Symphysis pubis dysfunction

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Pregnancy-related pain in the region of the symphysis pubis accounts for a great deal of discomfort for many women. When the bones that form the front of the pelvis become unstable and move, the associated bone and nerve pain can, and does impact on normal, everyday mobility. Which is why pregnant women with Symphysis Pubis Dysfunction (SPD) are often desperate to know what causes this condition and what they can do to relieve their symptoms.

The first thing to remind yourself of is that you are not alone. It is estimated that around 3 in every 10 women will experience some degree of SPD. Many healthcare professionals consider the incidence to be higher than this, though not all women are formally diagnosed. Women commonly put their discomfort down to “one of those things” or general pregnancy discomfort when in fact, it is a condition that responds very well to correct management.

Because SPD symptoms can build up gradually, it can be difficult to pinpoint exactly how much discomfort is due to the condition. It can pay to invest some time and thought into focusing on particular areas that are causing problems. 

What are the Symptoms of Symphysis Pubis Dysfunction?

  • A sharp and sometimes overwhelming pain in the front region of the pubic area.
  • A stabbing, shooting, or burning type of pain, which can also be felt into the hip bones, the back, the perineum and the backs of the legs
  • A waddling walking gait
  • Knee pain, which may extend down to the ankles and the feet & is generally a result of alignment problems further up in the pelvis
  • The pain can be felt more acutely when lifting one leg in front of the other or when standing on one leg, i.e. when climbing stairs, getting out of bed or twisting, the pain can be felt more acutely.
  • Often the pain is worse at night when lying on the back, so turning over in bed and lifting the legs to get out of bed can exacerbate the pain
  • A grating, clicking or grinding noise may be heard or even felt in the region of the pubic bone
  • Some women experience difficulty in passing urine 

What Increases the Risk of Getting Symphysis Pubis Dysfunction?

  • Gaining an excessive amount of weight during pregnancy
  • Having a multiple pregnancy or a very large baby (gestational diabetes can add to gestational weight gain and increase birth weight)
  • Repeated jarring type exercises, strenuous activity, poor posture and previous injury all increase the likelihood of developing this condition
  • The quality of an individual woman’s muscle and connective tissue also affects the stability of her pelvis
  • Previous trauma or fracture to the pelvis 

 

What causes Symphysis Pubis Dysfunction?

The pelvic bones are generally kept stable and well supported by the ligaments that surround them. During pregnancy, hormones designed to relax the joints and help to facilitate an easier birth are released. However, these hormones can also make the pelvic joint unstable, leading to pain and discomfort. 

The specific area affected in SPD is the narrowest point of the bones in the pelvic girdle, which lies directly in front of the bladder. The symphysis pubis is the region at the front of your pelvis, which is normally covered by pubic hair. 

Another contributing factor is the change in weight distribution, which creates stress on the pelvis, the spine and all the structures supporting them. 

How is it Diagnosed?

Symphysis Pubis Dysfunction is diagnosed through taking a thorough medical history. Ultrasounds may help in the diagnosis as well. It is not advisable for pregnant women to have X-Rays unless absolutely warranted. 

What is the Management of Symphysis Pubis Dysfunction?

Treatment is generally based around limiting movement that could make the condition worse. Avoiding any movement that aggravates SPD can be difficult, especially when there are older children to care for. Adjusting work and sleeping areas can be helpful; so can asking for help with activities that have become painful. Obstetric physiotherapists and occupational therapists can provide expert advice and guidance on modifying work and rest areas. 

Straddling movements are out when SPD has been diagnosed. Think about the position of the legs when sitting on a horse or riding a bike. It’s the separation of the legs that causes problems. The key is to try to brace the pelvis to keep it stable before any movement and to keep the knees together, so pelvic bones don’t have a chance to rub against each other and cause pain. 

What Can Really Help to Relieve the Pain

  • Rigid or non-rigid pelvic support girdles/belts or corsets can provide a lot of relief. These help to support the bones of the pelvis back into their correct alignment. Corsets need to be custom-fitted by a physiotherapist and adjusted as the abdomen enlarges. They may also need to be worn during sleep if the SPD pain is impacting on being able to sleep and stay comfortable in bed.
  • Side sleeping can be helpful as long as the abdomen and upper leg are well supported by pillows. Full length body pillows can be very useful during pregnancy and are available from large department stores and specialty sleeping outlets.
  • Avoid lying on the back during sex and instead, try lying on your side. Often SPD can be so uncomfortable that it makes sex impossible.
  • Be careful when getting in and out of a car, moving in bed and doing any activity which requires one leg to be lifted independently rather than two together. Squeezing the knees together when moving rather than separating them is beneficial and helps to stabilise the pelvic joint.
  • Exercises that focus on training the muscles of the pelvic floor and strengthening them are generally helpful.
  • Avoid standing on one leg, which can make pain worse.
  • Avoid wearing high heels. Limiting heel height to no more than 3-4 cm is ideal. This helps to reduce the strain on the lower back.
  • Avoid sitting with your legs crossed, sitting twisted or sitting on the floor.
  • Avoid cycling, it can create further problems with opening the already unstable joint.
  • For some women, accupuncture, massage and deep muscle relaxation exercises have been found to be helpful.
  • Sometimes gentle treatment with an osteopath or chiropractor can be useful. Be cautious whenever following any complimentary or alternative medicine route. It is always wise to check with your healthcare provider to ensure there are no contra-indications.
  • Placing insulated icepacks over the tender area can help with swelling and pain. Just be cautious about not leaving them on for too long: 5-10 minutes every few hours is plenty.
  • Analgesics are sometimes necessary though it is imperative that you speak with your healthcare provider or a pharmacist to ensure that the medication you plan to take is safe to ingest during pregnancy. 

How Long will it Last?

Generally there is an improvement in symptoms and joint stability after birth. Once the pregnancy hormone relaxin is no longer produced, the joint becomes more stable and there is an improvement in comfort level. 

Occasionally SPD is so severe that a vaginal delivery is not possible. In this case a caesarean section is performed. 

Will I always have Problems?

This is unlikely. Some women experience on-going problems with their back or pelvic floor following delivery but most recover very well. If you have had SPD with a previous pregnancy, you are more likely to have it again. There are real benefits in seeing a specialist obstetric physiotherapist if pain, discomfort or incontinence are present. 

Are there any Complications?

Occasionally, the pelvic joint may actually separate causing more intense pain. This is a condition known as symphyseal separation or diastasis of the symphysis pubis. This can be acutely painful. Bed rest and heat treatment are usually prescribed. Orthopaedic and physiotherapy assessment and management are necessary to help manage this condition. Some women are also advised to limit their weight bearing activity and need to walk with elbow crutches to alleviate further pain.

 
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