Symphysis pubis dysfunction (SPD)
Symphysis pubis dysfunction (SPD) is a group of symptoms that cause discomfort in the pelvic region. It usually occurs during pregnancy, when your pelvic joints become stiff or move unevenly. It can occur both at the front and back of your pelvis. SPD is also sometimes referred to as pelvic girdle pain. The condition isn’t harmful to your baby, but it could be extremely painful for you. In some, the pain may be so severe that it affects mobility.
What is symphysis pubis dysfunction?
Symphysis pubis dysfunction (SPD), or pelvic girdle pain (PGP), happens when the ligaments that normally keep your pelvic bone aligned during pregnancy become too relaxed and stretchy soon before birth (as delivery nears, things are supposed to start loosening up). This, in turn, can make the pelvic joint — the symphysis pubis — unstable, causing some pretty strange sensations, including pelvic pain.
The incidence of diagnosed SPD is about 1 in 300 pregnancies, though some experts think that up to 25 percent of all pregnant women will experience SPD (though not all have it diagnosed).
The symptoms of SPD can vary for different people, both in terms of severity and presentation. The most commonly experienced symptoms are:
- pain in the front center of your pubic bone
- pain in your lower back on one or both sides
- pain in your perineum, the area between the anus and vagina
The pain sometimes travels to your thighs, and you might also hear or feel a grinding or clicking sound in your pelvis.
The pain is often more obvious when you are:
- using stairs
- putting your weight on one leg
- turning over in your bed
It might also be challenging to widen your legs. This can make daily tasks such as getting out of bed, getting dressed, or getting in and out of a car difficult.
The most common cause of SPD is pregnancy. It’s thought that SPD affects up to 1 in 5 pregnant women to some extent.
During pregnancy, hormones such as relaxing are released to loosen the ligaments and muscles in your:
- pelvic floor
This loosening is intended to increase your range of motion in order to help you give birth, but it also means that your joints can become unbalanced and more mobile than they usually would be. This can cause discomfort or pain. Although this slackening is intended to help with birth, sometimes you can start producing these hormones in early pregnancy. You may experience the symptoms of SPD long before it’s time to give birth. The baby’s weight and position are also thought to affect pelvic pain. The symptoms of SPD tend to worsen as the pregnancy progresses. It’s much less common for SPD to occur outside of pregnancy, but it does happen. Other causes of SPD range from pelvic injuries to conditions like osteoarthritis. In some cases, there’s no known cause.
Early diagnosis can be really helpful in managing SPD. If you’re pregnant and experiencing pelvic pain, talk to your doctor or healthcare provider. They’ll be able to refer you to a physiotherapist who can assess the stability and strength of your joints and pelvic muscles. They’ll also help you plan what activities you’ll be able to do.
SPD isn’t medically harmful to your baby, and most women with the condition are still able to deliver vaginally. However, chronic pain can lead to sadness or even depression, which is sometimes thought to negatively affect your baby. Although the symptoms of SPD don’t tend to disappear entirely until after you’ve given birth, there are lots of things that can be done to minimize your pain. That’s why it’s important to seek help. The Pelvic, Obstetric and Gynaecological Physiotherapy group from the U.K. suggests that you try to avoid the following activities if you’re experiencing SPD:
- putting your weight on only one leg
- twisting and bending while lifting
- carrying a child on your hip
- crossing your legs
- sitting on the floor
- sitting in a twisted position
- standing or sitting for long periods of time
- lifting heavy loads, such as wet laundry, shopping bags, or a toddler
- pushing heavy objects, such as a shopping cart
- carrying anything in only one hand
Physiotherapy is the first course of treatment for SPD. The aim of physiotherapy is to:
- minimize your pain
- improve your muscle function
- improve your pelvic joint stability and position
A physiotherapist can provide manual therapy to ensure that the joints in your pelvis, spine, and hips move normally. They’ll also be able to offer you exercises to strengthen the muscles in your pelvic floor, back, stomach, and hips. They may recommend hydrotherapy, where you do the exercises in the water. Being in the water can take the stress off your joints and allow you to move more easily. The physiotherapist will be able to give you suggestions on comfortable positions for sex, labor, and birth. In severe cases of SPD, pain medications or TENS therapy may be prescribed. You may also be provided with supportive equipment such as crutches or pelvic support belts. Application of heat or cold to the area may reduce pain or swelling.
There’s very little that you can do to prevent yourself from getting SPD in pregnancy. However, it’s more common if you’ve had a previous pelvic injury, so it’s always important to take whatever measures possible to protect this vital area of your body.
SPD doesn’t directly affect your baby, but it may lead to a more difficult pregnancy due to reduced mobility. Some women may also have difficulty having a vaginal delivery. Symptoms of SPD often reduce after giving birth. Talk to your doctor if your symptoms still don’t improve. They can check if they may be the result of another underlying condition.