When Does Pelvic Pain Start in Pregnancy? Everything You Need to Know
Pelvic pain is one of the most common and misunderstood complaints during pregnancy. For many people, discomfort begins earlier than expected. Others don’t notice symptoms until the second or third trimester. The truth is that pelvic pain can start at any point in pregnancy, depending on the underlying cause.
At Cappuccino Physical Therapy, we help pregnant patients every day with our pelvic PT program who are navigating pelvic pain, pelvic floor dysfunction, and musculoskeletal changes as their bodies adapt to growing a baby. In this post, we’ll break down when pelvic pain typically starts, the different types of pain you may experience, and—most importantly—what you can do to feel better.
So… When Does Pelvic Pain Actually Start during pregnancy?
Pelvic pain can begin as early as the first trimester, but it’s most common to feel discomfort between weeks 12–20 as hormones like relaxin increase joint mobility and the pelvis begins to widen. Pain can also appear later in pregnancy, especially as the baby grows heavier and the center of gravity shifts.
Common timing patterns include:
First trimester: mild pelvic floor tension, cramping, round ligament sensitivity
Second trimester: round ligament pain, pubic symphysis discomfort (SPD/SPD-like symptoms), pelvic instability
Third trimester: pelvic pressure, tailbone pain, SI joint pain, coordination issues between the core and pelvic floor
It’s important to remember: Pelvic pain at ANY stage of pregnancy is common, but not something you have to live with.
Why Pelvic Pain Happens During Pregnancy
Your body goes through profound physical changes to support pregnancy. These changes affect the hips, pelvis, abdominal wall, and pelvic floor—sometimes creating discomfort.
The main contributors include:
Hormonal changes: Relaxin softens ligaments and joints
Postural changes: Increased lumbar lordosis and rib flare
Growth of uterus: Shifts your center of gravity
Pelvic floor strain or overactivity: Especially with nausea/vomiting, constipation, or stress
Weakness or lack of coordination in the core/pelvic stabilizers
Understanding the why helps guide the most effective treatment.
Types of Pelvic Pain in Pregnancy
Not all pelvic pain is the same—and different symptoms often point to different root causes. Here are the most common types we see in the clinic:
1. Round Ligament Pain
Round ligament pain is extremely common, especially in the second trimester.
What round ligament pain feels like:
Sharp or stabbing pain
Usually on one side, but can be both
Triggered by rolling in bed, standing up quickly, coughing, or walking
Why round ligament pain happens:
The round ligaments stretch rapidly as the uterus grows, which can create sudden pulling sensations.
What helps round ligament pain:
Gentle stretching
Core and pelvic stabilization
Controlled transitions (rolling, standing)
Manual therapy to reduce abdominal wall and pelvic floor tension
Support bands if necessary
Round ligament pain is temporary, but it can be intense. With proper mechanics and treatment, it becomes much more manageable.
2. Pubic Symphysis Pain (SPD or PGP)
SPD (sometimes called pelvic girdle pain) occurs when the pubic joint at the front of the pelvis becomes irritated or unstable.
Symptoms include:
Pain at the pubic bone
Difficulty with single-leg activities
Pain when walking, getting dressed, rolling in bed
Clicking or popping at the front of the pelvis
Why SPD happens:
The combination of relaxin, increased load, and changes in muscle activation can place extra stress on the pubic symphysis.
What helps with SPD:
Stabilizing exercises
Core and deep hip strengthening
Avoiding asymmetrical movements
SI/pelvic belt bracing
Hands-on manual therapy
SPD can begin as early as week 12–16 but often becomes more noticeable as pregnancy progresses.
3. SI Joint Pain
The sacroiliac (SI) joints connect the pelvis to the spine. As pregnancy advances, increased laxity and load can cause pain in this area.
What SI Join pain feels like:
Pain just above the buttock on one or both sides
Pain with walking, stairs, or standing on one leg
Discomfort when transitioning from sitting to standing
What helps SIJ Pain:
Glute strengthening
Pelvic stabilization
Manual therapy
Postural training
Serola Belt
SI joint pain is often highly treatable with targeted physical therapy.
4. Pelvic Floor Dysfunction
Many people assume pelvic floor issues only appear postpartum, but they often begin during pregnancy.
Pelvic floor dysfunction can include:
Pain or pressure in the pelvis
Tailbone pain
Pain with sitting
Groin or vaginal aching
Difficulty relaxing the pelvic floor
Pain during intercourse
Why it happens:
Increased load on the pelvic floor
Core system changes
Constipation or nausea-related clenching
Stress or guarding
Changes in posture and breathing mechanics
Pelvic floor dysfunction can begin in any trimester and is one of the most common contributors to pelvic pain during pregnancy.
What helps with pelvic floor dysfunction:
An individualized assessment from a pelvic floor physical therapist to get to the root cause of your symptoms.
