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Symphysis Pubis Dysfunction

Symphysis pubis dysfunction (also known as SPD) is a condition associated with childbirth and pregnancy in which the pubic symphysis—the cartilaginous joint that unites the forward-located hip bones of the pelvis—becomes too elastic to adequately perform its function, which is to keep your pelvic bones properly aligned. The result is an uncomfortable combination of odd sensations, back pain, and pelvic pain that can be difficult to put up with. SPD is also sometimes referred to as pubic separation, symphyseal separation, or pelvic girdle pain.

In its milder form, symphysis pubis dysfunction affects one out of every four pregnant women, afflicting 88 percent of them in their second or third trimester. Approximately 7 percent of women who suffer this condition continue to experience serious symptoms after giving birth. Approximately 1 percent of pregnant women develop a severe form known as diastasis pubis, a much wider separation that can cause such severe pain that the patient may require a walker.

Symphysis pubis dysfunction has always been with us—Hippocrates observed it in the fourth century BC—but sadly there is still little in the way of effective treatment for it. The incidence of SPD also appears to have risen in recent years, but it is difficult to say whether this is due to an increase in the average age of pregnant women or simply a result of more frequent diagnosis.

Symptoms of Symphysis Pubis Dysfunction

The most common symptom of symphysis pubis dysfunction is acute pain in the central low pelvic region, whichradiates outward to the lower back, the hips, the abdomen, and the legs. The pain is often accompanied by peculiar and unsettling sensations; the sufferer may hear the joints in her hips and lower back clicking as she walks or when she changes position while lying down, or she may feel them popping in and out of place.

Symphysis pubis dysfunction is usually characterized by a waddling gait, and sufferers may experience difficulty walking, climbing stairs, putting on clothes, getting into and out of cars, or even standing up. If the sufferer lies still and does not move, usually there is no pain at all.

Causes of Symphysis Pubis Dysfunction

The primary cause of symphysis pubis dysfunction is widely believed to be a hormone called relaxin, whose function is to prepare a woman’s normally inelastic pelvic structures for the demands of childbirth. As its name implies, relaxin has the effect of increasing the elasticity of tendons, ligaments, and muscles in the region of the birth canal. Although relaxin has long been associated with SPD, however, recent European studies have called its role into question.

Diagnosis and Treatment of Symphysis Pubis Dysfunction

If you believe you are suffering an abnormal amount of back pain during your pregnancy, you should make an appointment to see your healthcare provider. Your doctor will want to give you a physical examination to determine whether your back pain is being caused by SPD or by some other condition, such as a herniated disc, or possibly even Braxton Hicks contractions or preterm labor.

Treatment of Symphysis Pubis Dysfunction

There are many options available to try to reduce the pain of SPD. Wearing a pregnancy support binder can help. Tight short pants like yoga pants or cycling pants can help stabilize the hip and pubic bones. There are pelvic support devices called pelvic girdles that act like a corset to hold the pelvic bones in place while you are pregnant. These are hard to find, but a physical therapist may have access to them through a specialty supplier. Some doctors recommend various exercises for the pelvic floor muscles such as Kegel exercises. If your SPD is sufficiently debilitating, you may need some type of assistance to walk, such as a cane, elbow crutches, or a walker. (If you use a walker, don’t forget to place the tennis balls under the front rubber feet!) You may even need a wheelchair for the remainder of your pregnancy, but this rarely happens.

Activities that cause pain should be minimized. Avoid squats, for example. For position changes such as turning in bed and standing up, you should use your arms as much as possible and minimize the use of your stomach muscles; this will reduce the pain.

One of the more frustrating aspects of symphysis pubis dysfunction is that the pain itself is difficult to treat and manage, owing to the inherent risks involved with administering medication to pregnant women. In some cases doctors may recommend Tylenol, and for severe pain, an occasional narcotic such as codeine or Vicodin. However pregnant women who take narcotics (which are opiates) risk causing respiratory and other problems in their babies.

Fortunately, symptoms of SPD—the back pain, the pelvic pain, and the alarming sensations—usually disappear soon after the patient has given birth, and very few women suffer serious symptoms for long after that. During and after your pregnancy, your doctor will want you to avoid strenuous activity or exercise, and will probably advise you to avoid standing for prolonged periods. You will be advised to avoid lifting or carrying anything, and to brace your pelvic floor muscles before undertaking any movement or action that you feel might cause you pain. You will be advised to bend your knees and keep your legs together when you get into and out of bed.

Giving Birth While Suffering From Symphysis Pubis Dysfunction

When the time comes for you to have your baby, your doctor will, of course, be aware of your condition, and may prefer that your baby be delivered by C-section. For vaginal birth, a modified birthing position such as lying on the side might be safer, so as to avoid the typical wide opening of the legs. A labor epidural is safe, but be aware that it can mask the underlying pain so that after the delivery and after the epidural has worn off, your condition might initially be more painful than expected.

Questions to Ask Your Doctor About Symphysis Pubis Dysfunction

  • I have been experiencing severe back pain and pelvic pain with my pregnancy; could I be suffering from SPD?
  • Will my symptoms disappear after my baby is born? If they do not, how long should I wait before coming in to see you?
  • Can I still give birth naturally, or would you prefer that I had a C-section?
  • Will I experience long-term difficulty with walking?
  • How long must I wait after the baby is born before I can resume my normal activities?
  • Is there any medication I can safely take for the pain?

Medical References:

    British National Health Service http://www.nhs.uk/conditions/pregnancy-and-baby/pages/backache-pregnant.aspx#close National Institute of Health http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3364059/ National Institue for Health and Care Excellence (NICE) http://www.nice.org.uk/nicemedia/pdf/CG62FullGuidelineCorrectedJune2008.pdf Pain In Childbearing, Key Issues In Management, Margaret Yerby, Lesley Page. ISBN: 0702022993, Publisher: Bailliere Tindall; 1st edition (March 15, 2000) Relaxin is Not Related to Symptom-Giving Pelvic Girdle Relaxation in Pregnant Women. Acta Obstet Gynecol Scand. 1996 Mar;75(3):245-9. Hansen A, Jensen DV, Larsen E, Wilken-Jensen C, Petersen LK.
[Page updated November 2014]