If every step feels like your pelvis is grinding apart, you’re not imagining it. SPD pregnancy pain is one of the most common — and most under-discussed — complaints of pregnancy in the UK, affecting roughly 1 in 5 pregnant women to some degree. For some it’s a dull ache that shows up by evening and fades overnight. For others, it gets bad enough that they can barely walk due to pelvic pain during pregnancy, and end up relying on crutches, a wheelchair, or a partner’s arm just to get from the sofa to the kitchen.
So what’s actually going on, and what helps? This guide covers what pregnancy pubic symphysis dysfunction is, why it happens, how to tell it apart from the half-dozen other things that can cause pelvic pain during pregnancy, and — the part most articles skip — what actually works, based on the approach used across NHS physiotherapy and obstetric services.
What Is SPD in Pregnancy?
Symphysis Pubis Dysfunction — SPD — is now more often called Pelvic Girdle Pain (PGP) in clinical settings, though most women searching for answers still know it by the older name. It happens at the pubic symphysis: the joint at the front of your pelvis, where the left and right pubic bones meet and are held together by cartilage and ligaments.
Here’s the mechanism. During pregnancy your body releases a hormone called relaxin, whose job is to soften the ligaments around your pelvis so it can expand slightly to accommodate a growing baby and, eventually, birth. Most women go through this without noticing much. In others, though, the joint loosens unevenly, or more than it needs to, and the pubic bones start to shift and rub against each other. That instability is what produces the sharp, grinding, or shooting pain linked to pelvis symphysis diastasis — a small separation or misalignment at the joint.
It’s worth saying plainly: SPD isn’t dangerous to your baby, and it doesn’t mean anything is wrong with the pregnancy. But left unmanaged, it can be genuinely disabling.
What Does Pelvic Pain Feel Like in Pregnancy?
No two women describe it quite the same way, which is part of why it gets dismissed or misdiagnosed so often. The most common descriptions:
- A sharp, stabbing pain in the pubic bone area, especially getting out of bed or a car
- A grinding or clicking sensation at the front of the pelvis when walking
- Pubic bone pain that flares when one leg is lifted — putting on trousers, climbing stairs
- A deep ache that spreads into the hips, groin, or lower back
- Pain that builds after standing or walking and eases with rest
Some women also notice pain near the vaginal or vulval side of the pubic bone, which can feel alarming even when it’s benign. Usually it’s still coming from the joint and surrounding ligaments rather than the vagina itself — but any new or sharp vaginal pain during pregnancy is worth mentioning to your midwife rather than assuming it’s “just SPD.”
Pelvic Pain During Pregnancy, Week by Week
There isn’t one week when SPD switches on. It can start at almost any point, though a rough pattern tends to hold:
First trimester. Pelvic pain this early usually traces back to the corpus luteum, implantation, or early round ligament stretching rather than SPD — the pelvis hasn’t yet taken on much extra weight.
Second trimester, roughly weeks 14–27. This is when SPD symptoms most often begin, as the uterus gets heavier and posture starts to shift.
Third trimester. Symptoms frequently intensify once the baby’s head engages and the pelvis carries more load and instability. This is also the stage where pelvic pain third trimester can’t walk stops being an exaggeration and becomes a very real, very common experience.
If your pain is escalating week on week rather than plateauing, flag it early rather than waiting for the next scheduled appointment. Physiotherapy referrals started earlier tend to produce noticeably better outcomes than ones that begin once things are already severe.
SPD vs Round Ligament Pain vs Hip and Groin Pain
So many structures sit close together in the pelvis that it’s easy to mix these up. Round ligament pain comes from the two ligaments supporting the uterus on either side, which stretch as the uterus grows. It tends to feel like a sharp, brief jab in the lower belly or groin — triggered by a sudden movement, a cough, or rolling over in bed — rather than the deeper, walking-related ache typical of SPD. When does round ligament pain start? Most women first notice it around 14–20 weeks, sometimes earlier. With twins, round ligament pain often shows up a few weeks sooner than in a singleton pregnancy, since the uterus expands faster.
