Pregnancy is a beautiful and transformative experience for women, but it can also bring about various physical discomforts and challenges.
One such condition that many pregnant women may encounter is symphysis pubis dysfunction (SPD), also known as pubic symphysis dysfunction. This condition involves excessive movement and misalignment of the pubic symphysis, which can result in pain and discomfort in the pelvic region. In this comprehensive guide, we will explore the causes, symptoms, diagnosis, and treatment options for SPD, with a particular focus on pregnant women and those who have recently given birth.
Understanding Symphysis Pubis Dysfunction
The pubic symphysis is a joint located at the front of the pelvis, connecting the two pubic bones. During pregnancy, hormonal changes, such as the release of relaxin and progesterone, cause the ligaments and muscles in the pelvic region to become more relaxed and elastic. This is necessary to accommodate the growing foetus and prepare the body for childbirth. However, in some cases, this increased mobility can lead to instability and misalignment of the pubic symphysis, resulting in SPD.
Causes of Symphysis Pubis Dysfunction
The primary cause of SPD is pregnancy itself. The hormonal changes that occur during pregnancy, particularly the release of relaxin, can lead to the loosening of ligaments and muscles in the pelvic region. This can result in excessive movement and misalignment of the pubic symphysis. Factors that may increase the risk of developing SPD include:
- Previous pelvic injury or trauma
- Multiple pregnancies
- Advanced maternal age
- Excessive weight gain during pregnancy
- History of difficult deliveries, including shoulder dystocia
- Physically strenuous work during pregnancy
- Genetic predisposition to joint dysfunction
While SPD is most commonly associated with pregnancy, it can also occur outside of pregnancy due to pelvic injuries or conditions like osteoarthritis. In some cases, the exact cause of SPD may be unknown.
Recognizing the Symptoms of SPD
The symptoms of SPD can vary in severity and presentation from person to person. The most common symptoms include:
- Pain in the front centre of the pubic bone
- Lower back pain on one or both sides
- Pain in the perineum (area between the anus and vagina)
- Pain radiating to the thighs
- Grinding or clicking sensation in the pelvis
The pain experienced by individuals with SPD is often exacerbated by activities that involve putting weight on one leg, walking, using stairs, or turning over in bed. It may also be challenging to widen the legs, making everyday tasks like getting out of bed, getting dressed, or getting in and out of a car difficult. It’s important to note that SPD is not harmful to the baby, but it can significantly impact the mother’s mobility and overall well-being.
Diagnosing Symphysis Pubis Dysfunction
If you are pregnant and experiencing pelvic pain, it is crucial to consult with your healthcare provider for a proper diagnosis. They will evaluate your symptoms, medical history, and perform a physical examination to assess the stability and strength of your pelvic joints and muscles. In some cases, imaging tests such as MRI scans, X-rays, or ultrasound may be recommended to rule out other conditions and confirm the diagnosis of SPD.
Managing Symphysis Pubis Dysfunction During Pregnancy
While SPD cannot be completely prevented during pregnancy, there are steps you can take to manage the pain and discomfort associated with the condition. It’s important to remember that each person’s experience with SPD may be different, so it’s essential to work closely with your healthcare provider to develop a personalised treatment plan. Here are some tips and strategies that may help alleviate symptoms:
1. Avoid Activities That Aggravate SPD
Certain activities can exacerbate the pain and discomfort caused by SPD. It is recommended to avoid or modify the following activities:
- Putting weight on one leg for extended periods
- Twisting and bending while lifting
- Carrying a child on your hip
- Crossing your legs
- Sitting on the floor or in a twisted position
- Standing or sitting for long periods
- Lifting heavy loads
- Pushing heavy objects
- Carrying anything in only one hand
By avoiding these activities, you can reduce stress on your pelvic joints and minimize pain and discomfort.
2. Practice Good Posture and Body Mechanics
Maintaining proper posture and body mechanics can help alleviate the strain on your pelvic joints and muscles. Here are some tips to improve your posture and body mechanics:
- Stand and sit up straight, aligning your head, shoulders, and hips.
- Use a supportive chair with good lumbar support.
- When standing or sitting, distribute your weight evenly on both legs.
- When lifting objects, bend your knees and use your leg muscles, rather than your back, to lift.
- Avoid excessive twisting or bending motions.
By practising good posture and body mechanics, you can reduce the strain on your pelvic joints and minimise the occurrence of pain.
