Pelvic girdle pain (PGP), sometimes referred to as symphysis pubis dysfunction (SPD), is a common discomfort experienced by up to one in five pregnant individuals. This pain results from the combined effects of the hormone relaxin, which loosens pelvic ligaments, and the increased weight of the growing uterus. The resulting joint instability often causes pain that intensifies at night. This intensification occurs because sustained positions and the lack of active muscle support allow gravity to place greater strain on the compromised joints. Finding the right nighttime strategy is necessary for managing this pain and improving sleep quality.
Positional Adjustments for Nighttime Comfort
The foundation of comfortable sleep with pelvic pain involves maintaining proper spinal and pelvic alignment while lying on your side. Sleeping on your side, preferably the left side, is typically recommended as it promotes optimal blood flow to the placenta and improves circulation for both the parent and the fetus. Crucially, the goal is to prevent the top leg and hip from sagging forward, which twists the pelvis and stresses the pubic symphysis and sacroiliac joints.
To achieve a neutral, pain-reducing position, you must keep the knees, ankles, and hips stacked and parallel. Placing a supportive cushion or pillow directly between your knees and extending it down to your ankles prevents the upper leg from rotating internally. This stacked alignment minimizes the sheer force across the front and back of the pelvis, giving the joints a chance to rest and stabilize.
Keeping the knees hip-width apart, rather than letting them press together, is also important to avoid putting the pelvis into a position that deactivates the stabilizing gluteal muscles. When the knees fall inward, a valgus stress is placed on the hip joints, which can increase the load on the already lax pelvic ligaments. Maintaining this parallel positioning ensures that the buttock muscles can offer some passive stabilization even while you are asleep.
Essential Support Tools and Accessories
While correct body positioning is essential, external tools are necessary to comfortably maintain that alignment throughout the night. Full-body maternity pillows, often shaped like a C, U, or J, are specifically designed to support the entire body, from the head down to the ankles. These pillows cradle the abdomen, take pressure off the lower back, and provide a secure place for the top leg to rest without collapsing forward.
In addition to a main body pillow, smaller foam wedges can be strategically placed to offer targeted support. A wedge under the belly can lift the weight of the abdomen slightly, reducing anterior pull on the pelvis and the strain on the round ligaments. Placing a wedge behind the back can also prevent unintended rolling onto the back, a position that can compress the vena cava and place uneven pressure on the pelvic floor.
Consider the surface you are sleeping on, as mattress firmness can contribute to hip soreness. If your mattress is overly soft, it may allow your hips to sink and twist, which exacerbates pelvic discomfort. Using a firmer mattress or a dense mattress topper can provide a more stable, level foundation for the spine and pelvis. For easier repositioning during the night, wearing silk pajamas or using a satin sheet can reduce the friction needed to turn without jarring the pelvis.
Preparing the Body for Rest
Reducing pain while sleeping begins with preparing the body and minimizing joint stress in the hours leading up to bedtime. The “log-rolling” technique is crucial for entering and exiting the bed. This involves moving the upper and lower body as a single unit, keeping the spine and pelvis straight to avoid twisting or separating the legs.
To get into bed, sit on the edge, then lower your body to the side while simultaneously lifting your legs onto the mattress, keeping your knees pressed together. This prevents the high-impact shearing forces that occur when the legs move independently. Once lying down, performing gentle pelvic tilts can help reset the neutral position of the pelvis before settling into your final sleep posture.
Applying localized heat or cold approximately 20 to 30 minutes before sleep can also help manage inflammation and muscle tension. A warm bath or a heating pad placed on the lower back or glutes can relax tight muscles that have been working hard to stabilize the pelvis throughout the day. Conversely, a cold pack applied to the pubic bone area can help numb the sharp, localized pain common with symphysis pubis dysfunction. It is also wise to avoid wide, asymmetrical leg movements, such as stepping out of a car or climbing stairs quickly, in the hour before rest, as these actions can significantly increase overnight pain.
When to Consult a Healthcare Provider
While many strategies can improve comfort, certain symptoms indicate that the pain requires professional medical evaluation beyond home remedies. You should contact a healthcare provider if the pelvic pain is sudden, severe, or debilitating to the point where it prevents you from bearing weight or walking. Pain that is accompanied by fever, chills, or persistent nausea could signal an underlying infection, such as a urinary tract infection, which requires prompt medical treatment.
A persistent pain that does not improve with rest, positional changes, or supportive devices should also be discussed with a doctor. In these cases, a referral to a specialized physical therapist, particularly one focusing on pelvic health, is often necessary. Physical therapy can offer a comprehensive diagnosis and specific exercises to stabilize the joints.
Additionally, any loss of bladder or bowel control alongside pelvic pain should be reported immediately, as this can be a sign of nerve involvement or a serious condition requiring urgent attention.