Symphysis Pubis Dysfunction

What is symphysis pubis dysfunction?

Symphysis pubis dysfunction refers to symptoms you feel when the joint between your left and right pelvic bones (pubic symphysis) allows for more movement than usual. Ligaments hold the joint in place so that your pelvic bones aren’t able to move or shift past the point of comfort. During pregnancy, due to hormonal changes, these ligaments loosen, so that the joint becomes flexible enough for your pelvic bones to widen during delivery. All the additional movement in your pelvis can be painful. The pain usually goes away after you’ve had your baby.

Who does it affect?

People who are pregnant are most likely to feel pain from this joint. If you’re pregnant, your pelvic area may hurt during pregnancy, while you’re in labor and after you’ve had your baby. The pain may come from the front of your pelvis, the back or both the front and back. Your pelvis may even feel loose and wobbly.

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 harm the joint.

How common is symphysis pubis dysfunction?

About 30% of people who are pregnant report symptoms linked to symphysis pubis dysfunction. As more people have learned about this condition, the numbers of reported cases have increased.

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.

What are the symptoms?

Your pain depends on how weight and pressure get distributed throughout your body. The way you move your body can make the pain better or worse. If you’re pregnant, the weight of the fetus or multiple fetuses can put pressure on the joint, making it hurt more. Often, the pain gets more intense the closer you are to delivery.

You may feel:

• Mild discomfort.
• Sudden, shooting pain coming from the front or back of your pelvis.
• Steady pain that radiates throughout your lower abdomen, back, groin, perineum (the space between your anus and vulva), thigh and leg.

Certain movements may make the pain worse:

• Walking (you may notice a clicking sound when you walk).
• Bending forward.
• Going up or down stairs.
• Adjusting yourself in bed.
• Getting in and out of the car.
• Standing on one leg or raising a leg.
• Raising yourself out of bed or out of a chair.

Symptoms other than pain can show up, too:

• 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 may contribute to symptoms linked to postpartum depression after your baby’s born. It’s a good idea to talk to your provider about behavioral health support if you’re experiencing symptoms associated with depression.

How is it diagnosed?

Your provider has different ways to tell whether or not you have symphysis pubis dysfunction.

• Your provider will check your medical history to see if you’re pregnant or if you’ve had an injury that could have harmed your pubic symphysis joint.
• Your provider may do a physical exam to check for tenderness, pain, or swelling. Your doctor may test to see how easily you can make certain movements.
• Your provider may take a closer look at your pelvis joint via ultrasound, CT scan or X-ray. If you’re pregnant, your provider will prescribe an imaging procedure that’s safe for the fetus.

How is symphysis pubis dysfunction treated?

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, you and your doctor can decide on the best ways to manage your pain. Some options include:

• Taking NSAIDs.
• Wearing comfortable shoes.
• Placing an ice pack on your pelvic area.
• Sleeping with a pillow between your legs.
• Wearing a pregnancy belt (pelvic support belt).
• Squeezing your legs together when you’re getting out of your car.

Getting care that’s tailored to your body can help manage symptoms. Your provider may suggest that you see a physical therapist, chiropractor, acupuncturist, or masseuse to relieve stress and strain in your body. Your provider may teach you stretches and exercises that will help you protect your pelvic area and help with stability. Keep in mind that the exercises you do during pregnancy may be different from the ones your provider recommends after pregnancy.

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. Your provider can guide you through approaches to relieve pain without harming other joints.

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. Try not to overexert yourself when you exercise, and wear comfortable shoes that support your feet.

What can I expect if I have symphysis pubis dysfunction?

Your pain should go away within six months post-pregnancy. If it doesn’t, check with your provider to see if there are other things happening that may be causing your discomfort. In the meantime, work with your provider to find ways to manage pain so that it doesn’t interfere with your everyday life.

What is the difference between Symphysis Pubis Dysfunction and Pubic Symphysis Diastasis?

Both symphysis pubis dysfunction and pubic symphysis diastasis involve the pubic symphysis joint. With symphysis pubis dysfunction, you may feel pain or sensitivity in your pelvic area because there’s more movement in that joint than you’re used to.

With pubic symphysis, the joint separates completely. It may separate because of pressure during childbirth. Sometimes the joint separates if the doctor used forceps during delivery or had to cut the joint for the baby to pass through (symphysiotomy). Pubic symphysis diastasis is rare, happening in anywhere from 1 in 300 to 1 in 3,000 vaginal deliveries.

A note from Cleveland Clinic

It isn’t unusual to feel pain in your pelvis when you’re pregnant. Knowing that the pain you’re feeling can be expected doesn’t make the experience any less stressful, though. The good news is that your symptoms will likely go away after you’ve had your baby. In the meantime, there are things you can do to take control so that you feel better. Talk with your provider about ways to manage pain that work with your lifestyle.