When you learn that you're pregnant, it comes with big changes - and not just those related to your baby. There are some aspects to pregnancy that are expected, or at least talked about, as they tend to be slightly more common among most people. Some of these symptoms include morning sickness, the “pregnancy glow,” cravings, swollen hands or feet, fatigue and more. However, what sometimes isn’t expected are the aches and pains that you may experience through the hips, low back or abdomen. This can be especially unexpected for those of us that haven’t dealt with these types of issues before. So, what’s going on?
The simplest answer is that your baby is growing. With that growth means space must be created in different places through the pelvic girdle and abdomen throughout each trimester. This addition of space is created through the stretching of the ligaments and the “spreading” of the bony pelvic girdle, which in turn creates more mobility where the two hip bones and tailbone meet. However, despite the necessity of this pelvic girdle mobility, you can sometimes develop more aches and pains due to all this extra motion.
For clarification, the pelvic girdle bones are always moving. They must in order for you to walk with a normal forward and backward motion through your hips. However, when you become pregnant, these tend to start moving more than they used to because your body is trying to figure out how to fit a growing baby in this small space with all your other organs. And fun fact, your baby does not stay in one place through your pregnancy. Your baby will move up and out of the pelvis as they grow, which means different areas will need to move and make space throughout the pregnancy.
Trimester One (Week One - Week 12/13): The Pelvic Girdle
When you’re in your first trimester, your baby will spend all their time in your pelvic girdle. The pelvic girdle is made of three bones; your two hip innominates (hip bones) and your sacrum (tailbone). This pelvic girdle is also where your bladder, rectum and vagina/uterus reside. These three bones are usually held together pretty snug via your pelvic floor muscles and ligaments, with only enough motion being allowed to let you move your hips forward and backward for walking, lunging, standing, etc. Once you get pregnant, the space between these bones increases just enough (we're talking millimeters of motion) due to the loosening of your ligaments to make extra space for your baby. In this phase, you might experience more pain through your tailbone and hips due to that extra movement.
Trimester Two (Week 12/13 - Week 25/26): The In-Between
In your second trimester, your baby is making their way out of your pelvic girdle and into your abdominal space. For many people, this might also be when you really start to notice the baby bump! However, since your baby is moving out of the pelvic girdle you might also find other things are moving a bit more, too. On one hand, you might start experiencing less pain through your tailbone in this phase as your baby moves out of the pelvic cavity. On the other hand, your abdominal organs will start getting a bit more squished and your pubic symphysis (where the two hip bones meet in the front) will start to carry more load. In this phase, you might experience more symptoms of constipation and pubic symphysis pain due to where your baby is moving. However, the pubic symphysis is still part of the pelvic girdle, so you may continue to experience any pain you had through your hips or tailbone in the first trimester.
Trimester Three (Week 25/26 - Week 39/40): The Abdomen and Low Back
Finally, you've reached your third trimester. In this final stretch of your pregnancy, your baby will have fully ascended into your abdominal cavity until they start to "drop" and prepare for childbirth. Your baby will be sharing space with your colon, your stomach, your diaphragm and several other important visceral organs. Furthermore, your baby is getting heavier as they grow, which will cause you to naturally need to shift your weight backwards to keep yourself balanced and will naturally cause an increase load for the pelvic floor to carry. In this phase, you might experience more symptoms of low back pain or sciatic pain, shortness of breath or groin "tension" due to our natural adjustment of body mechanics for our babies. You might also start to notice more urgency or frequency going to the bathroom.
Trimester 4 (Week 40 and Beyond): Postpartum
You've successfully given birth to your baby and are on the next step of the adventure. However, before you jump back into everything you used to do, remember all of the big changes your body just went through. If you don't feel like you're "back to normal," that is to be expected. Your body needs time to heal, so remember that the six to eight weeks of healing that's recommended is the minimum amount of time you need before you're going to start feeling normal again. If you still don't feel like you're on track by your six to eight week follow-up appointment, talk to your health care provider about your options.
If you have any issues at any point in your pregnancy with ongoing pain, weakness or incontinence, talk to your doctor and seek out your local pelvic health physical therapist.
Maria Robison, P.T., D.P.T., is a physical therapist at MyMichigan Health.
