Pubic Symphysis

What is the pubic symphysis?

Your pubic symphysis is a joint that connects your left and right pubic bones in your pelvis. Unlike other joints, your pubic symphysis doesn’t move much. Its big job is to hold your pelvic bones in place. It makes small movements that help absorb upper body weight.

You may not think much about this body part until something like pregnancy or a sports injury affects it.

What is the purpose of the pubic symphysis?

Your pubic symphysis helps with:

• Holding your pubic bones in place
• Absorbing shock when you walk or run
• Passing weight from your upper body to your legs and feet
• Letting your pelvis widen during pregnancy and vaginal childbirth

Where is it?

Your pubic symphysis is at the bottom of your pelvis, where your left and right pubic bones meet. The joint is wider in the front than it is in the back. It’s in front of your bladder and above your genitals.

Certain tendons connect with ligaments in the pubic symphysis, including:

• Thigh muscle tendons (gracilis)
• Oblique muscle tendons (obliques)
• Abdominal muscles tendons (rectus abdominis)

What is it made of?

Your pubic symphysis has two types of cartilage and four ligaments. Together, they make a strong yet flexible connection between your pelvic bones. It allows a little bit of flexibility.

It includes:

• Fibrocartilage disk: Fibrocartilage is a thick mesh of fibers made of mostly type I collagen. It forms a sturdy, fibrous disk in your public symphysis joint. Ligaments and tendons attach to the fibrocartilage disk to help hold it in place.
• Hyaline cartilage coating: Hyaline cartilage is made of mostly type II collagen — the most common building block that makes up cartilage. Hyaline cartilage covers the ends of your pubic bones and sandwiches the fibrocartilage disk.
• Ligament connectors: Four different ligaments attach to the fibrocartilage disk to keep it from slipping or moving more than it should. They include the superior, inferior, anterior and posterior pubic ligaments.

What conditions affect the pubic symphysis?

Symphysis pubis dysfunction (SPD) is an umbrella term for symptoms you feel because of changes in your pubic symphysis. Two types include:

• Pubic diastasis: The joint separates more than 1 centimeter without a pubic fracture.
• Osteitis pubis: This is inflammation of the joint that isn’t caused by an infection.

Pregnancy is a common cause of SPD. During pregnancy, a hormone called relaxin loosens the ligaments that hold your pubic symphysis in place. This can cause issues. Sports injuries are another common cause, especially when you make quick, sharp changes in movement.

Bone and joint conditions that can affect your pubic symphysis include:

• Degenerative diseases, like osteoarthritis
• Fractures
• Metabolic bone diseases, like osteoporosis and renal osteodystrophy
• Pseudogout
• Rheumatoid arthritis
• Tumors or cancer

Signs that something’s wrong

Issues with your pubic symphysis often cause pain and an unstable pelvis. You may feel a sharp pain in your pelvis or groin. Sometimes, the pain can spread out across your abdomen, hips and back.

Having trouble with certain movements can cue that something’s wrong. You may feel:

• Less flexibility in your groin
• A grinding feeling when you move your pelvis
• Pain or a clicking sound when you’re walking
• Aching in your groin when you try to run, kick, stand or sit
• Pain when you twist your body or maneuver to reach something

Your healthcare provider can check if a problem with your pubic symphysis is causing your symptoms. They’ll do a physical exam and may recommend imaging tests.

How can I keep my pubic symphysis healthy?

Taking care to strengthen and move your body mindfully is a great way to avoid injury. Your healthcare provider may recommend:

• Pelvic floor exercises and core strengthening
• Wearing comfortable shoes that are right for your feet
• Easing into exercise
• Exercising on soft, even surfaces