The Pelvic Girdle Questionnaire, PGP, has been validated and tested in a Swedish cohort study. Mapping of diagnostics and treatment of BS has been carried out by the Swedish National Agency for Medical and Social Evaluation, where Helen Elden was an expert in the project group.
Pelvic pain affects about 30 percent of all pregnant women and usually starts around pregnancy week 18, but can sometimes start as early as in pregnancy weeks 8-10 and as late as three weeks after delivery. Pelvic pain can also come after trauma to the pelvis. The cause of pregnancy-related pelvic pain is unknown, but secretion of the hormone relaxin, the growing stomach and the altered posture are considered to play a role. The hormone secretion means that the mobility in all joints of the body increases and that a softening of connective tissue in the joints takes place that specifically aims to increase the mobility in the pelvis to facilitate the baby's passage during childbirth. These factors place greater demands on muscles and ligaments and increase the risk of pelvic pain.
Suggested risk factors for pelvic pain that have been investigated in several studies are age, Body Mass Index and smoking, but a systematic review describing the role of these risk factors for developing pelvic pain during pregnancy is lacking.
The diagnosis is made after a standardized examination where lower back pain has been ruled out and pain provocation tests have been able to cause pelvic pain. The specific history includes pain located between the iliac crests and the hamstring folds, together with or without pain in the pubic bone. The pain can move from side to side and often radiates down to the thighs.
The women describe a negative impact on the experience of being pregnant, function, partnership, motherhood, the opportunity to work and worries that the problems will persist after the birth.
The treatment consists of information about the condition, ergonomic advice, a pelvic belt, acupuncture, crutches, muscle stabilizing training and full-time or part-time sick leave. A report in 2021 shows that out of the 33 relevant systematic reviews that were identified, 15 had a low to moderate risk of bias. Fourteen of these reviews have studied one or more of the treatment methods general exercise (eg yoga, group exercise, aqua aerobics), torso stabilizing exercise, pelvic floor exercise, pelvic girdle, relaxation exercises, massage, acupuncture, and manipulation of the pelvis in the form of massage, osteopathy and chiropractic treatments.
The outcomes studied are pain, function, quality of life, sick leave, persistent pelvic pain after childbirth and side effects of the treatment. Although the results of the reviews are not unambiguous, the individual reviews show that there are both scientific knowledge gaps and some evidence for the treatment methods. There is no scientific evidence for classification systems.
Most women who get pelvic pain have problems throughout pregnancy but recover in the first months after giving birth, regardless of whether they received treatment for it during pregnancy or not, but it can also be the beginning of a chronic pain condition. Pelvic pain after childbirth has been reported in 17.5, 8.5 and 10 percent of women after 3 months, 2 years and 11 years. The risk of recurrence of pelvic pain during a new pregnancy is great but not definitive. Women with previous lower back pain and pain in all pelvic joints (both sacroiliac joints plus the symphysis) and positive pain provocation tests during pregnancy, have the greatest risk of chronic problems, which has an impact on function in everyday life and thus give a reduced quality of life. For some women, anxiety about recovering pelvic pain make them to choose not to become pregnant again.