Pelvic girdle pain (PGP) is a common postpartum complaint and may co-occur with pelvic floor symptoms and low back pain-related disability [1] This study aimed to evaluate the association between clinically relevant postpartum PGP, pelvic floor symptom impact, and low back pain-related disability in postpartum women.

A cross-sectional online survey was conducted in accordance with STROBE guidelines, from January to December 2024. Eligible participants were women aged ≥18 years who were 3–12 months postpartum after vaginal delivery or caesarean section. Exclusion criteria included pre-pregnancy or pre-delivery PGP, pelvic floor pain/dysfunction, or back pain; a history of urogynaecologic disease; serious psychiatric, neurologic, internal, orthopaedic, or oncologic disease; ongoing physiotherapy; and incomplete questionnaires.
Validated questionnaires were used: the Pelvic Girdle Questionnaire (PGQ; clinically relevant PGP defined as a PGQ total score ≥28), the Pelvic Floor Impact Questionnaire–Short Form 7 (PFIQ-7), and the Oswestry Disability Index (ODI). Associations between PGQ, PFIQ-7, and ODI scores were assessed using Spearman’s correlation, and differences between women with non-clinically relevant versus clinically relevant PGP were evaluated using an ANOVA test (p < 0.05).
The sample size was determined using the following formula: n = Z2P(1−P)/d2 (Z = 1.96 for a 95% confidence level; p = 0.4 for the maximum expected prevalence of PGP; and d = 0.05 for a 10% confidence interval). Based on this calculation, we aimed to recruit at least 369 participants. To account for an anticipated 20% dropout rate, the minimum sample size was increased to 443 women.

Of 920 women recruited, 791 (86.0%) met the eligibility criteria; 129 were excluded mainly due to pelvic/back pain prior to delivery (n = 52), a history of urogynaecologic disease (n = 33), serious comorbidities (n = 9), incomplete questionnaires (n = 23), or ongoing physiotherapy (n = 12).
Regarding maternal/obstetric characteristics, age, gestational weight gain, and infant birth weight did not differ significantly between groups, whereas pre-pregnancy BMI was higher in women with clinically relevant PGP (25.65 ± 5.45 vs 24.11 ± 4.73; p < 0.001). No significant differences were observed for delivery mode, episiotomy, epidural analgesia, or twin pregnancy; however, assisted vaginal delivery (vacuum/forceps) differed significantly, with a higher proportion in the pain group.
Correlation analysis showed strong positive associations between PGP severity and co-occurring symptoms: PGQ correlated with ODI (r = 0.716) and with PFIQ-7 total (r = 0.753). Correlations were moderate-to-strong for PFIQ-7 bladder (r = 0.668), bowel/rectum (r = 0.541), and vagina/pelvis (r = 0.690) domains (all p < 0.001). Correlations with age, gestational weight gain, parity, and infant birth weight were not significant; BMI showed only a weak correlation (r = 0.113; p = 0.001).

PGP severity was strongly associated with both pelvic floor symptom impact and low back pain-related disability, suggesting that postpartum PGP often co-occurs with a broader lumbopelvic and pelvic floor symptom burden rather than presenting as an isolated complaint.

Given the strong association with low back pain-related disability and the moderate-to-strong association with pelvic floor symptom impact, postpartum screening and management may benefit from an integrated approach addressing both lumbopelvic function and pelvic floor symptoms.

Wiezer M, Hage-Fransen MAH, Otto A, et al. Musculoskelet Sci Pract. 2020;48:102154.