Pelvic girdle pain in pregnancy and symphysis pubis dysfunction
20-40% of pregnant women suffer from girdle pelvic pain which may occur in the last weeks of pregnancy. The pain is localized in the pelvis.
How the pelvis is made
The pelvis is a complex of bones consisting of:
- two iliac bones which form the anterolateral part and which articulate with each other thanks to the pubic symphysis.
- the sacrum that closes the pelvis posteriorly
- the coccyx which articulates with the sacrum.
The pelvic region is the inner region circumscribed by these bones that form the pelvis.
The symphysis pubis comprises a dense network of ligaments that are put under great strain during pregnancy.
Doctors and physical therapists classify any type of pelvic pain during pregnancy as girdle pelvic pain.
Symphysis pubis diastasis and symphysis pubis dysfunction are two types of pelvic girdle pain.
Diastasis of the symphysis pubis (DSP) happens when the gap in the symphysis pubis joint gets too wide. It is a rare condition that can only be diagnosed by an X-ray, ultrasound or MRI.
Symptoms of symphysis pubis dysfunction (SPD)
The most common symptoms are pain in the pubic area and groin but it can also manifest itself with:
- Back pain, pain in the back of the pelvis or pain in the hip.
- Pain along the inner thighs or between the legs.
- Pain that gets worse when opening the legs, walking, climbing stairs, or getting out of bed
- Pain that gets worse at night and prevents you from sleeping well. Getting up to go to the bathroom at night can be a particularly painful activity in these cases.
Dysfunctions of the symphysis pubis can occur at any time during pregnancy or after delivery.
The cause
During pregnancy, the body produces a hormone called relaxin , which softens the ligaments to help the baby pass through the pelvis at delivery. This means that the joints in the pelvis naturally become looser.
However, this flexibility doesn’t necessarily cause the painful problems of SPD. Usually, the nerves and muscles are able to adapt and compensate for the increased flexibility in the joints. The body is then able to make changes in posture as the baby and baby bump grow. However, when the body is unable to compensate for these changes then SPD occurs.
Physiotherapy is the best way to treat SPD, because it is a condition related to the relationship between muscles and bones, and not to the fact that the joints are loose.
You are much more likely to develop SPD if:
- the woman has already suffered from pain in the pelvic girdle before becoming pregnant
- the woman had a previous injury to her pelvis
- the woman suffered from pelvic girdle pain during a previous pregnancy
- the woman is already overweight before becoming pregnant
- the woman has hypermobility in all joints
How is SPD diagnosed?
If the woman reports these pains to the doctor or midwife, they should be referred to a physiotherapist for diagnosis.
How is it treated?
SPD is managed in the same way as other pelvic girdle pain.
The treatment includes:
- Strengthening exercises to improve the stability of the pelvis and back. Water aerobics could also help. In addition, the physiotherapist should advise the woman on how to make daily activities less painful and how to make childbirth easier. The midwife should also write a birth plan that takes into account the symptoms of SPD.
- Acupuncture can help reduce pain and is safe during pregnancy when done by accredited professionals.
- Other manual therapies, such as osteopathy can help. Also in this case the professional must be qualified and experienced in the treatment of pregnant women.
- A support band can also help
What can I do to ease the pain of SPD?
- Being active when possible is good but without exaggerating and above all without going to the point of feeling pain.
- Perform the exercises recommended by the physiotherapist
- Asking for and accepting offers of help with household chores, in short, putting aside pride and getting help is imperative in these cases!
- Organize yourself so that you can do normal activities without problems. For example, buy trolley bags for shopping or to carry things around.
- Be careful moving your legs when you get out of bed, car or get out of the bath. These movements can be very painful. If you are lying on the bed, pull your knees up as far as you can to make it easier to get your legs down.
- Avoid activities that make the pain worse or put your pelvis in an irregular position, such as sitting cross-legged or carrying your baby on your hip. If something hurts, stop doing it. If you let the pain unleash it may take some time to pass.
- Try to sleep on your side with your legs bent and a pillow between your knees.
- Rest regularly and try to do standing activities like ironing while sitting.
- Try not to lift heavy loads or push overcrowded shopping carts. Pushing supermarket trolleys can often make the pain worse.
- Take one step at a time when climbing stairs. First with one leg and then return the other to the same step and so on.
- Avoid standing on one leg.
- Dressing for sitting.
Will everything pass after the baby is born?
It is very probable that everything will pass within a few weeks of birth. But if possible it is good to continue physiotherapy even after the birth of the child. During the first weeks of your baby’s life make sure you have someone to help you.
If you suffered from symphysis pubis dysfunction in your first pregnancy it is likely that it will also happen with your next one. Tell your doctor and referring midwife in the early stages of SPD because SPD causes less discomfort if it is managed early in the pregnancy.
Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.
Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.