Treating symphysis pubis dysfunction (SPD), also known as pelvic girdle pain (PGP), may require physical therapy, lifestyle changes and medications.
Symphysis pubis dysfunction or SPD may go away after the baby is born. Medical attention and proper treatment are essential to reduce its severity and allow a more comfortable experience during pregnancy.
While many women tend to accept it as a normal part of pregnancy, symphysis pubis dysfunction may be treated by:
- Physical therapy:
- Helps relieve the discomfort while ensuring better movement during pregnancy and may include stretches, exercises and manual therapy, including massages.
- Your physical therapist may help you perform certain stretches to lower the pain, facilitate mobility and strengthen the muscles, especially the muscles of the spine, abdomen and pelvis.
- The physiotherapist may help you perform exercises in water to lower the pain and teach you to do certain exercises at home, such as core stability exercises, pelvic floor strengthening exercises, pelvic tilts and back and inner thigh stretches.
- Lifestyle changes:
- Avoid vigorous exercises, lifting or pushing heavyweights (including children, vacuum cleaners and shopping carts at the supermarkets).
- Do not stand or sit for longer periods.
- Walk gently and take smaller steps while walking.
- Do not restrict all activities, and try to be as active as possible within your pain limits.
- Avoid sitting cross-legged or putting more weight on one buttock while seated or on one leg while standing or moving around.
- Avoid squatting or sitting on the floor.
- Try using a pregnancy pillow while lying down or sleeping, or you may put a normal pillow between the legs or under your baby bump.
- Keep your knees together as you turn or get out of bed or the car.
- Do chores, such as cooking, ironing or getting dressed, while you are sitting rather than standing.
- Avoid bending and twisting movements.
- Avoid carrying any weight on one hip.
- Avoid activities that cause pain.
- Try taking one step at a time while moving up and down the stairs.
- Consider alternative sex positions, such as lying on your side or kneeling on all fours.
- Warm or cold fomentation:
- Applying a warm or cold pack to the pubic area may provide relief. Avoid using very hot packs or applying them for too long at one time (more than 10 minutes).
- Supportive equipment or belts:
- These include using crutches or pelvic support belts to ease the discomfort, especially while moving around.
- These include medications to relieve pain, although do not take any medications during pregnancy without consulting your doctor.
- Steroid injections may be needed in some patients to relieve the pain.
- Transcutaneous electrical nerve stimulation (TENS):
- It may be tried in cases where patients are not responding to the above treatment options.
- TENS involves the usage of a low voltage electric current for pain relief.
- Other options:
What is symphysis pubis dysfunction (SPD)?
The term symphysis pubis dysfunction (SPD) refers to the pain and instability in the pelvis during pregnancy. This pain may affect the joints in the pelvis, including the pubic symphysis joint in the front and the sacroiliac joint at the back of the pelvis.
The term symphysis pubis dysfunction is no longer used because it wrongly indicates the involvement of just one joint, the pubic symphysis. Thus, it has been replaced by the term pelvic girdle pain or PGP. It affects about one in five pregnant women and may lead to significant pain and discomfort if not effectively managed.
The cause of PGP may be explained by the various changes occurring in pregnancy, including the laxity of ligaments and widening of the pelvic joints in preparation for childbirth. These changes occur under the influence of hormonal adjustments (such as increased levels of the hormone, relaxin) during pregnancy. The growing baby in the womb puts a mechanical strain on the pelvis to further exacerbate the condition.
What are the symptoms of symphysis pubis dysfunction (SPD)?
The symptoms of SPD or pelvic girdle pain may vary depending on the severity of the condition. Pain may occur at any stage during pregnancy but is more common during advance stage pregnancy.
Symptoms generally include:
- Pain in the
- Pubic region (pubic symphysis)
- Sacroiliac joint
- Lower back
- Lower lack
- Pelvic floor or perineal region
- Pain worsens on walking, climbing stairs, standing or moving around
- Pain during sexual intercourse
- A clicking or grinding sensation in the pelvic area (could even be audible)
- Limitation of movement at the hip joint, such as moving the thigh outward
What are the complications of symphysis pubis dysfunction (SPD)?
Although SPD does not harm the unborn baby, it can cause considerable ill-effects on the mother’s well-being, which may indirectly affect the baby. For example, limitation of movement may lead to excessive weight gain and persistent stress. Additionally, this pain may hinder proper nutritional intake and the ability to get rest or sleep.
Rarely, a severe case of SPD may result in a condition called symphyseal separation or diastasis symphysis pubis. This is caused by the separation of the pubic symphysis joint in the absence of a fracture. It may cause extreme pain in the pelvis, buttocks and groin. Also, in rare cases, SPD may worsen after childbirth and need medical intervention.