If turning over in bed, climbing stairs, or getting out of the car sends a sharp jolt through your pubic bone, hips, or lower back, you may be dealing with symphysis pubis dysfunction (SPD), sometimes called pelvic girdle pain. It's one of pregnancy's more specific and disruptive discomforts, and also one of the more common ones: pelvic and lower back pain together affect roughly three in five pregnant women, with the joint at the front of the pelvis often at the center of it. For a real share of that group, the pain is serious enough to disrupt daily life. It's rarely dangerous, and with the right approach, most people find meaningful relief well before delivery.
Key Takeaways
- Symphysis pubis dysfunction (SPD), also called pelvic girdle pain, causes pain at the pubic joint, hips, and lower back, and is common in pregnancy and rarely dangerous on its own.
- It's driven by pregnancy hormones loosening the pelvic ligaments, combined with the pelvis carrying uneven, asymmetrical load.
- What helps most: moving symmetrically, avoiding positions that spread your legs, wearing a supportive pelvic belt, and working with a pelvic health physiotherapist.
- Get medical attention if pain stops you from weight-bearing, comes with fever or numbness, or follows a fall.
What Symphysis Pubis Dysfunction Feels Like
The symphysis pubis is the joint at the front of your pelvis, where the left and right pubic bones meet in the middle, held together by cartilage and ligaments. Along with two joints at the back of your pelvis, it forms your pelvic girdle - the ring of bone that supports your spine and connects to your legs.
When that joint and its surrounding ligaments come under strain, you'll typically feel pain right at the pubic bone, sometimes spreading into the groin, inner thighs, hips, or lower back. A few patterns are common:
- Sharp or aching pain that worsens with movement, especially anything that separates your legs or shifts weight onto one leg.
- A grinding, clicking, or "give way" feeling at the pubic bone when you walk.
- Pain getting out of bed, turning over, climbing stairs, or getting in and out of a car.
- Difficulty walking normally - some people develop a waddling gait to manage the discomfort.
- Pain that builds by the end of the day or after time spent on your feet.
If that sounds familiar, you're dealing with something specific and well understood - and you're far from the only one.
Why It Happens in Pregnancy
A few things stack up here, each adding strain to a joint that isn't built to move much.
Hormones loosen the joint on purpose
Early in pregnancy, your body releases relaxin and other hormones that soften the ligaments around your pelvis, letting the pelvic joints shift slightly to make room for delivery. That's necessary and normal - but it also means the symphysis pubis has more give than it's used to, and more give can mean more irritation.
Your pelvis carries uneven load
As your baby grows, your posture, gait, and center of gravity shift. Everyday movements that use one leg more than the other - climbing stairs, stepping into the bath, getting out of a car - put uneven stress through the pubic joint, which can set off or worsen pain.
The joint is working overtime
Your pelvic girdle carries more weight for longer than it's designed to, particularly in the second half of pregnancy. Combined with looser ligaments, that added load is often what tips things from mild discomfort into daily pain.
A history of pelvic or back pain
If you've had pelvic girdle pain in an earlier pregnancy, lower back pain before pregnancy, or a previous pelvic injury, you're more likely to develop it again this time.
Carrying twins, or later in pregnancy generally
More weight and more pressure through the pelvis raise the load on the joint, which is part of why pelvic girdle pain tends to show up more with twin pregnancies and tends to intensify in the third trimester.
How It's Diagnosed
There's no blood test or scan needed to diagnose SPD. Diagnosis relies mainly on your symptoms and a physical exam - ideally with a pelvic health physiotherapist, midwife, or doctor - that checks for tenderness at the pubic joint and specific movements known to reproduce the pain, following clinical diagnostic guidelines for pelvic girdle pain.
One thing worth knowing: SPD is often under-recognized in routine antenatal care. If your concerns feel brushed off, it's reasonable to ask directly for a referral to a pelvic health physiotherapist.
Managing the Pain Day to Day
Most of the relief for SPD comes down to reducing the uneven load on the joint, wherever you can.
Move symmetrically
Keep your knees together and your legs roughly level whenever you can. Small habit changes add up: sit down to get dressed rather than standing on one leg, bring your knees together before turning over in bed, and take stairs one at a time.
Get in and out of the car sideways
Swing both legs out together rather than stepping out leading with one leg, which spreads the pubic joint under load.
Log-roll to get out of bed
Roll onto your side with your knees together, then use your arms to push yourself up sideways, rather than sitting straight up from lying flat.
Avoid positions that spread your legs
Wide squats, lunges, breaststroke-style kicks, and sitting cross-legged all place extra strain on the joint. It's not about avoiding movement - it's about avoiding the specific positions that load the joint unevenly.
Try a pelvic support belt
A well-fitted maternity support belt, worn low around the hips, helps stabilize the pelvic girdle and can meaningfully reduce pain during activity for many people. A pelvic health physiotherapist can help you find the right fit and position.
Rest between activities
Break up standing or walking with short rests rather than pushing through until the pain builds. Little and often tends to work better than long stretches followed by a crash.
Use heat for comfort
A warm compress over the pubic area or lower back can ease the muscle tension that builds up around a strained joint.
Movement That Helps (and What to Avoid)
Staying completely still isn't the goal. Gentle, well-chosen movement tends to help more than rest alone.
