What is Symphysis Pubis Dysfunction (SPD)?
The two halves of your pelvis are connected at the front by a stiff joint called the symphysis pubis. This joint is strengthened by a dense network of ligaments which means that under normal conditions, very little movement occurs. In order to make your baby's passage through your pelvis as easy as possible, your body produces a hormone called relaxin, which softens the ligaments in your pelvis. As a result, these joints move more during and just after pregnancy.
We are not sure exactly what causes SPD but current thinking indicates that if one side of the pelvis moves more than the other when you walk or move your legs, this can lead to pain and inflammation at the symphysis pubis. X-rays and scans may not diagnose the problem as this rotation does not show up on most scans. Many women with SPD experience significant pain without any great separation of the joint -- the amount of pain isn't related to the degree of separation.
A related condition is diastasis symphysis pubis (DSP) in which the pubic joint loosens and leaves an abnormally wide gap between the two pelvic bones. The average gap between the bones in a non-pregnant woman is 4-5mm and during pregnancy it's normal for this gap to widen by 2-3mm. If the gap is 10mm or more, DSP is diagnosed. This is a rare condition and can only be diagnosed by X-Ray.
When does it happen?
SPD can occur towards the end of the first trimester or after delivery. Many women notice their symptoms for the first time around the middle of their pregnancy. If you experience SPD in one pregnancy, it is more likely that it will reoccur in your next pregnancy. The symptoms may also come on earlier and progress faster, so it is important to seek help as early as possible. It can help if you allow the symptoms from one pregnancy to settle before trying to conceive another child.
What are the symptoms?
Pain in the pubic area and groin are the most common symptoms. You may also suffer from back pain in pregnancy, Pelvic Girdle Pain (PGP) or hip pain. It is common to feel a grinding or clicking in your pubic area and the pain may travel down the inside of the thighs or between your legs. The pain is usually made worse by separating your legs, walking, going up or down stairs or moving around in bed. It is often much worse at night and can stop you getting much sleep. Getting up to go to the toilet in the middle of the night can be especially painful.
How is it diagnosed?
SPD is becoming more widely understood by GPs, obstetricians and midwives. Your doctor or midwife should refer you to a physiotherapist from the Association of Chartered Physiotherapists in Women's Health, who will have experience in treating this complaint. It is diagnosed by a combination of your own description of symptoms and a series of tests designed to look at the stability, movement and pain in your pelvic joints.
How is it treated?
A pelvic support belt can often give quick relief. Exercises -- especially for the tummy and pelvic floor muscles -- form a large part of the treatment and are aimed at improving the stability of your pelvis and back. You may need mobilisation (a gentler form of manipulation) of your hip, back or pelvis to correct any underlying movement dysfunction. Hydrotherapy (exercise in water) and acupuncture can sometimes be useful. Surgery is only used to treat the most severe DSP cases and is often unsuccessful.
You should also be given advice on how to make normal daily activities less painful and on how to make the birth easier. Your physiotherapist or midwife can help you to devise a birth plan which takes your SPD symptoms into account.
Other therapies that may be useful include osteopathy and chiropractic but it is essential that you see a registered practitioner who is experienced in treating pregnant women.
Self-help tips
Avoid pushing through any pain. If something hurts, if possible don't do it. If this type of pain is allowed to flare up, it can take a long time to settle back down again.
Move little and often. You may not feel the effects of what you are doing until later in the day or after you have gone to bed.
Rest regularly by sitting reasonably upright with your back well supported.
Avoid heavy lifting or pushing (supermarket trolleys can be particularly painful).
When dressing, sit down to put on clothing such as your knickers or trousers. Pull the clothing over your feet and then stand up to pull them up. Don't try to put your legs into trousers, skirts or knickers whilst standing up.
When climbing stairs, go up them one step at a time. Step up onto one step with your best leg and then bring your other leg to meet it. Repeat with each step.
Avoid separating your legs and making straddling movements -- such as when getting in and out of the car or bath. If you need to separate your legs, do so slowly and carefully and keep your back arched.
Avoid swimming breaststroke if you can and take care with other strokes. Swimming can often feel like it is helping whilst you are in the water but cause an increase in pain when you get out.
Performing regular pelvic floor exercises and lower abdominal exercises can help to reduce the strain of the pregnancy on your pelvis. To perform a safe and easy lower abdominal exercise, get down onto your hands and knees and level your back so that it is roughly flat. Breathe in and then as you breathe out, perform a pelvic floor exercise and at the same time pull your belly button in and up. Hold this contraction for 5-10 seconds without holding your breath and without moving your back. Relax the muscles slowly at the end of the exercise.
Follow the advice in our protecting your back and pelvis article.
You can get in touch with other women in your situation by contacting The Pelvic Partnership, a charity which was set up to offer support to women with SPD. The National Childbirth Trust also offers information and support to women with a range of pelvic dysfunctions.
How soon will I recover from my SPD symptoms after the birth?
A recent study showed that around 60% of women with SPD still experienced some symptoms after delivery. Most women find that their symptoms improve after the birth of their baby although a small percentage still have pain when their babies are a year old. You should continue with physiotherapy after the birth and get help with looking after your baby during the early weeks if you can. Some ex-sufferers find they experience pain every month just before their period is due, which is caused by hormones which have a similar effect to the pregnancy hormone relaxin.
Until now I've put it down to the weight of the baby.
