Pubic Symphysis Dysfunction during pregnancy


Pubic Symphysis pain or pelvic girdle pain is the pain that can be experienced

  • sharp/shooting pain on the front of your pubic bone,

  • pain on your sacroiliac joint/lower back on one or both sides

  • pain in your perineum

Every 1 in 5 women are affected by this debilitating pain during their pregnancy. A lot of women are given crutches to use and are on bed rest during their third trimester.

Pain is worst with movement especially with turning in bed, getting out of the bed, wearing pants, climbing stairs, sitting cross legged, and walking. Every day tasks like getting in and out of car/bed, pushing grocery cart, sitting at work for long time, walking can become increasing painful.

Causes

One of the main causes is hormonal (relaxin and pro-gesteron) which is responsible for relaxing the ligaments and muscles to help you with the birth but can also put you at risk of injury and pain. Other factors that can cause PSD is any trauma, pregnancy weight, the head circumference of baby, position of baby and weight of baby which can increase the discomfort later on. It can also be due to muscle weakness and sometimes can be postural.

I also see post-natal women with this diagnosis which can be due to long hours of pushing in lithotomy position.

(On a side note, I have seen few men with this pain which is trauma related and so this pain is not gender specific.)

Treatment

Physical Therapy is the best and first line of treatment for pubic symphysis pain. It is advisable that you go to your obgyn first to rule out other pathologies and then visit a women's health/pelvic health specialized PT.

Treatment would include correcting the alignment of your pelvic, fitting you with the correct support belt, re-education about posture, for example looking at how you sleep, sit, walk and then correcting it to reduce pain and giving you appropriate home plan. If the pain is severe, you may have to ask you MD for pain relief medication. If you are in third trimester and again is the pain is of a higher degree, you may want to discuss the birth plan with your obgyn.

References

Howell, E. (2012). Pregnancy-related symphysis pubis dysfunction management and postpartum rehabilitation: two case reports. Journal of Canadian Chiropractic Association, 56(2), pp.102-111.

Depledge, J., Keal-Smith, C., Williams, M. and McNair, P. (2005). Management of Symphysis Pubis Dysfunction During Pregnancy Using Exercise and Pelvic Support Belts. Physical Therapy, 85(12), pp.1290-1300.

Symphysis Pubis Dysfunction: Symptoms, Treatment, Risks, and More.https://www.healthline.com/health/symphisis-pubis-dysfunction#causes

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