What tends to help
- Walking in shorter, more frequent stretches rather than long ones.
- Swimming with a gentle kick, avoiding breaststroke, which spreads the legs.
- Pelvic floor and deep core activation exercises, guided by a pelvic health physiotherapist.
- Gentle hip and lower back stretches, kept within a comfortable range.
What tends to make it worse
- Breaststroke swimming.
- Standing on one leg, such as while getting dressed.
- Deep squats or lunges.
- High-impact exercise or running.
- Sitting cross-legged or wide-legged for long periods.
A pelvic health physiotherapist can build you an individualized plan. Exercise tailored to the person, rather than a generic routine, is a central part of the recommended approach to pelvic girdle pain, and what works best varies from person to person.
When to Get Help
SPD is uncomfortable rather than dangerous for the vast majority of people. But a few signs are worth a same-day call to your provider:
- The pain is severe enough that you can't weight-bear or walk at all.
- It follows a fall or direct injury.
- It comes with fever, or pain that spreads well beyond the pelvis.
- You notice numbness, tingling, or weakness in your legs.
- The pain keeps intensifying despite rest and the strategies above.
Trust your instinct here. If something feels different from your usual discomfort, it's always reasonable to check.
Will It Go Away After Birth?
For most people, symphysis pubis dysfunction eases significantly in the weeks after delivery, as hormone levels settle and the pelvis stabilizes again. It doesn't always resolve immediately, though - for some, mild symptoms can linger for months while the joint and surrounding ligaments finish recovering.
A minority of people continue to have some pelvic girdle pain well beyond the postpartum window. In a long-term follow-up of women with pregnancy-related pelvic pain, roughly 4 in 10 still reported some degree of pain 12 years after giving birth, though the majority had none. That's not a reason to expect the worst - it's a reason to take ongoing pain seriously rather than assuming it will fade on its own.
If pain continues past the early postpartum weeks, a pelvic health physiotherapist is the right first stop - they can assess how your pelvic girdle, core, and pelvic floor are working together and build a plan around what you specifically need. Some people prefer a structured rehabilitation approach that combines breathing, core function, and pelvic floor recovery. Programs such as Restore Your Core are one example, and can complement care from a pelvic health physiotherapist rather than replace it.
Frequently Asked Questions
Is symphysis pubis dysfunction the same as pelvic girdle pain?
Largely, yes. Symphysis pubis dysfunction (SPD) refers specifically to pain and instability at the pubic joint, while pelvic girdle pain (PGP) is the broader term for pain anywhere across the front and back joints of the pelvis. In practice, the two terms are often used to describe the same experience.
How early can SPD start in pregnancy?
There's no fixed timeline. Some people notice symptoms as early as the first trimester, though it's more common from the second trimester onward as weight gain and postural changes increase. It can also appear suddenly, sometimes triggered by a particular movement.
Can I still have a vaginal birth with SPD?
Yes, for most people. SPD on its own isn't usually a reason to avoid a vaginal birth. It's worth telling your midwife or doctor in advance, though, so your birth team can help you find comfortable positions and avoid movements, like wide leg positions in stirrups, that might aggravate the joint during labor and delivery.
Does SPD mean something is wrong with my baby?
No. SPD is about the mechanics of your pelvis and ligaments responding to pregnancy, and it isn't a sign of a problem with your baby's growth or wellbeing.
What's the fastest way to relieve SPD pain in the moment?
Stop the activity that triggered it, bring your knees together, and rest in a symmetrical position - lying on your side with a pillow between your knees works well. A well-fitted support belt can also bring quick relief during activity.
Will I get SPD again in a future pregnancy?
It's more likely, though not guaranteed. If you've had pelvic girdle pain before, working with a pelvic health physiotherapist early in a future pregnancy, sometimes even before symptoms start, can help you manage it more effectively from the outset.
This article is general information, not medical advice. Talk with your provider, midwife, or a pelvic health physiotherapist about your own situation, especially if pain is severe, worsening, or affecting your ability to get around.
References
- Vleeming, A., Albert, H. B., Östgaard, H. C., Sturesson, B., & Stuge, B. (2008). European guidelines for the diagnosis and treatment of pelvic girdle pain. European Spine Journal, 17(6), 794-819. https://pmc.ncbi.nlm.nih.gov/articles/PMC2518998/
- Wu, W. H., Meijer, O. G., Uegaki, K., et al. (2004). Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence. European Spine Journal, 13(7), 575-589. https://pmc.ncbi.nlm.nih.gov/articles/PMC3476662/
- Shanshan, H., Liying, C., Huihong, Z., et al. (2024). Prevalence of lumbopelvic pain during pregnancy: A systematic review and meta-analysis of cross-sectional studies. Acta Obstetricia et Gynecologica Scandinavica, 103(2), 225-240. https://pmc.ncbi.nlm.nih.gov/articles/PMC10823407/
- Bergström, C., Persson, M., Nergård, K.-A., & Mogren, I. (2017). Prevalence and predictors of persistent pelvic girdle pain 12 years postpartum. BMC Musculoskeletal Disorders, 18, 399. https://pmc.ncbi.nlm.nih.gov/articles/PMC5602957/