Symphysis Pubis Dysfunction (SPD) in Pregnancy

by Dr. Alison Gault The symphysis pubis is the joint between two pubic bones at the front of the pelvis.  Symphysis Pubis Dysfunction is a condition that can occur in pregnancy in which there is pain occurring in the pubic symphysis joint but joint widening remains within the normal range for pregnancy of up to 9mm.  This is a condition that we have grouped within the pelvic girdle pain in pregnancy  conditions.

Symphysis Pubis Dysfunction (SPD) Symptoms

Primary Symptoms

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

 Secondary symptoms

  • Pain in the posterior part of your pelvis at the dimples or sacroiliac joints (SIJ).
  • 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.

The symptoms are similar to Diastasis symphysis pubis but are not as severe or debilitating.

Aggravating factors

You may find asymmetrical movements especially aggravating SPD in pregnancy 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 when you have SPD in pregnancy such as:

  •  walking
  • standing still for long periods such as with ironing, showering, washing dishes, hanging washing
  • heavy carrying such as toddlers, shopping, washing
  • bending over to pick up children or items off the floor

SPD in pregnancy – What is happening and why?

This condition occurs for several reasons: Pregnancy hormones causing ligament softening: This occurs to all ligaments including those that support the pelvic joints. With SPD, the widening of the pubic symphysis is within the normal range for pregnancy of under 9mm. The softening however does enable more movement within the pelvic joints. Increasing weight of the baby: Puts more strain on all the muscles and joints in the low back and pelvis. Altered biomechanics: As the pelvis is essentially a large circle, if one joint is affected, so are the others. With SPD, most commonly the primary issue is one of the SIJ’s not moving properly resulting in more strain through the pubic symphysis with movement. This results in joint irritation, inflammation, pain and the development of protective muscle spasm. Change in centre of gravity: Due to the forward growth of your bump, the centre of gravity adjusts to prevent you from falling over, this changes how your muscles and joints act.

Treatment and prevention of SPD in pregnancy (symphysis pubis dysfunction treatment)

Avoid

  • Avoid standing on one leg, get dressed sitting down
  • Avoid standing for long periods. Sit down wherever possible for tasks that require you to stand such as food preparation or ironing
  • Avoid squatting where possible
  • Avoid repetitive tasks
  • Avoid high intensity exercise
  • Avoid the extreme ranges of movement of your hips, pelvis and low back
  • Avoid separating your thighs where possible, especially turning over in bed

Health Practitioners

  • Hands on treatment with practitioners such an osteopath, physiotherapist, myotherapist, chiropractor, acupuncturist can assist in improving and managing your symptoms by decreasing muscle tension and improving joint mechanics.
  • Discuss your symptoms with your GP, midwife, obstetrician.
  • Exercise program to strengthen pelvic musculature with a specialised personal trainer, physio, pilates or yoga instructor.
  • Pelvic floor and core strengthening can assist greatly especially learning to brace these muscles when you need to lift or bend. Having a strong core and pelvic floor can increase the stability of your pelvis. Speak to your health practitioner about these.
  • Some women experience feelings of depression, guilt, grief or anger associated with the condition. Speaking to a psychologist, councillor or a support group can assist.

Everyday tasks to help with SPD in pregnancy

  • Listen to your body, pain is there for a reason. If it hurts, you are best to stop and avoid that activity. Ie- shopping, vacuuming, sweeping.
  • Ask for help with everything, the less you strain your pelvis, the better you will be ie- shopping, cleaning, childcare, work, lifting.
  • Avoid heavy lifting- try to get a toddler to climb onto a stool or chair before lifting them up.
  • Reduce straining everyday activities as much as possible. Ie- buy groceries online, get your groceries delivered, get a clothes and nappy washing service, get a cleaner, get meals delivered.
  • Get a stool to sit on when doing tasks such as ironing, washing dishes and cooking.
  • Play with children when seated where possible.

Sleeping with SPD in pregnancy

  • Sleep with something in between your knees such as a body pillow or leg spacer.
  • Try sleeping with silk or satin PJ’s as you can slide rather than have to pick yourself up to turn over.
  • You may find it easier to turn over in bed by going up on all 4s.
  • A mattress topper can take some of the pressure off your pelvis when lying.
  • When turning over, keep your knees together where possible and contract your pelvic floor and core abdominal muscles to give you more support.

Movement

  • Reduce the strain on the pelvic joints when walking by taking shorter steps.
  • Don’t put asymmetrical strain through your pelvis ie: avoid stairs where possible. You may find it less painful to walk up the stairs side wards. If one side is less painful than the other, always step up with that leg first.
  • Swing both of your legs onto the ground before getting out of the car.
  • You need to rest and avoid irritating the joints however you still need to remain active to avoid losing muscular strength. This is a delicate balancing act.
  • Always keep your legs together! Abducting your thighs puts a great deal of pressure on the symphysis. Ie- keep your legs together when getting out of bed or your car and turning over in bed.

Sit

  • With your knees under the height of your hips.
  • Without crossing your legs.
  • With your knees together
  • With your weight evenly over both of your sitting bones.

Tips

  • Ice packs over the symphysis can be beneficial in reducing the pain.
  • Stretch your gluteal and adductor muscles but avoid over stretching as this will take away some of the remaining support of the pelvis.
  • Learning relaxation techniques such as meditation may assist by decreasing sensitivity to pain, decrease muscle tension and improve sleep.
  • The majority of women have no pain after 3 months post birth and have a very significant decrease in the pain in the days following the delivery.
  • Sitting on bum balls may help decrease tension and pain in your gluteal muscles. Getting your partner to gently put pressure on the gluteal muscles when you are lying on your side may also give you some relief.
  • Be careful not to slip, your pelvis is very vulnerable.

Prevention

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 functioning as best as possible 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 that having a 2 year gap between pregnancies enables the body to recover and decreases the chance of re-occurrence.

How  products assist with your Symphysis Pubis Dysfunction – SPD in pregnancy?

The sacroiliac brace 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 decrease in pain and an increase in your ability to function. It is especially good to wear the belt in your more physically demanding times such as at work, doing housework or going shopping.  As all the joints of the pelvis are so closely linked, improving the function of the sacroiliac joints also improves the function of the pubic symphysis. A pregnancy support pillow lifts the belly when sleeping to take pressure off your low back and improve your spinal and pelvic alignment. A leg spacer takes the stretch off your hip and pelvic muscles when lying on your side by slightly elevating your top leg. This can help to reduce discomfort in both the pubic symphysis and the gluteal muscles when sleeping. As exercise is so important in maintaining pelvic strength and flexibility, a pregnancy exercise DVD  is a great way to achieve your goals whilst fitting into your routine. Compression wear is a comfortable and lightweight way of increasing stability of the pelvis as well as activating the gluteal muscles.