Symphysis Pubis Dysfunction (SPD) is a medical condition which causes pain in the pubic region. It usually develops during pregnancy, but not exclusively, and it can be extremely painful.
Factors such as hypermobility, being overweight, carrying twins and/or a history of back or pelvic girdle pain can play a role in symphysis pubis dysfunction during pregnancy.
The condition can affect mobility, but it is not harmful to your baby.
During pregnancy, the ligaments that hold the pubic bones together relax due to the presence of the hormone Relaxin. This induces hypermobility, which causes the bones to separate to facilitate the delivery of the baby.
The average symphysis pubis gap in the last two months of pregnancy is 7.7mm, but when this gap increases to more than 10mm, the bones become misaligned, and this can cause pain.
However, most women can still give birth vaginally, and SPD usually resolves itself after delivery within six to 12 months post-partum. It rarely becomes a longer-term issue.
Symptoms
- ‘Shooting’ pain in the symphysis pubis radiating into the lower abdomen, the back, the groin, the inner thigh and the perineum (this is the area between your vagina and anus).
- Clicking sounds in the symphysis pubis.
- Pain whilst sleeping.
- Discomfort when turning in, or getting out of bed, or in and out of cars.
- Pain on movement, especially when walking, weight-bearing on one leg, ascending and descending stairs, or rising from a chair.
- Pain on hip abduction (movement of the leg away from the midline of the body).
- Discomfort relieved only by rest.
- Pain during intercourse.
Avoid
- Sitting cross-legged or with a twisted posture.
- Sitting on the floor.
- Prolonged sitting or standing.
- Standing with more weight on one leg, especially when you are getting dressed.
- Carrying or pushing heavy objects.
- Waddling while walking.
- Wide-legged stances and asymmetrical stretching.
Differential diagnosis
Some other conditions may also lead to SPD. They are:
Nerve compression (intervertebral disc lesion), low back pain (lumbago and sciatica), pubic osteolysis, osteitis pubis, bone infection (osteomyelitis, tuberculosis, syphilis), urinary tract infection, round ligament pain, femoral vein thrombosis.
How to prevent Symphysis Pubis Dysfunction
One solution to help relieve pain from SPD is to create more stability in the pelvis by doing the following:
- Sleep with a pillow between your legs and lie on your side instead of your back to reduce your pelvis load.
- Sit on your sitting bones rather than the coccyx (tail bone).
- Keep your knees together when getting in and out of your car.
- Use a support belt to help stabilise your pelvis, or crutches if the pain is more severe.
- Apply ice to the area to relieve the pain.
- Use a TENS machine.
- If you want to have sex, consider kneeling on all fours.
- When getting into bed, sit on the edge of the bed, keep knees close together, then lie down on your side, lifting both your legs up sideways. Reverse this to get out of bed. Do not attempt to pull yourself up from lying on your back.
- When rolling in bed, keep your knees together.
- If you get up from a chair, keep your knees close together, put your hands on your knees, and slowly come up.
- When climbing the stairs, step up sideways one step at a time.
How osteopathy can help Symphysis Pubis Dysfunction
Pregnant women require a gentle, drug-free treatment to ease their discomfort, and osteopathy offers a safe and effective treatment option.
Articulation of the lumbar spine, sacroiliac joint, hip, and direct techniques applied to the pubis symphysis can help ease the pain.
Soft tissue massage to the muscles around the pelvic and lower back region is also beneficial.
Research has shown that specific osteopathic treatments can help reducing discomfort whilst exercise will help to strengthen your pelvic floor, stomach, back and hip muscles.
This approach contributes to a swifter recovery process.
Exercise programme
Please, consult your therapist before attempting any of these exercises.
- To stabilise the abdominal muscles (Internal and External Obliques, Transversus Abdominis): Sit on a chair with your feet resting on the floor, and gently pull in your lower abdominal muscles. Hold for five seconds. Repeat five times, continuing to breathe normally.
- Pelvic Floor: Sit tall on a chair or while standing, squeeze to close around your openings. Lift and hold for five seconds. Repeat five times. Breathe normally.
- Gluteus Maximus muscle: Sit on a chair or while standing, squeeze buttocks together. Hold for five seconds. Repeat five times.
- Latissimus Dorsi muscle: Sit on a chair in front of a table. Grasp table with both hands and pull toward you. Hold for five seconds. Repeat five times.
- Hip Adductor muscles: Sitting down, put your fist or a rolled towel between your knees. Squeeze knees together. Hold for five seconds. Repeat five times.
If you are affected by the symptoms of SPD, or any other musculoskeletal condition, contact us now for more information.
REFERENCES
Aslan A., Fynes M. (2007). Symphysial pelvic dysfunction, Current Opinion Obstetrics and Gynecology,19 pp 133–139.
Depledge J., McNair P.J., Keal-Smith C., Williams M. (2005). Management of symphysis pubis dysfunction during pregnancy using exercise and pelvic support belts. Physical Therapy, 85(12), pp 1290–1300.
Jain S., Eedarapalli P., Jamjute P., Sawdy R. (2006). Symphysis pubis dysfunction: a practical approach to management. The Obstetrician & Gynaecologist, 8, pp 153–158.
Leadbetter R.E., Mawer D., Lindow S.W. (2004). Symphysis pubi dysfunction: a review of the literature. J Maternal-Fetal Neonatal Medicine, 16, pp 349–354.
Mens J., Vleeming A., Snijders C, et al. (1997). Active straight leg raising test: a clinical approach to the load transfer function of the pelvic girdle in: Vleeming A., Mooney V., Dorman T., et al, eds. Movement, Stability and Low Back Pain. Edinburgh, Scotland: Churchill Livingstone; pp 425–432.