Pregnancy is often an exciting time, but it can also be a time of discomfort and unpleasant symptoms. Symphysis pubic dysfunction is one of the more painful problems a pregnant woman might experience.
When you aren’t sure which symptoms are normal and which require attention, it can be even harder to cope with pregnancy ailments.
Pain in the front of the pelvis is a common cause of mild to extreme discomfort for approximately 1 in 300 pregnant women.
Most mothers-to-be accept this pain as general pregnancy discomfort and, instead of seeking support, simply put up with it.
Other women are extremely debilitated by the pain and unable to move, so they’re desperate to find out why it’s happening. They also want to know what they can do to relieve the symptoms.
Symphysis Pubic Dysfunction (SPD)
Known as symphysis pubic dysfunction (SPD), this condition can build up over time but often responds well to correct management.
What Is Symphysis Pubic Dysfunction?
Your pelvis isn’t a completely locked circle of bone. If you poke around at the front of your pelvic bones, just below your bikini line, you should be able to feel a sort of dip. This is the symphysis pubic, or the pubic arch. It’s a joint between the two halves of your pelvis. The space between the bones is connected by ligaments, which are usually firm and don’t have much movement.
When you are pregnant, the symphysis pubic become flexible, thanks to a hormone called relaxin. The movement and flexibility allow your baby to pass through your pelvis during birth.
Also during pregnancy, as the joint widens (either the two halves move apart or slightly up or down), it can cause inflammation, pain, and difficulties with certain movements. If your pelvis is not aligned properly it can also cause the pubic arch to be affected.
What Are The Symptoms Of SPD?
The most obvious sign that something’s not quite right is pain located at the front of your pelvis, in the pubic area. You might also experience lower back pain, but this can be difficult to distinguish from normal pregnancy-related back pain, especially if you’re in the third trimester.
The pain associated with symphysis pubic dysfunction is often described as a sharp, shooting, burning or tearing sensation. The pubic bone can feel very tender to the touch. Pain might extend down the thighs, between the legs, into the hips or even the knees.
Activities involving separation of the pelvis – such as rolling over in bed, getting out of the car, standing on one foot, walking, or using stairs – can be very difficult or painful. You might also experience a clicking sensation in the pelvis when walking. Women often report the pain is worse at night when they are lying on their back.
If you experience any of these symptoms, talk to your midwife or doctor, or see a women’s health physiotherapist for confirmation of SPD.
How Is SPD Managed?
If you are experiencing symphysis pubic dysfunction, it’s important to listen to your body and, where you can, make adjustments to your lifestyle.
- Keep your legs parallel as much as possible when rolling over in bed.
- Similarly, when exiting a car, swing both your legs out of the car together, rather than one after the other.
- Try to keep your weight evenly balanced when standing and sitting.
- Use a cold pack directly on the pubic bone for pain relief.
- Make your movements slowly and carefully.
- Sit down while dressing, especially when putting on underwear, pants, sock and shoes.
- Try acupuncture for pain relief.
- Osteopathy or physiotherapy, with a practitioner who specialises in pregnancy, can help with alignment and ongoing treatment.
- Try a pelvic girdle to keep your pelvis in place. These can be very helpful, but some women experience more pain (probably due to severe misalignment).
- Use pillows to support your legs and body during sex.
- Use a birth ball, or get onto your hands and knees, to take the baby’s weight off your pelvis.
- Avoid any movements that involve straddling or wide open knees, including squatting, tailor sitting, or sitting on a chair backwards.
- When doing anything that causes more pain, stop immediately.
- Avoid pushing heavy objects, such as a shopping trolley.
- Floating in water can alleviate the weight of baby on your pelvis, but when swimming, avoid breaststroke or too much kicking.
Will SPD Affect My Labour?
During labour, being active and choosing the positions that feel best for you are wonderful ways to relieve pain and achieve a natural birth. Not surprisingly, women with symphysis pubic dysfunction are often concerned that SPD pain will affect their ability to labour naturally, and might even cause lasting damage to the symphysis pubic. Listening to your body during labour, and finding a position that feels right to you, can prevent SPD from having too much impact on your labour and causing any long-term damage.
While squatting is a great position for opening up the pelvis, if you have symphysis pubic dysfunction this position puts a lot of strain and pressure on the affected joint. The weight of both uterus and baby can press on the weak area and cause an excess separation of the pubic arch. When pushing in this position, your baby’s head can also put pressure on the area from the inside. Squatting with SPD can lead to long-term or permanent pain and damage.
Another position to be avoided is lying on your back during labour. Aside from the huge benefits of an upright labour, lying down or semi reclining during labour usually involves your legs being held apart by stirrups, birth supports, or by midwives.
In this position you’re sitting on your tailbone, which prevents it from moving out of the way as your baby descends through the pelvis. In a free and active birth, women will often choose to labour in more upright or forward positions. The tailbone is a joint designed to move when the baby passes it, again thanks to relaxin. If the tailbone can’t move, it forces more pressure against the pubic arch. You should avoid stirrups, as they force you onto your tailbone with a wide space between your legs – increasing the pressure on your pubic bone.
The best position for labour is the one you choose. Most women with SPD find the hands and knees position the most helpful, as they can control how wide apart their knees are. There is less pressure on the pubic arch as well, which reduces the strain on the joint. Standing and sitting are also great positions, but be sure to keep your weight evenly distributed and knees not too far apart. Side lying is also a good position if you are tired and need to rest your legs, but make sure your upper leg is not lifted too high when you are pushing.
If possible, avoid any medication which will prevent you from moving or feeling your pelvis. This mainly relates to epidurals and spinal blocks, as they restrict you to a lying or semi reclining position. You’ll also be unable to feel your lower body and it’s possible to overstretch or permanently damage the symphysis joint because you aren’t able to feel any pain. If you choose an epidural, ask a nurse or support person to note how far you can comfortably stretch your legs apart prior to receiving the epidural, and to help you not to overstretch while you’re unable to feel your lower body.
When you have an epidural it’s also common to be coached to push with each contraction, which can place a great deal of pressure on your tailbone and pubic arch. If you’ve chosen an epidural, consider asking for it to be ‘turned down' so you’re able to feel the urge to push and to listen to your body; this will prevent you from pushing too hard, or be in a position that might worsen SPD pain.
If you do experience SPD, be as informed as possible about the treatments and options available to you. After birth, SPD can continue for some months, especially if you had high levels of relaxin during pregnancy. To avoid placing further strain on the joint, continue to use good positioning techniques following birth. Your care provider or women’s health physiotherapist can advise on correct exercises to do, to ensure your muscles and joints stabilise.
It’s also important to take plenty of time to heal and rest, whether you have symphysis pubic dysfunction or not. Taking a post-natal month to rest, heal and bond is excellent following pregnancy and birth, as well as after SPD.