Symphysis Pubis Dysfunction

What is symphysis pubis dysfunction?

Symphysis pubis dysfunction (SPD) describes uncomfortable symptoms you feel in your pubic symphysis, typically during pregnancy. Your pubic symphysis is a joint at the front and bottom of your pelvis. It connects your left and right pubic bones. Its job is to stabilize your pelvis. It also helps with movement and absorbs shock during physical activities like running. Ligaments hold the joint in place so that your pelvic bones can’t move unevenly or shift past the point of comfort.

Your body goes through many changes during pregnancy, and changes to your pelvic joints, muscles and ligaments aren’t an exception. Your pelvic joint can’t move as comfortably due to pressure from the fetus. Your ligaments also loosen and stretch more easily, thanks to a hormone called relaxin. While stretching and loosening are great and allow your pelvis to expand, the movement to your pelvic joints can be too much. This puts further strain on your pelvis and leads it to shift more than usual. Plus, you’re carrying extra weight and adjusting to moving with that extra weight.

The good news is that the pain usually goes away after your baby is born. In the meantime, though, dealing with SPD can affect your mood and quality of life. Tell your pregnancy care provider if you have pain in your pelvic region that makes it hard to climb stairs, get out of cars or walk. While being slightly uncomfortable is normal in pregnancy, being in pain and experiencing sadness because you can’t do your typical activities isn’t something you should accept.

SPD is sometimes called pelvic girdle pain. Your pelvic girdle is made up of your pubic symphysis, sacrum and hip bones. Some healthcare providers use this newer term because it more accurately describes how you feel pain across your entire pelvis, not just at your pubic symphysis joint.

How common is symphysis pubis dysfunction?

SPD and pelvic girdle pain affect about 1 in 4 people during pregnancy.

What are the symptoms of SPD?

Your pain depends on how weight and pressure distribute throughout your pelvis. If you’re pregnant, the weight of the fetus can put pressure on the joint, making it hurt more. Often, the pain gets more intense the closer you are to delivery because the fetus is at its heaviest.

You may feel:

• Mild discomfort that tends to stay in the front of your pelvis.
• A sensation that your pelvis is loose and wobbly.
• Sudden, shooting pain coming from the front or back of your pelvis.
• Tingling, burning, stabbing or throbbing pain in your pelvic region.
• Steady pain that radiates throughout your lower abdomen, back, groin, perineum and thigh.

Certain movements may make your pelvic pain worse. Some of these movements are unavoidable and part of day-to-day life, which makes it very hard to live your usual life. Take extra care when you do the following:

• Walk.
• Bend forward or sit up straight.
• Go up or down stairs.
• Adjust yourself in bed.
• Get out of bed.
• Get in and out of the car.
• Stand on one leg or raise one leg.
• Raise yourself out of a chair.
• Spread your thighs or legs apart.

Symptoms other than pain can show up, too. These could include:

• Having trouble peeing or pooping.
• Feeling fatigue that doesn’t have a clear source.
• Hearing a clicking or grinding sound from your pelvis.

The pain and discomfort can take a toll on your mental health. It can make it hard to go about your usual activities or simply live your life. It can even contribute to symptoms of postpartum depression after your baby’s born. It’s a good idea to talk to your provider about support if you’re experiencing symptoms of depression both during pregnancy and after your baby is born.

Is walking bad for SPD?

The benefits of walking typically outweigh the risks, but walking is one of the activities that becomes hard with SPD. If walking causes you extreme pain or makes your symptoms worse, you may need to adjust how often you walk, where you walk or what shoes you wear.

What causes symphysis pubis dysfunction?

When you’re pregnant, your body produces a hormone called relaxin that makes the ligaments in the joint between your left and right pelvic bones more relaxed. Your body may start producing this hormone as early as 10 weeks into your pregnancy. Loosening the grip that your ligaments have on the joint means that the joint can move around more. That extra movement allows your left and right pelvic bones to widen when it’s time for your baby to be born.

These changes in the way that your pelvic bones can move make vaginal childbirth possible. But they can also lead to instability in the joint or the joint moving in ways it’s not meant to. Plus, you’re carrying extra weight in your pelvic region, which puts added pressure on the pelvis joints.

Who is most at risk for SPD?

People who are pregnant are most likely to feel pain from the pubis symphysis. If you’re pregnant, your pelvic area may hurt during pregnancy, while you’re in labor and after you’ve had your baby.

You don’t have to be pregnant for this joint to feel painful, though. Sports injuries can cause you to jam or dislocate your pelvic bones around the joint area. The cartilage in this joint can wear down over time (osteoarthritis) so that it’s less able to support your pelvic bones. Infections and inflammatory conditions (osteitis pubis) can also harm the joint.

If you have back problems or a history of pelvic injury, you’re also more at risk for SPD.

What are possible complications of symphysis pubis dysfunction?

