Symphysis Pubis Dysfunction and Pregnancy

Written by: James Gill BOst GOsC 6039. Registered Osteopath, Founder & Clinic Director

Medically Reviewed: Yannick Gracia, M.Ost GOsC 10475. Registered Lead Osteopath

What is Symphysis Pubis Dysfunction?

Symphysis Pubis Dysfunction (SPD) is described as a discomfort in the pelvic area that most commonly occurs during pregnancy. It is also commonly referred to as ‘pubic symphysis dysfunction’ or ‘pelvic girdle pain’. Symphysis Pubis Dysfunction occurs when the ligaments that keep your pelvis aligned become too relaxed as a result of the hormone ‘relaxin’. This hormone is vital in the lead up to childbirth, it allows increased joint mobility, allowing the pelvis to loosen up so that the child can pass through the birthing canal during labour. This loosening also means that joints can become more unbalanced and mobile than they usually would be, leading to pain and discomfort.

What are the signs & symptoms of Symphysis Pubis Dysfunction?

Typically, the majority of the pain experienced during SPD is in the central pubic area but it can radiate to the upper thighs and perineum (area between the anus and vulva) and across 1 or both sides of your back. It is often described as an ache but can also be a sharp shooting or stabbing pain or a deep muscle pain. The pain tends to worsen with walking and doing one-legged weight-bearing activities such as getting dressed, turning over in bed and getting in and out of a car and is usually relieved by rest.

What are the common causes of Symphysis Pubis Dysfunction?

Symphysis Pubis Dysfunction is most often seen in pregnancy, mostly in the second and third trimester and is diagnosed in 1 in every 300 pregnancies (Owens, Pearson and Mason, 2002). It can happen for no apparent reason during pregnancy although it is linked to previous pelvic damage, weight and position of the baby, previous history of SPD in prior pregnancies, being overweight and having a physically demanding job.

However it can also occur as a result of diastasis recti ( this is the separation of the rectus abdominis muscle), previous surgery or fracture of the pelvis, after an injury with legs in hyper-abduction (seen in gymnastics and horse-riding) and following a prostatectomy.

How is Symphysis Pubis Dysfunction diagnosed?

Symphysis Pubis Dysfunction is normally diagnosed through a thorough case history and physical examination. An early diagnosis is important to reduce any longer-term problems and allow as much intervention to occur in the early stages.

Although it’s diagnosed symptomatically, the only way to confirm diastasis and separation of the pubic bones is via MRI or X-Ray. This isn’t often done unless symptoms continue postpartum due to risk of ionising radiation on the baby.

In the interim, ultrasonography can be safely used to measure the distance between the bones using electronic callipers. In most women this is 4-5mm. This increases 2-3mm in the final trimester, however this is often increased in those with SPD. A gap of 10mm or more indicates diastasis of the symphysis pubis (or symphyseal separation), which tends to cause more serious pain and needs to be taken into consideration when creating a birthing plan.

How long does Symphysis Pubis Dysfunction last?

With treatment, symptoms can be managed however most have to adjust their activities for the remainder of the pregnancy in order to avoid any pain-provoking movements.

For most, pain relieves within 2-6 weeks after childbirth due to the decrease in the hormone relaxin production and the reduction in pressure on the pelvis. If pain persists at your 6 week check-up, speak to your GP.

What are the treatment options for Symphysis Pubis Dysfunction?

The earlier a diagnosis can be made, the better. This will allow you to keep pain to a minimum and avoid longer-term discomfort. It is recommended to seek help from your GP or physical therapist for SPD if it occurs.

