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The pubic symphysis is a small joint at the front of your pelvis where the two pelvic bones meet. It can cause pain in both men and women, but especially in pregnant women
The pubic symphysis and the sacro-Iliac joints (in the back of the pelvis) are especially important during pregnancy, as their flexibility allows the bones to move freely and to expand to help a baby fit through more easily during birth. The hormones relaxin and progesterone help the ligaments of your body to loosen and be more flexible.However, in some women, either because of excessive levels of hormones, extra sensitivity to hormones, or a pelvis that is out of alignment, this area is extra lax or there is extra pressure on the joint.
It is most commonly called Symphysis Pubis Dysfunction (or SPD),. Other names for it include:symphyseal separation,pubic symphysis separation ,separated symphysis ,pelvic girdle relaxation of pregnancy Pubic Diastasis) is the name for the problem in its most severe form where the pubic symphysis actually separates severely or tears).
The symptoms of SPD vary from person to person, but almost all women who have it experience substantial pubic pain. Tenderness and pain down low in the front is common, but often this pain feels as if it's inside. .
Any activity that involves lifting one leg at a time or parting the legs tends to be particularly painful. Lifting the leg to put on clothes, getting out of a car, bending over, sitting down or getting up, walking up stairs, standing on one leg, lifting heavy objects, and walking in general tend to be difficult at times. Many women report that moving or turning over in bed is especially excruciating. Many movements become difficult when the pubic symphysis area is affected. Although the greatest pain is associated with movements of lifting one leg or parting the legs, some women experience a 'freezing', where they get up out of bed and find it hard to get their bodies moving right away--the hip bone seems stuck in place and won't move at first. Or they describe having to wait for it to 'pop into place' before being able to walk. The range of hip movement is usually affected, and abduction of the hips especially painful. Many women also report sciatica (pain that shoots down the buttocks and leg) when pubic pain is present. SPD can also also be associated with bladder dysfunction, especially when going from lying down (or squatting) to a standing position. Some women also feel a 'clicking' when they walk or shift just 'so', or lots of pressure down low near the pubic area.
Pubic pain often comes on early in pregnancy, even as early as 12 weeks. One mother reports that she had it at 17 weeks. She says: A although pubic pain often does go away after pregnancy, many women find that it sticks around afterward, usually diminished but still present. If treatment to resolve any underlying causes is not done, long-term pain usually sticks around. Anecdotally, this often seems to be associated with long-term low back pain or reduced flexibility in the hips. Even worse, if the mother is mishandled during the birth, the pubic symphysis can separate even more or be permanently damaged.
No one knows why SPD occurs for sure, or why it happens in some women and not in others. Some ethnic groups report a high incidence, especially Scandinavian women and perhaps Black women. Other risk factors may include having lots of kids, having had large babies, pre-existing problems with this joint, past pelvic or back pain, or past trauma (car accident, obstetric trauma, etc.) that may have damaged the pelvic girdle area. It also seems logical that women who have broken or injured their pelvis in the past would probably be prone to this problem.
. Tips for Coping with Pubic Symphysis Pain
- Use a pillow between your legs when sleeping; body pillows are a great investment!
- Use a pillow under your 'bump' (pregnancy tummy) when sleeping
- Keep your legs and hips as parallel/symmetrical as possible when moving or turning in bed
- Some women also find it helpful to have their partners stabilize their hips and hold them 'together' when rolling over in bed or otherwise adjusting position
- Some women report a waterbed mattress to be helpful
- Silk/satin sheets and nighties may make it easier to turn over in bed
- Swimming may help relieve pressure on the joint avoiding
- Deep water aerobics or deep water running may be helpful as well (there are flotation devices to help you stay afloat easily during this; you do not need to know how to swim in order to do this)
- Keep your legs close together and move symmetrically (other sources recommend a very small gap between the legs with symmetrical movement)
- When standing, stand symmetrically, with your weight evenly distributed through both legs
- Sit down to get dressed, especially when putting on underwear or pants
- Avoid 'straddle' movements
- Swing your legs together as a unit when getting in and out of cars; use plastics or something smooth and slippery (like a garbage bag) on the car seat to help you enter car backwards and then turn your legs as a unit
- An ice pack may feel soothing and help reduce inflammation in the pubic area; painkillers may also help
- Move slowly and without sudden movements
- If sex is uncomfortable for you, use lots of pillows under your knees, or try other positions
- If bending over to pick up objects is difficult, there are devices available that can help with this
- Really severe cases may need crutches, although these should probably only be used as a last resort
- Some women report that pelvic binders/maternity support belts are helpful for pelvic pain
There are osteopathic manipulations that can treat restrictions in pubic symphysis movement and allow the joint surfaces to realign. An osteopath will also look at the other joints of the area, especially the sacro-iliac joints. Sacro-ilac joints that are not moving properly can put extra loads on the pubic symphysis
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