There aren’t usually serious complications from SPD. But it can be painful, particularly during pregnancy or in the weeks after delivery. It can affect your quality of life and make it hard to do activities you enjoy. Some of the possible complications of SPD are:

• Difficulty standing, walking or doing any physical activities.
• Pain during sex.
• Arthritis of your pubis symphysis joint.
• Depression or feeling sad about the limitations SPD puts on you.

How is symphysis pubis dysfunction diagnosed?

Your healthcare provider has different ways to tell if you have symphysis pubis dysfunction. Diagnosing it could involve:

• Checking your medical history to see if you’re pregnant or if you’ve had an injury that could’ve harmed your pubic symphysis joint.
• Doing a physical exam to check for tenderness, pain or swelling. Your provider may watch to see how easily you can make certain hip and back movements.
• Taking a closer look at your pelvis joint using ultrasound, CT scan (computed tomography scan) or X-ray. If you’re pregnant, your provider will prescribe an imaging procedure that’s safe.

How do you treat symphysis pubis dysfunction during pregnancy?

The pain you’re feeling in your pelvis will usually go away a few months after your baby is born. Once your body stops producing relaxin, your ligaments tighten again, and the joint moves less. In the meantime, your healthcare provider can help you manage your pain and reduce stress on your pubic symphysis. Some options include:

• Taking NSAIDs (nonsteroidal anti-inflammatory drugs).
• Wearing comfortable shoes with extra cushioning.
• Standing and sitting with good posture. This means standing tall with your shoulders back and your butt tucked in.
• Avoiding sitting for long periods of time.
• Placing an ice pack on your pelvic area.
• Sleeping with a pillow between your knees.
• Wearing a pregnancy support belt to help stabilize your pelvis.
• Squeezing your legs together when you’re getting out of your car.
• Trying things like acupuncture, massage therapy, chiropractic care or physical therapy to help with movement and relieve pain.

Your provider may teach you stretches and exercises that’ll help you protect your pelvic area and help with stability. This could include pelvic floor exercises. Keep in mind that the exercises you do during pregnancy may be different from the ones your provider recommends after pregnancy. Exercises that are easy on your joints like swimming are better than exercises like cycling or weight-bearing movements.

Learning how to move safely is important, too. When you feel pain, it’s natural to move differently to try and get relief. It’s easy to overcorrect, though, and put too much strain on other joints in the process. For example, you might need to learn the best way to bend down to lift a child or heavy shopping bag. Overtwisting or turning your body too far can also make matters worse. Your provider can guide you through approaches to relieve pain without harming other joints.

What is the best sleeping position for symphysis pubis dysfunction?

It’s best to sleep on your side with a pillow between your knees and lower legs if you have SPD.

Does SPD require bed rest?

No, SPD shouldn’t require bed rest. Most people can manage their pain to a point where bedrest isn’t necessary.

How can I prevent symphysis pubis dysfunction?

You can’t prevent pain from your pelvic joint during pregnancy, but you can protect your pelvic area from injury. Some tips to reduce your risk for SPD are:

• Wear comfortable shoes that support your feet. Avoid wearing shoes like flip-flops that offer no support.
• Maintain a healthy weight throughout pregnancy. Ask your provider if you’re unsure what’s healthy for you.
• Listen to your body. If something hurts, stop. Don’t overdo it.
• Be mindful of your posture and how your body moves. Avoid twisting motions or motions that strain your pelvis such as squats.

What can I expect if I have symphysis pubis dysfunction?

Everyone experiences pain from SPD differently. While it can make pregnancy extremely frustrating, most people say their pain subsides within a few months of giving birth. If it doesn’t stop after your baby is born, check with your provider to see if other things are happening that may be causing your discomfort. In the meantime, work with your pregnancy care provider to find ways to manage pain so that it doesn’t interfere with your everyday life.

Does SPD mean labor is near?

No. SPD and pelvic girdle pain don’t mean your labor is near or progressing. Be mindful of signs of labor that do mean delivery is right around the corner.

When should I see my healthcare provider?

Let your healthcare provider know if your pelvic pain interferes with your daily life. If normal movements like walking, climbing steps or getting in and out of the car cause discomfort, your pubic symphysis may be to blame. There are ways to manage your pain, though. Your provider can discuss the best ways to cope with the discomfort so that you can have improved mobility for the rest of your pregnancy.

A note from Cleveland Clinic

It isn’t unusual to feel pain in your pelvis when you’re pregnant. But having intense or stabbing pains that make weight-bearing movements like walking extremely difficult can be a sign of symphysis pubis dysfunction (SPD). The good news is that it typically goes away within a few weeks after your baby is born. But that doesn’t make your current situation any easier to deal with. If your pelvic pain prevents you from moving normally or causes extreme discomfort, talk to your pregnancy care provider. There are things you can do to manage pelvic joint pain during pregnancy.