Osteitis Pubis

What is osteitis pubis?

Osteitis pubis is inflammation in the joint between your left and right pubic bones (your pubic symphysis). It causes pain and swelling in your groin or lower abdomen.

Osteitis pubis is a type of symphysis pubis dysfunction that’s usually caused by repetitively using your hips, pelvis and groin. It’s most common in athletes. People who are currently pregnant, have recently experienced the birth of a child or have had surgery on or near their abdomen sometimes develop osteitis pubis, too.

You’ll need to rest and avoid physical activities like sports for a few months to recover from osteitis pubis. Some people need surgery to repair their pubic symphysis joint if it’s severely damaged or hasn’t gotten better after other treatments.

Who does osteitis pubis affect?

Anyone (male or female) can irritate their pubic symphysis. However, osteitis pubis usually affects people who are especially active or athletes who use their core and hips to twist, kick or suddenly change direction a lot. Some sports that can cause osteitis pubis include:

• Soccer.
• Hockey.
• Marathon running.
• Basketball.
• Martial arts.

People who are pregnant, have recently had a child or who’ve had a recent surgery near their abdomen are also more likely to experience osteitis pubis.

How common is osteitis pubis?

Osteitis pubis is rare. Experts estimate that osteitis pubis causes less than 15% of all cases of groin pain.

How does osteitis pubis affect my body?

Usually, the pubic symphysis flexes with your pelvis as you twist, bend and move. It’s the point where your two pubic bones meet. Ligaments hold the joint in place so that your pelvic bones aren’t able to move or shift too much.

If you have osteitis pubis, the cartilage in your joint is irritated and inflamed, which can make it difficult or painful to move and do any physical activities.

What are the symptoms of osteitis pubis?

Symptoms of osteitis pubis include:

• Groin pain or lower abdomen pain (constant dull pain or an aching throb when you’re moving).
• Pain in your thigh adductor muscles (your inner thigh muscles).
• Difficulty walking the way you usually can.
• A feeling of tightness or pressure above your pelvis.
• Swelling.
• Pain in or near your genitals.

What causes osteitis pubis?

The most common causes of osteitis pubis include:

• Playing a sport: Sports injuries are the most common cause of osteitis pubis. Athletes who put repeated strain on muscles, tissues and surrounding structures of their pubic symphysis can irritate the joint.
• Pregnancy: Being pregnant or having a long labor can cause osteitis pubis. Some people develop osteitis pubis after their pregnancy, as well.
• Surgery: Osteitis pubis can be a side effect of some types of surgery — usually urological surgery — near your abdomen or groin. In cases after surgery, you may have additional tests run to see if there’s an infection. Osteomyelitis, or an infection of the bone, can cause similar symptoms to osteitis pubis.
• Other health conditions: Any injury or health condition that affects the way you walk (your gait) or how your hips and pelvis are aligned can cause osteitis pubis. People who have cam-type femoroacetabular impingement (FAI) — sometimes referred to as hip impingement — are more likely to develop osteitis pubis due to changes in how their hips move.

How is osteitis pubis diagnosed?

Your healthcare provider will diagnose osteitis pubis with a physical exam and imaging tests. They’ll ask you about your symptoms and examine your groin for signs of inflammation.

You’ll need one of a few imaging tests to take pictures of your pubic symphysis joint, including:

• X-rays.
• MRI (magnetic resonance imaging).
• A CT (computed tomography) scan.

How is osteitis pubis treated?

The most common treatment for osteitis pubis is rest and then a gradual return to previous activities. This gradual return will make sure you stay strong and are appropriately increasing activities in a safe and pain-free way. Avoiding the activity that irritated your pubic symphysis joint will give it time to heal. This is especially important if the osteitis pubis was caused by a sport or other physical activity. Most people need to avoid full participation in their sport for up to six months.

Your provider might also recommend physical therapy. Physical therapy can help strengthen the muscles around your pubic bones to support them better. It can also address any faulty movement patterns that may have caused small stresses to your joints over time.

Over-the-counter (OTC) NSAIDs can help reduce inflammation and any pain you’re experiencing. Talk to your provider before taking NSAIDs for more than 10 days in a row.

Some studies have found corticosteroid injections and prolotherapy can reduce inflammation caused by osteitis pubis, but experts still aren’t sure if these are effective treatments. Talk to your provider about your symptoms and ask if your case of osteitis pubis might respond well to these treatment options.

Osteitis pubis surgery

It’s rare to need surgery for osteitis pubis. However, if you’re still having symptoms after at least six months of rest and other conservative treatments, your provider might recommend surgery to repair your pubic symphysis.

The most common surgeries for osteitis pubis are repairing the cartilage in the joint or surgically strengthening the muscles on the floor of your abdomen. Your surgeon will explain which procedure you’ll need and what to expect. Most people need four to six months to recover from osteitis pubis surgery.

How do I manage my osteitis pubis symptoms?

The best way to manage your osteitis pubis symptoms is to avoid the activities that caused them. Further stress on your pubic symphysis joint can make your symptoms worse (and make your recovery take longer).

Avoid intense physical activity. Talk to your provider or physical therapist about exercises that you can do to stay active safely while your pubic symphysis joint heals.

How long does it take to recover from osteitis pubis?

It takes a few months to recover from osteitis pubis. Most athletes are able to resume their sport with no symptoms three to six months after starting treatment.

How can I prevent osteitis pubis?

The best way to prevent osteitis pubis is to avoid overusing your pubic symphysis joint.

During sports or other physical activities:

• Wear the right protective equipment.
• Don’t “play through it” if you feel pain during or after physical activity.
• Give your body time to rest and recover after intense activity.
• Actively stretch and warm up before playing sports or working out.
• Stay consistent with a well-planned strengthening and training program outside of your sport.
• Cool down and stretch after physical activity.

What can I expect if I have osteitis pubis?

You should expect to make a full recovery from osteitis pubis.

It’ll take time to heal your pubic symphysis joint, but you should be able to resume all your usual activities and sports. Even if you need surgery, osteitis pubis shouldn’t have any long-term impacts on your ability to walk, move or do the activities you love.

Will I need to miss work or school while recovering from osteitis pubis?

You shouldn’t need to miss work or school if you can do your job or studies without putting more stress on your pubis symphysis joint. If a repetitive motion at your job caused the osteitis pubis, talk to your provider about accommodations for which you might be eligible.

When should I see my healthcare provider?

Visit your provider as soon as you notice any symptoms in or around your groin. Osteitis pubis shares symptoms with several other groin issues. It’s important to get your pain and swelling diagnosed by your provider right away. They’ll be able to rule out other issues like a sports hernia or osteomyelitis (a dangerous bone infection).

What questions should I ask my doctor?

• Do I have osteitis pubis or another issue?
• How long should I avoid playing sports?
• Which imaging tests will I need?
• Will I need surgery?

A note from Cleveland Clinic

Osteitis pubis is easy to treat, and the hardest part for lots of people is the time they’ll need to spend on the sidelines. Even if it’s tough to miss a few months of your favorite sport or activity, it’s important to give your body the time it needs to heal.

As soon as your pubic symphysis joint has recovered and your symptoms have gotten better, you should be cleared to get back on the field, ice or court with no long-term concerns.