Diastasis Symphysis Pubis in pregnancy

by Dr. Alison Gault


The symphysis pubis is the joint between the two pubic bones at the front of the pelvis.  Diastasis Symphysis Pubis is a condition that occurs in pregnancy in which there is pain occurring in the pubic symphysis joint associated with an abnormal joint widening of over 10mm.  Pain primarily occurs at the pubic symphysis joint but secondary symptoms of low back, posterior pelvic and lower abdominal pain are also common.

Symptoms of diastasis symphysis pubis

Primary symptoms

Pain occurs primarily in the pubic symphysis with the joint being very tender to touch.  On examination, widening of the pubic symphysis is found to be MORE THAN the normal range for pregnancy of approximately 9mm.

Secondary symptom

  • Low back and posterior pelvis pain or aching.
  • Pain or tightness in the inner thigh or adductor muscles and hip muscles.
  • Lower abdominal pain.
  • Waddling gait.
  • Clicking or clunking sound coming from the pelvis.
  • Pain at the symphysis pubis is almost always associated with pain in the posterior pelvis or SI joints as the pelvis is like a large ring.

The symptoms are similar to symphysis pubis dysfunction but are generally more severe.

Aggravating factors

You may find asymmetrical movements especially aggravating such as:

  • standing on one foot to get dressed
  • getting in and out of the car
  • stairs
  • turning over in bed
  • getting in and out of the bath

You may also find other physically straining activities painful such as:

  • walking
  • standing still for longer periods such as ironing, showering, washing dishes, hanging washing.
  • Carrying heavy things such as toddlers, shopping, washing.
  • Bending over to pick up children or items off the floor.

What happens and why?

Pelvic ligaments soften due to the actions of the hormones relaxin, progesterone and oestrogen enabling the pubic symphysis to widen from 4-5mm to up to 9 mm in a normal pregnancy.  In diastasis symphysis pubis, an abnormal gap of more than 1cm is present.  There may also be a shear through the pubic joint so that the two bones are not in correct alignment with each other.  The abnormally widened gap can only be conclusively diagnosed with X-ray, MRI or ultrasound. Natural widening of the symphysis pubis has been shown to occur from the 8th week of pregnancy.

In order to increase stability within the symphysis, muscles of the pelvis, low back and thighs contract to increase tension.  This tightening can eventually cause muscle fatigue resulting in pain and the occasional feeling that the pelvis is going to give way.   A long term increase in muscle tension can result in these muscles becoming weak causing further instability.

There are several other contributing factors to diastasis symphysis pubis: 

  • Increasing weight of the baby: Puts more strain on all the muscles, ligaments and joints in the low back and pelvis. This can result in further joint irritation and muscle fatigue.
  • Joint misalignment: As the pelvis is essentially a large circle, if one joint is affected, so are the others. If one of the sacroiliac joints is not moving properly, more strain goes through the pubic symphysis with movement. This results in further joint irritation and protective muscle spasm and pain.
  • Change in centre of gravity: due to the forward growth of the abdomen, the centre of gravity adjusts to prevent you from falling over; this changes how your muscles and joints act.

The amount of joint separation, hormone levels, foetal size, maternal weight/age/height, x-ray or ultrasound does not always correlate with the degree of symptoms experienced nor can it predict postnatal outcome.

Prevention of  pregnancy related diastasis symphysis pubis

If you have had instability in prior pregnancies or a history of low back pain, it may be beneficial to:

  • Do some rehabilitation with a physiotherapist, Pilates instructor or personal trainer to ensure that your core and pelvic musculature is strong and functioning as best as possible prior to getting pregnant.
  • Get treatment from your chiropractor, osteopath or physiotherapist to ensure your pelvis and low back are in good working order before trying to get pregnant.
  • Act as soon as you start to experience symptoms they tend to worsen as the pregnancy progresses.
  • It has been suggested having a 2 year gap between pregnancies enables the body to recover and decreases the chance of re- occurrence.

How our products can help with your pregnancy related diastasis sympthysis pubis

The sacroiliac belt or suitable compression wear puts compression through the joints of the pelvis that may increase the stability, reduce inflammation, increase healing and decrease muscular spasm.   The end result being a reduction in pain and an increase in your ability to function.  It is beneficial to wear the belt in your more physically demanding times such as at work, doing housework or going shopping.

The pregnancy support pillow  is great under your side and abdomen when lying down to lift the belly and take pressure off your low back and improve your spinal and pelvic alignment.

Leg spacer  between the knees to take the stretch off your hip and pelvic muscles and to improve pelvic and spinal alignment whilst lying on your side. This item is a great alliterative to a pillow between your knees as it is attached to your leg so does’t move from its position when you turn over.

The couple it underwear release system  enables you to put your underwear on when seated.  This removes the need to stand on one leg to get dressed which can be very painful for those suffering from this condition.

Compression wear is also another lightweight and non-bulky way of supporting the pelvis.  These are great to wear all day under your clothes and even better when trying to get some sleep at night!

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