Pubic Symphysis

What is the pubic symphysis?

Your pubic symphysis joins your left and right pelvic bones. Unlike joints like your elbow and knee, your pubic symphysis doesn’t move much. Its big job is to hold the right and left pelvic bones in place. Still, it does make tiny movements that help your pelvis absorb weight from your upper body. These joint movements get even bigger when you’re pregnant. The joint gets more flexible during pregnancy, helping your pelvic bones spread enough for childbirth.

What is the purpose of the pubic symphysis?

The pubic symphysis joins your left and right pelvic bones to make one pelvis that’s strong enough to support your body but that’s able to stretch during childbirth. The joint connects each pelvic bone so that they are roughly mirror images of each other. Together, your pelvic bones help distribute the weight from the top part of your body to your legs and feet. Your pubic symphysis joint allows movement of up to 2 millimeters and one degree of rotation. This movement helps your pelvis absorb shock when you’re walking or running. This joint is especially important if you’re pregnant. It becomes extra flexible so that your pelvic bones can widen and a baby can pass through the birth canal.

Where is the pubic symphysis?

Your pubic symphysis joint sits at the bottom of your pelvis, where your left pelvic bone connects with your right pelvic bone. The joint is wider in the front than it is in the back by about 3 to 5 millimeters. It’s in front of your bladder and above both the clitoris and the penis.

Tendons from some of the muscles in your torso and thighs connect with ligaments in the pubic symphysis.

• Tendons from your thigh muscles (gracilis).
• Tendons from your oblique muscles (obliquus externus).
• Tendons from your abdominal muscles (rectus abdominis).

What is the pubic symphysis made of?

Your pubic symphysis joint is made of two kinds of cartilage and four ligaments that make the connection between your pelvic bones strong but not rigid. The pubic symphysis allows more flexibility than the joints that connect the bones in your skull but less flexibility than joints like your elbow.

• Fibrocartilage disk. Fibrocartilage is a thick mesh of fibers made of mostly type I collagen. Type I collagen creates a solid structure for bones, skin, tendons, and connective tissues, like joints. The fibrocartilage fibers form a sturdy, fibrous disk in your public symphysis joint. Ligaments and tendons attach to the fibrocartilage disk, helping hold it in place.
• Hyaline cartilage coating. Hyaline cartilage is made of mostly type II collagen. Type II collagen is the most common building block that makes up cartilage. Hyaline cartilage covers the ends of your pelvic bones. The fibrocartilage disk is sandwiched between hyaline cartilage on your left pelvic bone and hyaline cartilage on your right pelvic bone.
• Ligament connectors. Four different ligaments attach to the fibrocartilage disk to keep it from slipping or moving more than it should: the superior pubic ligament, the inferior pubic ligament, the anterior pubic ligament, and the posterior pubic ligament.

What conditions and disorders affect the pubic symphysis?

Symphysis pubis dysfunction is an umbrella term for symptoms you feel because of changes in your pubic symphysis. Most of the time, pregnancy causes symphysis pubis dysfunction. During pregnancy, hormone changes cause the ligaments that hold the pubic symphysis in place to loosen. More slack in the ligaments makes your joint more flexible. This flexibility allows your pelvic bones to separate during childbirth when it’s time for the baby to come. These changes can be painful.

Pregnancy isn’t the only condition that changes your pubic symphysis.

• Joint jamming and dislocation. Your pubic symphysis gets a little wider when your legs move apart. If you’re playing sports or exercising, you can position your body so that the joint widens too much and the pelvic bones dislocate or jam when they come back together.
• Metabolic diseases and disorders. Overweight and obesity can create strain on the pubic symphysis that makes it easier to injure. Diseases can cause the joint to widen (renal osteodystrophy) or calcium deposits to build up in the joint (ochronosis).
• Joint diseases. The cartilage can break down and become less supportive over time (osteoarthritis).
• Infection. Staph and strep bacteria can attack the joint and cause it to get inflamed.
• Inflammation. The most common inflammatory condition that affects the pubic symphysis (osteitis pubis) can happen as a result of injury, infection, pregnancy, osteoarthritis, or surgery.

What are some common signs or symptoms of conditions affecting the symphysis pubis?

Depending on what’s affecting your symphysis pubis joint, you may feel a sharp pain in your pelvis. Sometimes the pain feels spread out across your abdomen, hips, and back. Having trouble with certain movements can cue you in that something’s wrong with your pubic symphysis:

• Less flexibility in your groin.
• Grinding feeling when you move your pelvis.
• Pain in your pubic area or inside of the thigh.
• 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 provider can help determine if a problem with your pubic symphysis is causing your symptoms.

What are some common tests to check the health of the pubic symphysis?

Usually, your doctor will be able to tell how healthy your pubic symphysis is by doing a medical history and a physical exam to test how strong and stable your pelvic muscles and joints are. In rare cases, your doctor may do a blood test or imaging. If you’re pregnant, your doctor will only suggest imaging that is safe for the fetus.

What are some common treatments for the pubic symphysis?

Your doctor will help you manage your pain while your body heals from an injury to your pubic symphysis.

• Getting more rest can give your body time to recover.
• Taking NSAIDS and using ice packs, and heating pads can all help with the pain. You shouldn’t put a heating pad on your belly or lower stomach if you’re pregnant, though.
• Getting treated by a musculoskeletal specialist, like a physical therapist or chiropractor, can help, too. They can offer treatments and exercises that can help you stabilize and strengthen your pelvic area while your joint gets better.

The best treatment for you depends on what’s causing your pain. Speak to your provider about your options.

How can I keep my pubic symphysis healthy?

Taking care to move your body in ways that won’t injure your pubic symphysis joint is a great way to avoid injury. Doing exercises to strengthen the muscles that surround and support your pelvis can help, too. Your doctor may recommend any of the following:

• Doing exercises that strengthen the muscle groups at the bottom of your pelvis (pelvic floor), your middle and lower back, hips, butt, abdomen, and vaginal wall (Kegel exercises).
• Wearing comfortable shoes that are right for your feet, so that you’re easing the pressure on your joints when you’re walking or running.
• Exercising on surfaces that aren’t hard or uneven, so that you’re not stressing your joints by pounding the pavement too hard. Running on smooth surfaces reduces the chance that you’ll fall and land in a way that twists or jams your pubic symphysis.
• Easing into exercise so that you’re not putting too much strain on muscles that aren’t ready for the work. Taking time to progress through an exercise routine can save your joints in the long run.

Talk with your provider about exercises you can do to prevent injury and how to plan for exercising so that you don’t risk injury.