Pelvic Pain during Pregnancy: What is Symphysis Pubic Dysfunction?137 Comments
Are you pregnant and having difficulty rolling in bed, getting in and out of your car, climbing stairs, or walking due to pelvic pain? You may be suffering from a common condition called symphysis pubis dysfunction. The pubic symphysis is located at the front of the pelvis where the two sides of the pelvis meet. This is typically a fairly stable joint, but changes in the hormones during pregnancy relax the ligaments and allow for increased movement, which can result in misalignment and more importantly pain. Pubic symphysis dysfunction is thought to affect up to 1 in 4 women during pregnancy. It can range in severity from mild discomfort during daily activities to inability to bear weight on the legs.
The main symptom of pubic symphysis dysfunction is pain at the front of the pelvic girdle, but many women also complain of lower back pain, leg pain, or lower abdominal pain. Women who are experiencing pain may also walk with a waddling gait and have pain with walking, lifting and carrying objects, rolling in bed, climbing stairs, getting in and out of the car, and standing. Any activity that requires asymmetrical movement of the legs is likely to cause pain due to shearing forces at the pubic symphysis.
Diagnosis can usually be made on symptoms alone as many imaging techniques are not recommended during pregnancy. Ultrasound may be used during pregnancy, and if symptoms persist after pregnancy, a pelvic x-ray or MRI may be indicated.
Physical Therapy as a Treatment Option
Many women suffering from symphysis pubis dysfunction during pregnancy respond favorably to physical therapy. Treatment may include soft tissue mobilization/massage, strengthening and stabilization exercises to improve support of the pelvic girdle, pelvic floor strengthening exercises, postural exercises, and education on body mechanics and strategies to minimize pain with activities of daily living. Anti-inflammatory medication is not recommended during pregnancy, but applying ice to the pubic symphysis regularly may help with pain and inflammation, and heating surrounding musculature may decrease muscle spasm and tightness to decrease pain. Bracing or external supports may also be beneficial in providing additional stability and decreasing pain with activity.
Discussing a birth plan with your doctor or midwife is important to minimize pain and further damage to the ligaments during labor and delivery and postpartum pain. Additionally, it is important to tell nurses and others assisting with your delivery that you have symphysis pubis dysfunction so that aggravating positions such as squatting and reclined sitting with the legs wide apart are minimized. Realize that if you have an epidural you will not be able to feel the pain during labor and delivery, which you may believe is good, but you may be causing further irritation/damage to the area that you will certainly feel once the anesthesia wears off. Alternative pushing positions such as hand and knees or side-lying may be utilized.
Tips to Manage Pain Associated with Everyday Activities:
- Sit down to perform activities when possible.
- Avoid periods of prolonged weight bearing.
- Avoid deep squatting.
- Avoid lifting and carrying heavy objects when possible.
- Avoid stepping over objects.
- Avoid stairs if possible.
- When rolling in bed, place a pillow between the knees and keep the legs together as you roll.
- When getting in bed, sit on the side of the bed with the legs close together, lie on your side first and then bring both legs up sideways.
- When getting in to the car, sit down on the seat first and then bring the legs into the car.
- When getting out of the car, bring both legs out of the car first and then stand up pushing equally with both legs.
- Avoid twisting movements of the body.
- Before performing activities that are painful, contract the pelvic floor muscles to give additional pelvic stability.
The good news is that if you can manage your symptoms during pregnancy, the majority of symphysis pubis dysfunction resolves after pregnancy as the hormones return to pre-pregnancy levels. If you believe that you have symphysis pubis dysfunction, discuss with your doctor or midwife.
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