What is Diastasis Symphysis Pubis?

by Dr. Alison Gault

Diastasis symphysis pubis in an abnormal widening of the pubic symphysis and is one of the medical conditions causing pain in pregnancy.  This can occur during pregnancy, due to pelvic trauma or postpartum due to the birthing process. In this blog post, I cover the basic anatomy of the pubic symphysis, what is normal and abnormal widening of the symphysis pubis in pregnancy and what symptoms you may experience if you are suffering from this condition. I also discuss which of our pregnancy pain products such as the sacroiliac brace may assist with they symptoms and management of this condition.

Anatomy of the pelvis

The symphysis pubis is the joint formed that the front of the pelvis between the two pubic rami of the Innominate bones. The two sides of the joint are connected by a strong fibrocartilage to ensure strength but enable the rotation movements required for motion.

There are many muscles and ligaments that attach to the pelvis around the pubic symphysis such as the abdominals, pelvic floor and adductor muscles of the thigh.  Tightness and dysfunction of these muscles can effect the function of the symphysis pubis.

Symphysis Pubis widening in pregnancy… whats normal?

Diastasis or widening of the symphysis pubis is a normal process that happens in pregnancy to enable the birthing process. The widening occurs due to the actions of those lovely pregnancy hormones such as relaxin which soften the structure of the fibrocartilage.    The width of the joint is normally 3-5mm in a non pregnant person.  In a normal pregnancy, the joint widens up to 4mm.  Joint widening of over 9mm however, is considered to be abnormal and is accompanied with the diagnosis of diastasis symphysis pubis.

As well as widening, there can also be instability in which there is vertical displacement or shearing of the symphysis pubis.  This occurs when one of the pubic rami is sitting higher than the other.  This occurs due to damage or a higher amount of laxity in the ligaments of the pubic symphysis.

How is Diastasis Symphysis Pubis diagnosed?

During pregnancy, x-ray is avoided where possible, the condition is imaged using ultrasound if required.  Postpartum however, x-ray is the best imaging option.  In most cases however imaging is not necessary as case history and symptoms are enough diagnose the condition.

Symptoms of Diastasis Symphysis Pubis

Diastasis symphysis pubis is one of the four conditions that comes under the banner of pelvic girdle pain.

  • The primary symptom is tenderness of the pubic symphysis with palpation
  • Low back or posterior pelvic pain
  • Muscular tightness and pain commonly in the hip, glutes and the inner thigh
  • Lower abdominal pain
  • Sharp grabbing pain in the sacroiliac joints of the posterior pelvis
  • Clicking or clunking sensation experienced in the pubic symphysis with certain movements such as walking
  • A waddling or altered gait

The symptoms of DSP are very similar to those of symphysis pubis dysfunction in which the joint widening remains within the normal limits of under 9mm.

Aggravating factors for Diastasis Symphysis Pubis

  • Standing on one foot to get dressed
  • Getting in and out of the car
  • Stairs
  • Turning over and getting out of bed
  • Walking
  • sitting for longer periods
  • Heavy lifting
  • bending
  • repeditive tasks
  • housework such as vacuming, mopping and cleaning the shower

Products for the management of Diastasis Symphysis Pubis

The pregnancy sacroiliac belt introduces a compressive force to all three of the joints of the pelvis to aid in normalising movement. The benefit to this type of brace is that it still enables proper contraction of the pelvic muscles so does not result in weakness.

Compression wear is another way of increasing stability of the pelvic joints.  These garments are especially helpful to wear in bed for added support when turning over and getting up.

A leg spacer or pregnancy body pillow to support your top leg, improve pelvic alignment and gently separate the knees.

The couple it underwear release system enables you to put your underwear on when seated.  This helps you avoid the painful and aggravating unilateral weight bearing that occurs when getting dressed.

This condition can cause high amounts of pain, disability and distress.  Please contact your GP, midwife or obstetrician if you are concerned about your symptoms.  Don’t do it alone!  This condition is experienced by many women just like you, please visit the pelvic instability association for more information and support.

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