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Pregnancy related pain in the region of the symphysis pubis accounts for a great deal of discomfort for many women. When the bones which form the front of the pelvis become unstable and move, then the associated bone and nerve pain can, and does impact on normal, everyday mobility. Which is why pregnant women with Symphysis Pubis Dysfunction (SPD) are often desperate to know what causes this condition and what they can do to relieve their symptoms.
The first thing to remind yourself of is that you are not alone. It’s estimated that around 1 in every 300 women will experience some degree of SPD. Many health care professionals consider the incidence is actually higher than this, though not all women are formally diagnosed. Women commonly put their discomfort down to “one of those things” or general pregnancy discomfort when in fact, it is a condition which responds very well to correct management.
Because SPD symptoms can build up gradually, it can be difficult to pinpoint exactly how much discomfort is due to the condition. It can pay to invest some time and thought into focusing on particular areas which are causing problems.
The pelvic bones are generally kept stable and well supported by the ligaments which surround them. During pregnancy, hormones are released which are designed to relax the joints and help to facilitate an easier birth. However, these hormones can also make the pelvic joint unstable which leads to pain and discomfort. The specific area affected in SPD is the narrowest point of the bones in the pelvic girdle which lies directly in front of the bladder. The symphysis pubis is the region at the front of your pelvis which is normally covered by pubic hair.
Another contributing factor is the changes in weight distribution which create stress on the pelvis, the spine and all the structures which support them.
Symphysis Pubis Dysfunction is diagnosed through taking a thorough medical history. Ultrasounds may help in the diagnosis as well. It is not advisable for pregnant women to have X-Rays unless absolutely warranted.
Treatment is generally based around limiting movement which exacerbates the condition. Avoiding any movement which aggravates SPD can be difficult, especially when there are older children to care for. Adjusting work and sleeping areas can be helpful; so can asking for help with activities which have become painful. Obstetric physiotherapists and occupational therapists can provide expert advice and guidance on modifying work and rest areas.
Straddling movements are out when SPD has been diagnosed. Think about the position of the legs when sitting on a horse or riding a bike. It’s the separation of the legs which causes problems. The key is to try to brace the pelvis to keep it stable before any movement and to keep the knees together so pelvic bones don’t have a chance to rub against each other and cause pain.
What Can Really Help to Relieve the Pain
Generally there is an improvement in symptoms and joint stability after birth. Once the pregnancy hormone relaxin is no longer produced, the joint becomes more stable and there is an improvement in comfort level.
Occasionally SPD is so severe that a vaginal delivery is not possible. In this case a caesarian section is performed.
This is unlikely. Some women experience ongoing problems with their back or pelvic floor following delivery but most recover very well. If you have had SPD with a previous pregnancy, you are more likely to have it again. There are real benefits in seeing a specialist obstetric physiotherapist if pain, discomfort or incontinence are present. Check The Australian Physiotherapy Website for more information.
Occasionally, the pelvic joint may actually separate causing more intense pain. This is a condition known as symphyseal separation or diastasis of the symphysis pubis. This can be acutely painful. Bed rest and heat treatment are usually prescribed. Orthopaedic and physiotherapy assessment and management are necessary to help manage this condition. Some women are also advised to limit their weight bearing activity and need to walk with elbow crutches to alleviate further pain.
Hold it Mama The Pelvic Floor & Core Handbook by Mary O’Dwyer (2011) Redsok Publishing.
Also check www.holditsister.com