Groin ache in pregnancy can stem from round ligament stretching, from SPD, or simply from extra weight and shifted posture pulling on the hip flexors. If your pregnant groin hurts specifically when you turn over in bed or lift one leg, that pattern points more toward SPD. If it’s a quick, sharp twinge on sudden movement, round ligament pain is the more likely culprit.
Pregnancy hip problems are frequently tangled up with SPD too, since the same relaxin-driven laxity that loosens the pubic symphysis also loosens the hip and sacroiliac joints. Hip pain that’s worse at night, lying on one side, is extremely common, and usually responds well to a pillow between the knees plus the same physiotherapy approach used for SPD.
Left-Side, Right-Side, and One-Sided Pelvic Pain
It’s very common for pelvic pain in pregnancy to feel worse on one side, and that lopsidedness tends to worry people more than it probably should.
Left side pelvic tenderness, or pain in the left side of the pelvic area, is often down to the position of the uterus, the sacroiliac joint on that side, or simply how you’re carrying your weight day to day. Pain in the right side of the pelvis, or pregnancy pain on the right side, follows the same logic — one-sided doesn’t automatically mean something is specifically wrong on that side.
That said, there’s a distinction worth knowing. Mild one-sided pelvic pain that comes and goes is usually mechanical — joints, ligaments, muscles doing what they do under new load. Pain that’s severe, constant, or paired with fever, bleeding, or feeling generally unwell is different and needs urgent assessment, since things unrelated to SPD — a urinary tract infection, or in early pregnancy an ectopic pregnancy — can also cause one-sided pain and need ruling out.
When It Becomes Severe: “I Can Barely Walk”
For a meaningful number of women, SPD moves from “manageable ache” to something that genuinely limits daily life. If you can barely walk due to pelvic pain during pregnancy, that’s classed as severe Pelvic Girdle Pain — a recognised, treatable condition, not something you’re expected to just push through.
A few signs you’ve crossed into that territory:
- Needing to hold onto furniture or walls to move around the house
- Pain that wakes you at night when you turn over
- Real difficulty separating your legs — getting dressed, getting in and out of a car
- Pain that no longer eases with rest
At this stage, a physiotherapy referral, a pelvic support belt, and sometimes mobility aids like crutches are entirely appropriate — and used routinely in NHS maternity care. Severe SPD isn’t something to quietly manage alone until the baby arrives. Early, active treatment genuinely shifts the outcome for most women.
Vaginal and Perineal Pain in Pregnancy
Pelvic and perineal pain — discomfort in the area between the vagina and the anus — is common later in pregnancy as the baby’s head presses down on the pelvic floor. It’s a separate issue from SPD, though the two can overlap. In clinical documentation this is often recorded under the general pelvic and perineal pain code (ICD-10 R10.2), while pregnancy-specific pelvic girdle pain typically gets logged under a separate pregnancy-related code. You don’t need to memorise any of that — it just explains why your GP or midwife might describe similar-sounding symptoms slightly differently depending on which structure is involved.
Sharp vaginal pain during pregnancy that’s sudden, severe, or comes with bleeding, fluid loss, or reduced baby movement should always be checked promptly rather than filed away as “probably pelvic girdle pain.”
A Note on Your Core: SPD and Diastasis Recti
Because SPD involves ligament laxity around the pelvis, quite a few women notice changes in their abdominal muscles around the same time — including diastasis recti, a separation of the two sides of the rectus abdominis (the “six-pack” muscle) down the midline. Can you prevent diastasis recti during pregnancy entirely? Not really — some abdominal stretching is a normal, expected part of making room for a growing baby. What does help is maintaining good pelvic floor and deep core activation rather than heavy crunches or sit-ups, and avoiding movements that make your abdomen “dome” or bulge outward. Both of these can reduce the degree of separation and support a faster postnatal recovery. A women’s health physiotherapist can assess your pelvic girdle and your core in the same appointment, since the two tend to be linked.
