Pregnancy – The Time Period of Change and Endless Questions
During the course of your pregnancy, as your body changes to accommodate the growing fetus and supporting structures, you may notice changes in the way in which your body feels and how it moves. This is a normal part of the pregnancy experience, although it is important to communicate these symptoms to your medical provider to optimize your pregnancy experience.
Although these symptoms may be normal, if you notice that these symptoms begin to interfere with your day-to-day life you may benefit from completion of a musculoskeletal evaluation by a pelvic health physical therapist. One of the common symptoms often reported during pregnancy is groin and suprapubic pain. Continue to read below regarding the potential areas which could be causing your groin and suprapubic pain during pregnancy.
Pubic Symphysis Dysfunction During Pregnancy
The incidence of pelvic pain in pregnancy has been reported between 48%-71% with the incidence of pubic symphysis dysfunction reported to occur in ~32% of pregnant women. (1) The pubic symphysis a fibrocartilaginous disc located in between the left and right pelvic (pubic) bone just above the genital region. This joint has physiologically minimal movement available and helps resist shearing, tensile and compressive forces. (2) During pregnancy, hormones such as relaxin induce physiological changes to this fibrocartilaginous disc to promote an increase in mobility and width thus preparing for labor and delivery. (2)
Women experiencing pubic symphysis dysfunction may describe “shooting” pain in the pubic symphysis with potential radiation into the lower abdomen, back, groin/perineum and thigh. Pain often more prominent especially with walking and asymmetrical movements with relief with rest. With observation and palpation women may notice tenderness locally, with potential associated swelling, and a “waddling” gait pattern.(1)
Round Ligament Pain During Pregnancy
The round ligament is fibro-muscular connective tissue, band-like in structure, which is attached to the top of the uterus, traverses through the deep inguinal ring and attaches to the labia majora. (3) This is a paired ligament with one located on either side of the uterus. During pregnancy with growth of the fetus and subsequently the uterus this ligament will “stretch” and increase in diameter or width. Around half-way through the pregnancy women may notice cramping and pain associated with stretching and contraction (Don’t forget this ligament contains muscular fibers!) of this ligament. This pain may intermittently be sharp and cause a “pulling” sensation but symptoms are usually temporary and resolve spontaneously with rest. (3) This is something to monitor but is a normal physiological change of pregnancy.
Hip Joint Pain During Pregnancy
Another anatomical region to take into consideration if you are experiencing groin pain during pregnancy is the hip. As a result of the network of interconnecting sensory nerves throughout the body referred pain can occur. Referred pain is pain perceived at a location other than the sight of the painful stimulus/origin. Per the literature, the hip joint typically refers to the groin in 55% of patients with symptoms also commonly referring to the buttock and thigh in 71% and 57% of patients. (4)
Spine Pain During Pregnancy
With the physical adaptations that occur during pregnancy to accommodate fetal growth our weight distribution/center of gravity changes and our pelvis and rib cage temporarily modify to accommodate the increase in abdominal girth. These factors can lead to the development of pain of spinal origin, primarily the thoracic and lumbar spine. A region which has been shown to commonly refer to the groin, based upon research-supported referral patterns, is the thoracolumbar junction which is the region where the thoracic and lumbar spine meet at the base of the rib cage. This region can mimic pain which is felt along the area of the pubic symphysis and groin/genitalia. (6)
Pelvic Physical Therapy
If you find yourself experiencing any of the above symptoms reach out to your local pelvic health physical therapist for evaluation so that you may be able to enjoy your pregnancy and most importantly stay active! So, to conclude there are many things which can cause pain during pregnancy but the good news is that there is something you can do about it!
References:
Howell, E. R. (2012). Pregnancy-related symphysis pubis dysfunction management and postpartum rehabilitation: two case reports. J Can Chiropr Assoc, 56(2), 102–111.
Becker, I., Woodley, S. J., & Stringer, M. D. (2010). The adult human pubic symphysis: A systematic review. Journal of Anatomy, 217(5), 475–487. https://doi.org/10.1111/j.1469-7580.2010.01300.x
Chaudhry, S. R., & Chaudhry, K. (2023). Anatomy, Abdomen and Pelvis: Uterus Round Ligament. StatPearls Publishing LLC.
Lesher JM, Dreyfuss P, Hager N, Kaplan M, Furman M. Hip joint pain referral patterns: a descriptive study. Pain Med. 2008 Jan-Feb;9(1):22-5. doi: 10.1111/j.1526-4637.2006.00153.x. PMID: 18254763.
Buckland, A. J., Miyamoto, R., Patel, R. D., Slover, J., & Razi, A. E. (2017). Differentiating hip pathology from lumbar spine pathology. Journal of the American Academy of Orthopaedic Surgeons, 25(2). https://doi.org/10.5435/jaaos-d-15-00740
Singh, T., Kumar, P. Pelvic pain in Maigne’s syndrome—a multi-segmental approach. Bull Fac Phys Ther 27, 4 (2022). https://doi.org/10.1186/s43161-021-00062-8