There may be a past history of surgery for infertility or other types of pelvic or abdominal surgery.

Bone, Cartilage and Joint Pains

  • Pain in the lower back and hips
    • This may occur as a result of :
    • laxity of the joints caused by pregnancy hormones
    • weight of the growing uterus changing the center of gravity of the mother
    • the way a woman carries herself
    • weakening and separation of the abdominal muscles to a lesser degree
  • Pelvic joint instability
    • The pelvis (pelvic girdle) is made up of two hip bones attached to the sacrum at the back and at the symphysis pubis in front by means of ligaments and cartilage.
    • Relaxin, a hormone secreted during pregnancy, helps to relax the joints of the pelvis, thus facilitating easy delivery of the baby.
    • However, excessive laxity of the joints makes it unstable and may result in pain.
  • Symphysis pubis dysfunction (SPD)
    • This may give rise to a type of pelvic joint pain felt by a woman particularly during pregnancy.
    • It usually starts from the second trimester onwards, but may be felt at any time during pregnancy or even after childbirth.
    • There may be symptoms of pain in the pubic area, groin, or inside of the thigh, along with low back and hip pain.
    • A clicking or grinding sensation may also be felt.
    • The pain may intensify when moving the legs apart, walking or climbing stairs.
  • Diastasis symphysis pubis (DSP)
    • This is a rare condition, related to SPD, which may occur during pregnancy.
    • There is normally a gap of 4 to 5 mm between the two pubic bones, which may stretch by another 2 to 3 mm during pregnancy.
    • If, however, there is further stretching of the bones, it can give rise to severe pain.
  • Sacroiliac joint dysfunction
    • The sacroiliac joint, between the sacrum and the part of the hip bone known as the ilium, is normally a very stable joint.
    • Laxity of this joint during pregnancy may give rise to low back pain, usually made worse with activities using one leg, such as climbing stairs or getting out of the car.

Related Articles

  1. Abdominal Pain in Pregnancy – Obstetric and Non-obstetric Causes
  2. Stomach Pains during Pregnancy – Warning Signs, Treatment, Surgery

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  • cutegal

    I’m almost 9 weeks pregnant 3rd pregnancy..
    since my 2nd pregnancy which didn’t make it…I’ve been having pain or sensitivity along side my left pelvis when pressing on it or just coughing alone it’s sensitive. it’s been couple months now and it’s constant. Some days i feel it more like there’s a weird sensation like burning..not sure..but when I’m standing left side looks more swollen then the right…i went to see doctors had and trans-vaginal ultrasound and nothing came up no cyst nothing abnormal…now i think that it could be my sigmoid colon. now i’m afraid that it can interfere with pregnancy and causing another miscarriage…what could it be? and should i ask for a sigmoidoscopy?

    • Dr. Chris

      Hi Cutegal

      It is not advisable to undergo any unnecessary diagnostic investigation like a sigmoidoscopy when pregnant. As long as your gynecologist did not detect any abnormality, there is no reason to suspect that your pregnancy is at risk. However, given your history and symptoms, regular check ups are essential. This could be related to problems with the pelvic joints which is discussed further under Joint Pain During Pregnancy. Speak to your gynecologist and if you are still concerned, seek a second opinion.