Self-care

You can apply a heating pad or ice pack to the area. Don’t leave this on for longer than 7 minutes at a time. You can safely cycle the pack on/off for every 10 minutes.
Avoid triggers: sit down to get dressed, avoid heavy lifting and pushing
Be as active as possible (within your limits!). It’s important to avoid sitting or standing for long periods of time. Many find swimming comfortable as it is a non weight bearing exercise. Sometimes breaststroke can be aggravating so be careful about which strokes you chose to do.
Some may find it useful to place a band around your legs slightly less than what normally brings on the pain to avoid moving into the painful ranges.
Wear flat, supportive footwear.
Avoid crossing your legs.
Try and get help with household chores and shopping from your partner, family or friends.
When turning in bed, try keeping your knees together while squeezing your buttocks. You may find it useful to have a small pillow between your legs. (Pelvic pain in pregnancy, 2021)

Manual Therapy
A manual therapist such as a physiotherapist, chiropractor or osteopath will take a full case history and conduct a thorough examination in order to exclude any other issues. Once a diagnosis of SPD is made, treatment will be tailored to you. It tends to consist of manual therapy to ensure that the pelvis, hip and spine are moving as efficiently as they can and any compensatory mechanisms are addressed. It is important to stabilise the pelvis as much as possible, so for this you will often be given exercises to strengthen your pelvic floor, back and hip muscles.

Shockwave Therapy
For persistent pain in the pelvis or pubic bone following childbirth, Focused Shockwave Therapy (FSWT) offers targeted relief. Postpartum pelvic pain, including symptoms of Symphysis Pubis Dysfunction (SPD) or Osteitis Pubis, can be challenging to resolve due to chronic ligament strain and inflammation. FSWT’s converging energy is ideal for treating deep, bony structures like the pubic symphysis or sacroiliac joints, stimulating regeneration and reducing inflammation precisely where the chronic pain is located. This non-invasive treatment is an excellent option for mothers whose pelvic pain has lasted beyond the initial six-week recovery period, providing a powerful adjunct to rehabilitation exercises.

Appropriate exercise
As with self care, it is important to keep moving, however this needs to be done in your pain-free movement. An osteopath, chiropractor or physiotherapist will often prescribe exercises that can help. In addition to this, you may find Clinical Pilates can be beneficial in assisting with SPD. Some of the chiropractors, Osteopaths and Physiotherapists at bodytonic clinic are also trained in this and can advise you whether they feel Clinical Pilates may be of benefit for you.

Medication
Pain medication can be taken to help with the discomfort you are receiving, however it is best to speak to your GP or local pharmacist about this.

Alternative Therapies

Walking Aids and Support Bands
In more severe cases, it may be necessary to use crutches or a pelvic support belt to assist with easing your symptoms.

Are there any considerations with labour?

It is important to speak to your midwife about your diagnosis of SPD. It should be established what distance between your legs is your pain-free range of movement. During child-birth it is suggested that you shouldn’t exceed this distance and use of stirrups and forceps should be avoided as they can strain the ligaments further. It is also recommended that those with SPD give birth in an upright position (kneeling, on all fours or standing) or consider a water birth (Jain, Eedarapalli, Jamjute and Sawdy, 2006).

Can Symphysis Pubis Dysfunction be prevented?

There is no definitive way to prevent SPD from occuring during pregnancy. It is possible to minimise the risk by maintaining a moderate body weight and seeing an experienced therapist to ensure that your body is best adapted to the physical stresses of pregnancy.

What are the best exercises for Symphysis Pubis Dysfunction?

Kegels

Pelvic Tilt

Overhead Reach

Lie on your back with your knees bent, legs hip width apart, neck long, and shoulders drawn down away from your ears.
Float your arms above your head, with your palms facing away from you, while exhaling
Inhale and hold
Exhale and lower both arms overhead, keeping the rib cage soft (if you feel the ribcage starting to lift then don’t progress further).
Circle your arms out and down while inhaling to finish with your hands over your shoulders. As if you are drawing a capital ‘D’.
Repeat this for 1 minute in a controlled manner.

Exercise has a positive effect if it is done correctly. Exercising incorrectly can also cause or worsen SPD or further injury, so make sure you have great technique and if needed gain advice from a personal trainer, 1-2-1 Pilates teacher or a physical therapist such as an osteopath or physiotherapist.

Do I need to go to the GP or visit my local hospital?

It is useful for your GP and midwife to be aware of a diagnosis in SPD due to the implications in your birthing plan.

SPD itself is not a medical emergency however, if you experience any pain while urinating, pins and needles/numbness in your legs speak to your GP or midwife. If you experience vaginal bleeding, fever, severe stomach or low back pain or any swelling in your legs call your midwife, GP or hospital immediately.