3. Use Supportive Equipment
Supportive equipment, such as pregnancy support belts and pelvic support belts, can provide additional support to the pelvic region and help stabilise the pubic symphysis. These belts can be worn during daily activities to alleviate pain and discomfort. Additionally, crutches or other mobility aids may be recommended for individuals with severe SPD to reduce pressure on the pelvic joints and improve mobility.
4. Physiotherapy and Therapeutic Exercise
Physiotherapy is a critical component of managing SPD during pregnancy. A physiotherapist or pelvic floor specialist can provide manual therapy techniques to ensure normal joint movement and offer exercises to strengthen the muscles in the pelvic floor, back, stomach, and hips. They may also recommend hydrotherapy, where exercises are performed in water, providing relief and making movements easier. Additionally, they can provide guidance on comfortable positions for sex, labour, and birth.
Exercise is an essential aspect of managing SPD, but it is crucial to perform exercises that do not exacerbate your symptoms. Your women’s health physiotherapist can recommend appropriate exercises, such as gentle stretches and low-impact activities like swimming or prenatal Pilates, that can help improve muscle strength, flexibility, and overall well-being.
5. Heat and Cold Therapy
Applying heat or cold to the affected area can provide temporary relief from pain and swelling. Heat therapy, such as warm compresses or hot water bottles, can help relax the muscles and improve blood flow. Cold therapy, such as ice packs or cold compresses, can help reduce inflammation and numb the area. It’s important to follow proper guidelines for heat and cold therapy, such as using a cloth barrier between the skin and the heat or cold source and limiting the duration of the therapy.
6. Pain Medication and TENS Therapy
In severe cases of SPD, pain medications may be prescribed to manage pain and discomfort. These medications may include acetaminophen, which is generally considered safe during pregnancy. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used in some cases, but they should be used with caution and under the guidance of a healthcare provider. Transcutaneous electrical nerve stimulation (TENS) therapy, which involves the use of a small device that delivers low-voltage electrical currents to the affected area, may also provide temporary pain relief.
7. Emotional Support
Living with SPD can be physically and emotionally challenging. Chronic pain can lead to feelings of sadness, frustration, and even depression. It’s important to seek emotional support from your healthcare provider, partner, family, or friends. Consider joining support groups or seeking counselling to help cope with the emotional aspects of living with SPD.
Managing Symphysis Pubis Dysfunction Postpartum
While most cases of SPD resolve within six months after delivery, some individuals may continue to experience symptoms postpartum. Here are some strategies to manage SPD during the postpartum period:
1. Rest and Recovery
Resting and allowing your body to recover after childbirth is crucial for healing. Avoid excessive physical activity and lifting heavy objects during the early weeks postpartum. Take advantage of support from family and friends to minimise the strain on your pelvic joints and allow your body to heal.
2. Gradual Return to Physical Activity
After obtaining clearance from your healthcare provider, gradually reintroduce physical activity into your routine. Start with gentle exercises, such as walking or Clinical Pilates, and gradually increase the intensity and duration as you feel comfortable. Listen to your body and do not push yourself too hard, as this can worsen symptoms.
3. Pelvic Floor Exercises
Pelvic floor exercises, also known as Kegel exercises, can help strengthen the pelvic floor muscles and provide support to the pubic symphysis. These exercises involve contracting and relaxing the muscles that control urination. Your women’s health physiotherapist or a pelvic floor specialist can provide guidance on proper technique and frequency of pelvic floor exercises.
If symptoms persist or worsen postpartum, consider seeking the help of a women’s health physiotherapist or pelvic floor specialist. They can provide targeted exercises and manual therapy techniques to address any remaining pelvic imbalances or muscle weaknesses. Physiotherapy can be a valuable resource for postpartum women looking to regain strength and function in the pelvic region.
FAQs About Symphysis Pubis Dysfunction
Q: When do women start experiencing SPD during pregnancy?
The onset of symphysis pubis dysfunction (SPD) can vary from woman to woman. Some women may experience symptoms as early as the first trimester, while others may not experience symptoms until the third trimester. In most cases, the symptoms of SPD worsen as the pregnancy progresses.
There are a number of factors that can contribute to the development of SPD, including:
- Hormonal changes: During pregnancy, the body releases hormones that relax the ligaments in the pelvis. This is necessary to allow the pelvis to widen during childbirth. However, in some women, these hormones can relax the ligaments too much, leading to SPD.
