Symphysis Pubis Dysfunction (SPD) in Pregnancy

Symphysis Pubis Dysfunction (SPD) in Pregnancy | Orthopaedics

What is symphysis pubis dysfunction (SPD) in pregnancy?

Symphysis pubis dysfunction (SPD) is a group of symptoms that cause uneasiness in the pelvic region. It usually occurs during pregnancy, when the pelvic joints developed stiff or move unevenly. It can occur in both the front and back of the pelvis. Symphysis pubis dysfunction (SPD) is also sometimes known as pelvic girdle pain.

The symphysis pubis dysfunction condition is not harmful to your baby, but it can be extremely painful for you. In some, the pain can be so severe that it affects mobility.

What are the signs and symptoms of SPD?

The most common symptoms of this symphysis pubis dysfunction are difficulty walking and tearing pain (as if the pelvis is tearing). The pain is usually concentrated in the pubic area, but in some women, it radiates to the upper thighs and perineum.

Pain can be worse when you walk and perform weight-bearing activities, particularly those that involve lifting one leg such as climbing stairs, getting dressed, getting in and out of a car, or even rolling over in bed.

What causes symphysis pubis dysfunction?

“We have connective tissue that attaches the two sides of the pubic bone. The connective tissue is called the symphysis pubis,” says Heba Shaheed, a physical therapist specifying in women’s and pelvic fitness who founded The Pelvic Expert in Sydney, Australia. In other words, the symphysis pubis is a cartilaginous joint located between the right and left sides of the pubic bone.

The hormone relaxin increases during pregnancy to increase your body’s range of motion during delivery. This hormonal change causes the ligaments around the pubic symphysis to become elastic, soft and relaxed. In turn, the symphysis pubis can become unstable and cause pain in some women. “People often feel that two sides of the pubic bone are sliding up and down against each other,” Shaheed explains. “It can be incapacitating if you don’t address the problem right away.”

She is aware that in its most severe form, SPD can cause a real separation of the pubic bone. Pelvic and hip pain can be tremendously painful in this situation. But the doctor says that parting of the pubic bone is rare, happening in less than 1 per cent of pregnancies.

Side effects and complications of symphysis pubis dysfunction

Pelvic pain and instability can affect other parts of the body as well. For example, pelvic pain can change the way a person walks and moves, which, in turn, could put stress on different parts of the body, such as the hips or back.

Research indicates that pelvic girdle pain is simple in about 20% of cases. Severe pain can delay mobility and normal daily activities. Walking can be painful and unsteady.

Emotional problems can also develop as a result of pain related to SPD. In one study, women reported feeling irritable, guilty, upset, and unfulfilled due to SPD. When pain touches mobility, it can also lead to social isolation and there is a risk of pain medicine abuse.

Treatment and remedies for symphysis pubis dysfunction

Both medical treatment and home remedies can help treat symphysis pubis dysfunction (SPD). The harshness of the pain will determine the treatment options. During pregnancy, not all treatments are suitable. For example, medication may not be advisable.

Treatment may include the following:

  • Soft tissue therapy: Soft tissue therapy generally includes chiropractic care, which may involve spinal manipulation and massage to improve the stability and position of the pelvic joint.
  • Wearing a pregnancy support belt: A pregnancy belt supports the pelvic bones and helps maintain proper alignment. The belt can relieve pain in the short term. A study involving 46 pregnant women with pelvic girdle pain found that wearing a pregnancy support belt successfully reduced pain, but only when the women used it regularly for short periods.
  • Extension: Since SPD affects everyone differently, stretches that work for one person may not work for another. It’s best to check with a doctor which stretches are safe, especially during pregnancy.

An example of a stretch that can relieve pain is the pelvic tilt. People can achieve this exercise by following these steps:

  • Lie on your backbone with your knees bent and your feet flat on the floor.
  • Pull your stomach muscles inward and squeeze your gluteal muscles to flatten your back and tilt your pelvis.
  • Hold the place for 5 to 10 seconds and then relax.
  • If this movement alleviates the discomfort, a person can do 10 to 20 repetitions.

Remedies of symphysis pubis dysfunction

These home remedies can also reduce SPD-related discomfort:

  • Insertion a pillow between your legs when sleeping
  • Avoiding sitting for a long time
  • Smear an ice pack to the pelvic area
  • Staying active but avoiding any activity that causes you pain
  • Incorporating breaks every day
  • Wearing supportive shoes
  • Keep your knees organized when getting in and out of the car
  • Perform Kegel exercises to reinforce your pelvic floor muscles.
  • Analgesic

Over-the-counter and prescription pain relievers can also help relieve the symptoms of SPD. However, not all pain relievers are safe during pregnancy. A healthcare professional can offer advice on the appropriate options.

Diagnosis of symphysis pubis dysfunction

Potential symptoms from the differential diagnosis of SPD should be firmly excepted thorough medical history, physical inspection, and appropriate investigations, to ensure the diagnosis of pubic symphysis dysfunction.

Symptoms that can lead to the diagnosis of SPD are nerve compression (injury to the intervertebral disc), symptomatic low back pain (lumbago and sciatica), pubic osteolysis, osteitis pubis, bone infection (osteomyelitis, tuberculosis, syphilis), urinary tract infection., rotund ligament pain, femoral vein thrombosis, and obstetric complications.

Diagnostic procedures of symphysis pubis dysfunction

As with all dysfunctions, an early diagnosis is important to minimize the possibility of a long-term problem. However, not all doctors recognize this problem.

Leadbetter et al. described, in accordance with their findings, a scoring system for diagnosing symphysis pubis dysfunction based on pain during four activities and a previous injury, which could be important in determining symphysis pubis dysfunction.

  1. Pain in the pubic bone when walking
  2. Standing on one leg
  3. Climb stairs
  4. Roll over in bed
  5. Previous damage to the lumbosacral spine or pelvis

Often the diagnosis is made symptomatically, eg. Eg after pregnancy, but imaging is the only way to confirm diastasis of the symphysis pubis. Radiography, such as an MRI (magnetic resonance imaging), X-ray, computed tomography (CT) scan, or ultrasound [1, level 1A], has been used to confirm separation of the symphysis pubis. Although it is not considered as the method of choice due to the danger of exposing the fetus to ionizing radiation. A better technique with superior spatial resolution and avoiding ionizing radiation is magnetic resonance imaging.

Other techniques that can aid in the diagnosis and follow-up of the treatment of pelvic symphysis dysfunction are transvaginal or transperineal ultrasound, which uses high-resolution transducers.  Ultrasound is a useful diagnostic aid that can measure interpubic distance. This may be a consequence of the diastasis of the pubic symphysis after delivery. Interpubic distance is usually measured with electronic callipers. It is also important to know that ultrasound provides a simple means of measuring the interpubic gap, without exposure to ionizing radiation.

Prevention of SPD

It is very little you can do to avoid getting SPD during pregnancy. However, it is more common if you have had a preceding pelvic injury, so it is always important to take all possible steps to protect this vital part of your body.

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