Getting a Diagnosis
If any of this sounds familiar, mention it to your midwife at your next appointment rather than waiting it out. Diagnosis is usually straightforward, based on:
- Your description of symptoms and what triggers them
- A physical assessment of pelvic movement and tenderness
- Ruling out other causes, particularly if the pain is one-sided, sudden, or accompanied by other symptoms
Imaging isn’t usually needed. SPD is a clinical diagnosis, built from your history plus a physical exam.
Treatment for Symphysis Pubis Dysfunction
The genuinely good news: treatment for symphysis pubis dysfunction is well established, and most women see real improvement once they get the right support in place.
Physical therapy for pubic symphysis dysfunction is generally considered the most effective long-term option — a women’s health or pelvic health physiotherapist can teach specific exercises to stabilise the pelvis, correct movement patterns, and take strain off the joint. Alongside that:
- Pelvic support belts, worn low around the hips, can reduce instability and pain during daily activity
- Manual therapy, where a physiotherapist works hands-on to ease joint and muscle tension
- Activity modification — avoiding movements that force the legs apart (wide squats, straddle positions, breaststroke), and keeping the knees together when turning in bed or getting out of a car
- Pain relief — paracetamol is generally considered safe in pregnancy for this; check with your midwife or pharmacist before taking anything beyond that
- Rest and pacing — alternating activity with rest tends to produce better results over the following weeks than pushing through until pain forces a stop
Practical Relief Tips for Everyday Life
Small daily habits add up, on top of formal treatment:
- Sit down to get dressed, especially for trousers and shoes
- Keep your knees together getting in and out of bed or a car — swing both legs as one unit
- Sleep with a pillow between your knees and one under your bump
- Take stairs one at a time, leading with the less painful leg
- Avoid standing on one leg (stepping into trousers, for instance) — sit instead
- Break up long stretches of standing or walking with regular rest
FAQs About SPD and Pelvic Pain in Pregnancy
Is SPD dangerous for my baby?
No. It affects your ligaments and joints, not your baby directly, and isn’t linked to pregnancy complications. It can, though, seriously affect your comfort and mobility, which is exactly why it’s worth treating rather than tolerating.
Can I still have a vaginal birth with SPD?
In most cases, yes. Your midwifery team can talk through birth positions that reduce strain on the pelvis and note a plan in your file ahead of labour.
Will SPD go away after birth?
For most women, symptoms ease considerably within weeks to months after delivery, as hormone levels settle. A smaller group continue with physiotherapy postnatally for lingering symptoms.
What does pelvic pain feel like in pregnancy if it’s specifically SPD, rather than something else?
It’s usually centred at the front of the pelvis, worsens with walking, stairs, or one-leg movements, and often comes with a grinding or clicking sensation — different from the sharp, brief jabs typical of round ligament pain.
When should I see a doctor urgently rather than waiting for my next appointment?
For sudden severe pain, one-sided pain with fever or feeling unwell, vaginal bleeding, fluid loss, or if you can barely walk due to pelvic pain during pregnancy and it’s stopping you caring for yourself day to day.
Can pelvic girdle pain start suddenly, or does it always build gradually?
Either. Some women get a slow-building ache over weeks; others feel a sudden onset after one specific movement, like stepping awkwardly or lifting something heavier than usual.
Dr. Tania Adib is an experienced gynecologist specializing in women’s health, pregnancy, and childbirth. She is dedicated to providing expert guidance and compassionate care to women throughout every stage of pregnancy and beyond. With extensive experience in obstetrics and gynecology, Dr. Tania Adib helps expectant mothers understand fetal development, maintain a healthy pregnancy, prepare for labor and delivery, and manage common pregnancy symptoms. Her goal is to provide accurate, evidence-based information that empowers women to make informed decisions for themselves and their babies.