- Genetics: Some women are more likely to develop SPD than others. This may be due to genetics or other factors that are not yet fully understood.
- Previous pelvic injuries: Women who have had previous pelvic injuries, such as a car accident or a fall, are more likely to develop SPD during pregnancy.
- Multiple pregnancies: Women who are pregnant with their second or subsequent child are more likely to develop SPD than women who are pregnant with their first child.
If you are experiencing symptoms of SPD, it is important to talk to your doctor. They can diagnose SPD and recommend treatment options. Treatment for SPD typically includes:
- Rest: This is the most important treatment for SPD. It is important to avoid activities that aggravate your symptoms.
- Physiotherapy: Physiotherapy can help to strengthen the muscles in your pelvis and improve your range of motion.
- Pain medication: Your doctor may prescribe pain medication to help relieve your symptoms.
- Support belts: Support belts can help to stabilise your pelvis and reduce pain.
In most cases, SPD resolves within a few weeks or months after childbirth. However, for some women, the symptoms may linger or even become chronic. If you are experiencing SPD, it is important to talk to your doctor about your symptoms and treatment options.
Q: What exercises should be avoided with pubic symphysis dysfunction?
A: It is generally recommended to avoid exercises that put excessive strain on the pelvic region and exacerbate symptoms of pubic symphysis dysfunction. These exercises may include high-impact activities, heavy weightlifting, jumping, running on hard surfaces, deep squats, and exercises that involve twisting or rapid changes in direction. It is important to listen to your body and modify or avoid any exercises that cause pain or discomfort.
Q: Why is SPD worse at night?
A: SPD symptoms can often worsen at night due to factors such as increased fatigue and changes in posture during sleep. When lying down, the pelvic joints may become misaligned or compressed, leading to increased pain and discomfort. Additionally, hormonal changes and fluid retention during pregnancy can contribute to nighttime discomfort. Using pillows for support, such as placing one between the legs or under the belly, can help alleviate the symptoms and provide better sleep.
Q: What are the long-term effects of SPD?
For most women, symphysis pubis dysfunction (SPD) resolves within a few weeks or months after childbirth. However, for some women, the symptoms of SPD may linger or even become chronic.
The long-term effects of SPD can vary from woman to woman. Some women may experience ongoing pain in the pelvic region, while others may have difficulty with activities that involve bending, twisting, or lifting. In some cases, SPD can lead to other pelvic problems, such as urinary incontinence, pelvic organ prolapse, or chronic pelvic pain.
There is no one-size-fits-all answer to the question of what the long-term effects of SPD are. However, if you are experiencing SPD, it is important to talk to your doctor about your symptoms and treatment options. Early intervention can help to prevent or minimise the long-term effects of SPD.
Some of the long-term effects of SPD include chronic pelvic pain, incontinence and pelvic floor prolapse.
Q: What kind of physiotherapy is helpful for SPD?
Physiotherapy can be a very effective treatment for symphysis pubis dysfunction (SPD). A women’s health physiotherapist will assess your individual needs and create a treatment plan that is tailored to you.
There are a number of different physiotherapy techniques that can be helpful for SPD, including manual therapy, stretching, strength training, functional exercises and education on how to manage your symptoms.
Physiotherapy can be a very effective way to relieve pain and improve function in people with SPD. If you are experiencing SPD, it is important to talk to your healthcare provider about whether physiotherapy is right for you.
In conclusion, symphysis pubis dysfunction (SPD) is a common condition that can cause significant pain and discomfort during pregnancy and postpartum. While it can be challenging to manage, there are various strategies and treatments available to alleviate symptoms and improve quality of life. By working closely with healthcare providers, physical therapists, and pelvic floor specialists, pregnant women and new mothers can find relief and support on their journey towards better pelvic health. If you are experiencing symptoms of SPD, do not hesitate to seek professional help and guidance. Remember, you are not alone, and there are resources available to help you on your path to recovery.
For comprehensive and personalised treatment of postnatal issues, consider visiting Core Fitness, your trusted partner for holistic postpartum care. Our team of women’s health experts in Singapore specialises in providing top-notch physical rehabilitation services to support your recovery journey. Don’t let SPD hold you back from enjoying motherhood to the fullest. Take the first step towards a pain-free and empowered postpartum experience by scheduling an appointment with Core Fitness today.