5. Hip and Groin Pain
As pregnancy progresses, the hips rotate and widen to accommodate your growing baby. This can place extra strain on surrounding muscles and joints, including the hip flexors, inner thigh muscles (adductors), and deep hip rotators. Hormonal changes—especially increased relaxin—also make the ligaments more lax, which can reduce joint stability.
This pain often shows up between weeks 20–30, but can start earlier, especially if there were pre-existing hip asymmetries, core weakness, or prior injuries.
Why It Happens:
Widening and rotation of the pelvis alters hip mechanics
Increased ligament laxity decreases joint stability
Overworking of hip muscles to compensate for a changing center of gravity
Asymmetrical movement patterns (standing on one leg, sleeping positions, carrying older children)
What Helps:
Pelvic floor physical therapy to restore hip and pelvic stability
Targeted strengthening of the glutes, deep core, and pelvic floor
Gentle mobility for tight hip flexors and inner thighs
Movement modifications (avoiding single-leg loading, adjusting sleep positions)
Supportive tools like pregnancy belts when appropriate
6. Tailbone (Coccyx) Pain
Tailbone pain during pregnancy is more common than many people realize. As posture changes and the pelvis shifts, the coccyx can become compressed or pulled on by surrounding muscles—particularly the pelvic floor.
This pain can appear at any point in pregnancy and often worsens later as the uterus grows and weight distribution changes.
Why It Happens:
Increased tension in the pelvic floor muscles attaching to the coccyx
Prolonged sitting with a posterior pelvic tilt
Pressure changes as the uterus descends
Previous tailbone injuries or falls that resurface under stress
Reduced mobility of the sacrum and coccyx
What Helps:
Pelvic floor PT to address muscle tension and coccyx mobility
Postural adjustments for sitting and standing
Use of a coccyx cut-out cushion or wedge for sitting
Gentle pelvic floor relaxation and breathing techniques
Avoiding prolonged sitting and alternating positions frequently
7. Vaginal or Vulvar Pressure
A feeling of heaviness or pressure in the vaginal or vulvar area is common—especially in the third trimester—but it can start earlier when pelvic floor dysfunction is present. Importantly, pressure does not always mean prolapse.
In many cases, it’s related to muscle tension, circulation changes, or how the body is managing increased load.
Why It Happens:
Tight or overactive pelvic floor muscles unable to lengthen under load
Increased blood flow and vascular congestion in the pelvis
Constipation increasing downward pressure
Postural patterns that direct pressure downward instead of distributing it
Fatigue of pelvic support muscles late in the day
What Helps:
Pelvic floor PT assessment to determine the true cause
Pelvic floor relaxation and coordination training (not just strengthening)
Bowel management strategies to reduce straining
Postural and breathing work to improve pressure management
Education on positions and movements that reduce pelvic strain
When Should You Worry About Pelvic Pain?
Most pelvic pain in pregnancy is musculoskeletal, which means it’s treatable and not dangerous.
However, contact your provider immediately if you experience:
Pelvic pain with fever
Vaginal bleeding
Severe abdominal pain
Sudden swelling or headaches
Persistent cramping
Otherwise, pelvic pain is incredibly common—and highly treatable—with pelvic PT.
How Pelvic Floor Physical Therapy Helps during pregnancy
At Cappuccino Physical Therapy, our pregnancy pelvic PT sessions focus on:
Manual therapy- to reduce muscle tension, improve mobility, and decrease pain.
Pelvic floor assessment: To determine whether the pelvic floor is overactive, underactive, or not coordinating well with the core.
Strengthening and stabilization: Targeting deep hips, glutes, and core—especially needed for SPD and SI joint pain.
Postural and movement training: To reduce strain during daily tasks, exercise, and sleep.
Techniques for round ligament pain: Gentle mobilization, taping, and abdominal support strategies.
Labor preparation: Helping the pelvis and pelvic floor function optimally for birth.
Most patients feel relief after just 1–2 sessions of pelvic PT, with consistent improvement as we build strength and reduce tension.
Can You Prevent Pelvic Pain in Pregnancy?
While not all discomfort can be avoided, you can drastically reduce the severity and frequency of pelvic pain by:
Strengthening the hips and glutes
Keeping the pelvic floor flexible and coordinated
Avoiding asymmetrical movements
Practicing proper lifting mechanics
Managing constipation
Staying active with safe prenatal exercise
Seeing a pelvic PT early—even before pain starts—can help keep you comfortable throughout pregnancy.
Where to find pregnancy physical therapy in Thousand Oaks
Pelvic pain can start at any point during pregnancy, but you don’t have to wait for it to get worse before seeking help.
Whether you’re dealing with round ligament pain, SPD, SI joint issues, or pelvic floor dysfunction, pelvic PT can make your pregnancy more comfortable, functional, and enjoyable.
If you’re experiencing pelvic pain at any stage of pregnancy, Cappuccino Physical Therapy is here to support you every step of the way.
To get started, simply click the button below. You’ll be able to fill out an appointment request form or give us a call to get started today.
