Symphysis Pubis

What is Symphysis Pubis Dysfunction? 
The pelvic bone isthe shape of a heart, and is formed by three bones held together by ligaments.The bones meet to form three fixed joints - at the front (the symphysis pubis) and at each side of the bottom of the spine (the sacro-iliac joints).

When a woman becomes pregnant, a hormone called relaxin is produced which loosens all the pelvic ligaments in order to allow the pelvis to open out at the time of birth.
Occasionally the ligaments loosen too much and too early before birth, resulting in free movement of the pelvis especially as the baby grows and can cause the joints to seperate.
The result is mild to severe pain, usually in the pubic area, and is called SPD.

What are the symptoms?
The most common is pain and difficulty when walking. Some women describe the feeling of their pelvis coming apart. The pain is made worse when turning in bed or doing something that involves standing on one leg, such as climbing up stairs, getting dressed and getting in and out of a car.
The pain is generally felt in the pubis and/or the sacro-iliac joints, but can also be experienced in the groin, the inner side of the thighs, the hips and in one or both buttocks.

When is it most likely to start?
At any time from the first trimester onwards. Some women can be fine during their pregnancy, but get the condition a few days after their baby has been born.SPD sometimes occurs following a period of immobility, an unusually busy overactive period or a particular activity such as swimming breaststroke or lifting something incorrectly.

Is there any treatment?
Unfortunately there is no way of tightening the ligaments again during pregnancy, so no treatment will be able to cure SPD. This includes any sort of osteopathy, reflexology or acupuncture. However, after the birth the body stops producing the hormone, so the ligaments tighten up and (for the majority of women) the symptoms gradually disappear.


So what can be done?
The most important thing is to avoid doing anything that aggravates the condition, such as standing on one leg.
Sit on a chair to get dressed.

  • Be very careful to get into a car by putting your bottom on the seat first, and then lifting your legs into the car.When you get out, lift your legs onto the pavement and then lift your bottom off the seat.
  • If you go swimming, dont swim breaststroke.
  • Always turn over in bed with your knees firmly together.Make sure you get a rest (in bed) every day.If you already have a child, you will need help, as you will find it difficult to lift him or her.
  • If the pain is severe, ask your GP for a referral to a physiotherapist, ideally one who has specialist training in obstetrics and is called a Physiotherapist in Woman's Health. She or he will be able to assess you and may fit you with a pelvic support belt, which helps to stabilise the pelvis. Your GP will also be able to prescribe painkillers that are safe to take in pregnancy.

During labour and delivery
Its not really possible to decide in advance what position you will deliver in, because it all depends on how your labour goes and what you find comfortable at the time, but it is useful to have a few ideas. The most important thing is that the doctor or midwife who is delivering you knows you have SPD.
You will need to keep separation of your legs to a minimum - which is the tricky bit during delivery. If everything goes smoothly and you dont need an epidural, you might find it comfortable to deliver on all fours. If you push in a sitting position during the second stage, do NOT let your feet be placed on your attendants hips. If you need an epidural, remember it will mask the warning pain of SPD as well as the contractions and the above is even more important. If by any chance you need an assisted delivery, which requires you to have your legs in stirrups (lithotomy position), it is vital that your partner reminds your midwives that you have SPD. They will be very careful to lift your legs up together symmetrically. The same applies if you need stitches after your baby has been born.
Most women recover spontaneously soon after birth, but you will need to rest (as much as possible) and avoid doing anything that provokes the pain.

Pain Management
Discuss options for pain relief with your doctor and  ask for a referral to a physiotherapist with an interest in treating pelvic girdle pain.  They will perform a thorough assessment of your spine. pelvis and hips and devise an individual plan of treatment for you.

The next generally recommended step in managing pain is to try non drug methods such as Transcutaneous Electrical Nerve Stimulation (TENS) and Acupuncture. TENS has been used by women during pregnancy for many years and no side effects have been reported for mother or baby.

Use the  link at the bottom of this page to purchase a TENS machine

Discuss your options with your doctor. Paracetamol is often the first thing to try  with  the next step up from this  usually  a combination of Paracetamol and codeine. Both these drugs are generally considered safe to use in pregnancy but like all medicines in pregnancy the potential risks/benefits should be considered carefully. Your GP will know your full medical history and will be able to advise you on the best options available to you.  All anti inflammatory medicines,  including aspirin and ibuprofen which are available to buy over the counter should be avoided in pregnancy.
If  you are continuing to have problems with pain control your GP may refer you to a pain clinic or ask your consultant obstetrician for advice.

Other therapies
Other therapies such as cognitive behavioural therapy can be useful in managing pain. Your GP or pain clinic can advise you.

Massage can be extremely beneficial in reducing pain from pelvic girdle pain/Symphysis Pubis Dysfunction(SPD). It is also helpful as a means of   relieving muscle tension and reducing muscle and joint pain  and has other  potential benefits including reducing fatigue and promoting feelings of well being.

Massage can  be very effective in conjunction with treatment from a physiotherapist, osteopath or chiropractor with experience in managing Pelvic Girdle Pain/Symphysis Pubis Dysfunction(SPD)

Other factors
Depression and anxiety can also affect the way your body responds to pain. Seek advise from your GP if you feel this may apply to you.  Remember you are not alone with this problem. Talking to others who are experiencing similar problems can be very therapeutic.

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