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The pelvis is made up of a few bones that are held together by ligaments. These ligaments, which normally stretch during pregnancy, sometimes lengthen so much that they cause pain and discomfort. The pubic symphysis is a joint that unites part of the pubic bones located above the bladder, and when this joint stretches an excessive amount or causes pain in pregnancy, it results in pubic symphysis separation, also known as symphysis pubic dysfunction, or SPD.

It is entirely normal for the pubic symphysis to widen in pregnancy. This usually happens by 28 to 32 weeks gestation, and it can increase from a normal width of 4 millimeters to up to 8 millimeters – that’s twice as wide!

The hormone relaxin is the culprit for this joint widening. Just like the name suggests, relaxin causes the joints to become looser and more relaxed — and the point is that it gives your baby more room to eventually deliver vaginally. This hormone is increased 10-fold in pregnancy, and affects many different joints. It is why a pregnant woman is more likely to feel unstable during certain exercises and also why the curvature of her spine changes as her pregnancy develops.

However, when joint relaxation goes overboard, pain can be the result. Women with SPD often report pain near their pubic symphysis that may shoot down their inner thigh when they stand. It can also leave a woman feeling wobbly on her feet, like her legs are going in opposite directions or don’t seem coordinated. Sometimes women say they hear a clicking or grinding sound at the joint. Most women with SPD tend to “waddle” when walking to try to find comfort.

The good news is that there are some things women can do to manage SPD in pregnancy, and in general most women find some relief. If you find yourself suffering with SPD, here are some things you can try:

  • Keep your knees together when rolling over in bed, or getting up from a chair. This helps to stabilize the joint.
  • Take smaller, shorter steps when walking.
  • Go upstairs sideways one at a time, and avoid making unnecessary trips.
  • Get into a car by sitting first, then swinging your legs in (keeping those knees together).
  • Sleep with a pillow between your legs to keep the joint more aligned.
  • Rest when it hurts!
  • Exercise to strengthen the muscles that support the pelvis: abdominal stabilization exercises, pelvic floor exercises, and lower back/hip exercises. Ask for a referral to a physical therapist experienced with SPD who can show you how to do these and what is safe in pregnancy.
  • Wear a pelvic support belt (though data is limited on their usefulness, they may help some women).

Luckily, most women find relief after delivery. Rarely is extended treatment or surgical intervention needed to fix the joint in place. If you think you might be experiencing SPD, talk to your doctor or midwife, so they can evaluate you and help get you more comfortable.

Takeaways

  • When the joints of the pelvis widen too much in pregnancy, a condition called SPD may develop.
  • Women with SPD often have pain with walking or going up stairs.
  • There are some things women can do to manage and relieve SPD.

References

  1. Gabbe SG et al. Obstetrics: Normal and Problem Pregnancies. 5th ed.
  2. J Depledge et al. Management of symphysis pubis dysfunction during pregnancy using exercise and pelvic support belts. Physical Therapy. December 2005. Vol 85, no 12: 1290-1300.
  3. JL Chang and V Wu. External fixation of pubic symphysis diastasis from postpartum trauma. Orthopedics 2008 May; 31(5):493.

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