Symphysis Pubis Dysfunction

Sounds scary, huh?! Well for those of you that are loyal readers you might remember me commenting on how I had kind of, sort of slipped in the bathroom about a week and a half ago and thought I had pulled my groin? Then at my doctor appointment last week, Dr. said she thought I had separated the cartilage in my pelvis or pubic bone - which I guess is fairly common in pregnant women. I didn't think much about it at the time because she said there wasn't really anything I could do about it, at least until after Jack is born, but then I thought, "Man, this really kind of sucks - I hurt all the time and going on walks - out of the question!" So I did a little more research and here are some interesting facts so that everyone else can relate and possibly even feel my pain!

This all came off a reliable, 100% accurate, Non-Dr. affiliated website - so take from it what you will!

Introduction/Background:
Your pelvis is a kind of a circular bone that goes all around and almost meets in the middle in front. The two sides do not quite touch; there is a small gap between them connected by fibrocartilaginous tissue reinforced by several ligaments. This area is called the Pubic Symphysis. This is important for helping your pubic bone to move freely, stabilizing the pelvis while allowing a good range of motion.

The Pubic Symphysis and the Sacro-Iliac joints (in the back of the pelvis) are especially important during pregnancy, as their flexibility allows the bones to move freely and to expand to help a baby fit through more easily during birth. In fact, the pregnancy hormones relaxin and progesterone help the ligaments of your body to loosen and be even MORE flexible than before, so that there is plenty of 'give' and lots of room for the baby to slip right through.

Because of these hormones, it is normal for there to be some extra looseness and pelvic pressure in pregnancy. This is good---it means your body is getting ready for birth! It's loosening up to give you maximum space and flexibility, and to help make things easy for you and your baby.

However, in some women, either because of excessive levels of hormones, extra sensitivity to hormones, or a pelvis that is out of alignment, this area is extra lax or there is extra pressure on the joint.

Symptoms:
The symptoms of SPD vary from person to person, but almost all women who have it experience substantial pubic pain. Tenderness and pain down low in the front is common, but often this pain feels as if it's inside. The pubic area is generally very tender to the touch; many moms find it painful when the doctor or midwife pushes down on the pubic bone while measuring the uterus (fundal height).

Any activity that involves lifting one leg at a time or parting the legs tends to be particularly painful. Lifting the leg to put on clothes, getting out of a car, bending over, sitting down or getting up, walking up stairs, standing on one leg, lifting heavy objects, and walking in general tend to be difficult at times. Many women report that moving or turning over in bed is especially excruciating.

Many movements become difficult when the pubic symphysis area is affected. Although the greatest pain is associated with movements of lifting one leg or parting the legs, some women experience a 'freezing', where they get up out of bed and find it hard to get their bodies moving right away--the hip bone seems stuck in place and won't move at first. Or they describe having to wait for it to 'pop into place' before being able to walk. The range of hip movement is usually affected, and abduction of the hips especially painful.

Many women also report sciatica (pain that shoots down the buttocks and leg) when pubic pain is present. SPD can also also be associated with bladder dysfunction, especially when going from lying down (or squatting) to a standing position. Some women also feel a 'clicking' when they walk or shift just 'so', or lots of pressure down low near the pubic area.

To summarize, SPD is the mild form of this problem. Its symptoms often include one or more of the following:

• pubic pain
• pubic tenderness to the touch; having the fundal height measured may be uncomfortable
• lower back pain, especially in the sacro-iliac area
• difficulty/pain rolling over in bed
• difficulty/pain with stairs, getting in and out of cars, sitting down or getting up, putting on clothes, bending, lifting, standing on one foot, lifting heavy objects, etc.
• sciatica (pain in buttocks and down the leg)
• "clicking" in the pelvis when walking
• waddling gait
• difficulty getting started walking, especially after sleep
• feeling like hip is out of place or has to pop into place before walking
• bladder dysfunction (temporary incontinence at change in position)
• knee pain or pain in other areas can sometimes also be a side-effect of pelvis problems
  

Tips for Coping with Pubic Symphysis Pain:
Although the best idea may be to resolve chronic SPD pain through realigning the pelvis girdle and soft tissues, most women have at least some residual pubic and low back pain stick around for pregnancy and the early postpartum weeks because of hormones. Therefore, tips for coping with pubic pain tend to be a focus of many SPD websites. Many of the suggestions include:

• Use a pillow between your legs when sleeping
• Use a pillow under your 'bump' (pregnancy tummy) when sleeping
• Keep your legs and hips as parallel/symmetrical as possible when moving or turning in bed
• Some women also find it helpful to have their partners stabilize their hips and hold them 'together' when rolling over in bed or otherwise adjusting position
• Some women report a waterbed mattress to be helpful
• Silk/satin sheets and nighties may make it easier to turn over in bed
• Swimming may help relieve pressure on the joint
• Deep water aerobics or deep water running may be helpful as well (there are flotation devices to help you stay afloat easily during this; you do not need to know how to swim in order to do this)
• Keep your legs close together and move symmetrically (other sources recommend a very small gap between the legs with symmetrical movement)
• When standing, stand symmetrically, with your weight evenly distributed through both legs
• Sit down to get dressed, especially when putting on underwear or pants
• Avoid 'straddle' movements
• Swing your legs together as a unit when getting in and out of cars; use plastics or something smooth and slippery (like a garbage bag) on the car seat to help you enter car backwards and then turn your legs as a unit
• An ice pack may feel soothing and help reduce inflammation in the pubic area; painkillers may also help
• Move slowly and without sudden movements
• If sex is uncomfortable for you, use lots of pillows under your knees, or try other positions
• If bending over to pick up objects is difficult, there are devices available that can help with this
• Really severe cases may need crutches, although these should probably only be used as a last resort
• Sciatica may be helped by stretching the hamstring muscles with a stirrup around your foot (long piece of rope, two neck ties tied together, etc.)
• Back pain can often be helped by resting backwards over a large gymnastic or 'birth' ball
• Some women report that pelvic binders/maternity support belts are helpful for pelvic pain. However, if the pelvic bones are really misaligned, some women report more pain with these.

Based off these recommendation I'm going to purchasing a waterbed ASAP, wearing a girdle, sliding around town on trash bags in my silk pajamas with an ice pack strapped to my groin - all at the same time that Chris keeps my hips aligned constantly? This is going to take some work!

In all reality I think I have a mild case - Alot of the symptoms apply to me and believe me it really does hurt, but not enough to try any of these "Tips for Relief" other then the pillows (which I already did) and the sitting down while dressing - that really hurts! Haha!

xoxo