What is it?
Symphysis Pubic Dysfunction (SPD) causes discomfort in the pelvic region. It is most common during pregnancy when the right and left side of the pelvic bones allow for too much movement
Normally there are ligaments in the area to hold the joint in place. However, when pregnant due to the hormone relaxin, the ligaments begin to loosen and expand so the pelvic girdle can open more for birth. All this additional movement in your pelvis can cause pain.
Symptoms
The symptoms of SPD can vary for different people. The pain can be located in the front center of your pubic bone, in the lower back on both sides, or pain in your perineum. Your pelvis may even feel loose and “wobbly”. The weight of the fetus can put pressure on the joint as well, causing it to hurt more. As the mother gets closer to delivery the pain may become more intense.
Some discomforts that might be felt include sudden, shooting pain coming from the front or back of the pelvis. There can also be a steady pain that radiates throughout the lower abdomen, back, groin, thigh and leg.
The patients may describe some of the pain as if they had bruised pelvic bone and there will be tenderness to the touch of that area. They can also describe a stabbing nerve pain in the groin area.
There can be some movements that may make pain worse and these include walking, bending forward, going up and down the stairs. Trying to move around in bed and getting in or out of the car may cause more pain as well. You may also notice putting on pants/socks/shoes may cause pain as you place most of your weight on one leg.
Other symptoms other than pain that are associated with pubic symphysis include having trouble using the bathroom, feeling of fatigue, and a clicking or grinding feeling in the pelvis.
About 1 in 5 of people who are pregnant report symptoms related to pubic symphysis.
In a few cases, a sports injury where the pelvic bone was jammed or dislocated can cause issues with the joint area. The cartilage in this joint can also wear down over time, so that it is less likely to support the pelvic bones.
Diagnosis
To diagnose pubic symphysis the clinician will look into the patient’s medical history. Then they may do a physical exam to check for tenderness, pain, or swelling. The clinician may also look at how the patient moves and what types of movements give them trouble. In some cases, the traumatic ones, they may request imaging such as an x-ray.
Management
Until your body stops producing the hormone relaxin, the doctor may give some recommendations to help ease the pain of the patient. They may recommend the use of NSAIDs that are safe for the fetus. They may also tell the patient that wearing comfortable shoes when having to walk will help with some symptoms. Placing an ice pack over the pelvic area may relieve some of the pain. Wearing a pregnancy belt may help suppose the pelvis. Sleeping with a pillow between the legs and squeezing your legs together may be some recommendations given for different positions that may help.
Different types of doctors may be able to help with symptoms of pubic symphysis. A physical therapist, chiropractor, acupuncturist, and a massage therapist can all help relieve some of the stress or strain that the patient’s body may be feeling. Alignment corrections in the pelvis and spine will help relieve most of the pain that is felt with pubic symphysis dysfunction.
Different stretches and exercises will help with this condition. The exercises and stretches will help with protection and stability of the pelvic area. There will be different exercises and stretches the patient can do during and after pregnancy to help with symptoms.
Some of the exercises that will be given will focus on weak gluteal muscles. The clinician will also give exercises that move the patient from side to side such as side lunges or lateral step ups.
Movement is the most important component of pubis symphysis dysfunction. Learning how to move the body safely is an important step for this condition. When a patient feels pain they may alter their movement patterns to find relief. When this happens it is important to not over-correct because it could put too much strain on the ligaments and joints.