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Symphysis Pubis Dysfunction

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Introduction

Symphysis pubis dysfunction (SPD) is a group of symptoms that cause discomfort in the pelvic region. It usually occurs during pregnancy. It is more likely for females to experience this condition; however, men can experience this too.

 

The pubic symphysis is found on the anterior side of the pelvis, but pain can also be felt around the back of the pelvis or lower back. The symptoms generally present due to a lack in the support system around the pelvis. This can be due to reduced support of the abdominal muscles, pelvic floor or lower back. It is thought that increased pressure through weight gain or pregnancy can contribute a decrease in the support system.

Presentation

The symptoms of SPD can vary for different people, both in terms of severity and presentation. The most common symptoms experienced are:

  • Pain in the front centre of your pubic bone.
  • Lower back pain on one or both sides and in the pubic region.
  • Pain in your perineum – the area between the anus and vagina, and in the anterior pelvic region.

 

If you are pregnant and you have noticed any decreased fetal movements, you should contact your midwife straight away.

 

The pain sometimes travels to your thighs but not beyond, and you might also hear or feel a grinding or clicking sound in your pelvis, this is nothing to worry about. However, it might be a good idea to seek advice from a Woman’s Health Physiotherapist if your symptoms do not settle with the following advice.

 

The pain is often more obvious when you’re:

  • Walking.
  • Using stairs.
  • Putting your weight on one leg.
  • Turning over in bed.

 

It might also be challenging to take your legs apart. This can make daily tasks such as getting out of bed, getting dressed, or getting in and out of a car difficult.

 

If you notice any swelling or redness in the area, or pain that is not settling – particularly if you have additional conditions such as Osteoporosis or metabolic conditions, you should seek advice from your Midwife or GP as soon as possible.

Prognosis

Most cases of SPD will settle with conservative management. Management advice and strengthening exercises can help to ease symptoms and maintain function. Most PSD pain related to pregnancy will settle after having baby. If you find your pain is not settling please seek advice from your GP or Physiotherapist.

Treatment & Management

It is important to try and limit positions which aggravate your symptoms – generally this will be moving your knees apart or repetitive loading on one leg as aforementioned. The following advice can help you to minimise the irritation.

 

  • Develop a birthing plan with your Midwife or Physiotherapist to allow for a comfortable birthing position.
  • Be as active as possible within your pain limits and avoid activities that worsen pain.
  • Try and accept help where possible for household chores and shopping etc.
  • Wear flat and supportive shoes.
  • Avoid sitting for long periods with your legs crossed.
  • If your Physiotherapist feels necessary, a support belt such as a pro-medic can be useful.
  • Sit down whilst getting dressed, avoid standing on just one leg.
  • Keep your knees together when getting in and out of the car – a plastic bag on the seat can aid this, helping you to swivel in the seat.
  • Sleeping could be difficult, using pillows where possible can help – i.e lower back or between the knees down to the ankles.
  • Turning over in bed try and keep the knees together and squeeze you buttocks.
  • Stairs – take one step at a time using a handrail where possible.
  • Although remaining as physically active as possible is ideal – elbow crutches or other walking aids can be useful if required – contact your Physiotherapist to discuss this.

Prevention

Following the above advice can help manage your pain. Make sure you stay as active as possible with in your pain tolerance. Strengthening and conditioning is a very important part of maintaining stability and strength for the joints and muscles around the pelvis and lower back.

 

Pelvic floor muscle exercises are a very important part of this, for more information & exercises, please click here to visit our website section on Pelvic floor muscle dysfunction

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