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Symphysis pubis dysfunction and Pregnancy related girdle pain
What is SPD and PRGP?
Pelvic pain is experienced by 1 in 5 expectant mothers, and can range from a minor niggle to severe, debilitating pain. Pelvic pain in pregnancy is known as symphysis pubis dysfunction (SPD) or PRGP (pregnancy-related girdle pain) and it can make everyday movements such as going up and down stairs, getting up from a chair and getting out of bed extremely uncomfortable. Pain can also be experienced at night, affecting sleep and therefore causing emotional health to suffer.
Doctors and physiotherapists classify any type of pelvic pain during pregnancy as PRGP. This is a collection of uncomfortable symptoms caused by stiffness of the pelvic joints or uneven movement at the back or front of the pelvis.
SPD is one type of PRGP, which is caused by a problem with the pelvis, which is mainly formed of two pubic bones which meet at the front of the pelvis at a joint known as the “symphysis pubis.” The ligaments that make this joint strong can become weaker during pregnancy due to the release of a hormone called “relaxin”. This instability can cause inflammation and pain (ranging from a dull ache to severe pain), characterising SPD.
DSP (diastasis symphysis pubis) is a second type of PRGP which is related to SPD. This occurs when the gap in the symphysis pubis joint widens too far. It is a rare condition which can only be diagnoses with an X-ray, ultrasound or MRI scan.
Where will I feel pain?
The pain caused by SPD or PRGP can be experienced in the hips, aove the pubic bone, between the vagina and perineum and down to the thighs. Some women may also hear or feel clicks or grinding in their pelvis as well as general discomfort. This pain can be experienced at any point throughout pregnancy or after giving birth. Pain can range from being a dull ache to a sharp stabbing, shooting pain.
The symptoms:
· Pain in the pubic area and groin
· Pain over the pubic bone at the front in the centre (in level with the hips)
· Back pain, pain and the back of the pelvis, or hip pain
· Pain plus a grinding/clicking sensation at the pubic area
· Pain down the inside of the thighs or between the legs
· Pain which is exacerbated by parting your legs, walking, going up/down stairs or moving in bed
· Pain which is worse at night and stops peaceful sleep.
· Pain which is worse when standing on one leg
· Waddling walking gait
Occasionally, the pelvic joint may separate causing more intense pain. This is called symphyseal separation or diastasis of the symphysis pubis and can be acutely painful. Bed rest and heat are usually prescribed to manage this, with orthopaedic and physiotherapy assessments required. In these cases, some women are advised to limit their weight-bearing activity and to use crutches to alleviate further pain.
When does it occur?
SPD occurs during pregnancy when your pelvic ligaments soften and become too relaxed and stretchy, meaning they struggle to keep the pelvis aligned correctly.
It’s not known exactly why some women are more affected than others but there have been links suggested to issues such as:
· previous pelvic damage,
· uneven movement at the pelvis
· weight or position of the baby
· changes to the way the muscles work to support the pelvic joints
· one joint not working properly (causing a knock-on effect to other joints)
You are more likely to develop SPD during your pregnancy if you:
· Had pelvic girdle or pelvic joint pain prior to pregnancy
· Have had previous pelvic injuries
· Had pelvic girdle pain in a previous pregnancy
· Have a high BMI/ you were overweight before you became pregnant
· Are hypermobile in all your joints
· Gain excessive weight during pregnancy
· Have a multiple pregnancy or very large baby (gestational diabetes can add to gestational weight gain and increase birth weight)
· Do repeated jarring type exercise, strenuous activity, or have poor posture.
Diagnosing SPD
If you are concerned that you are developing or suffering with SPD, your doctor or midwife should refer you to a physiotherapist who will test the stability, movement and pain in your pelvic joints and muscles. Diagnosis can also be aided using ultrasound (x-rays are ill-advised during pregnancy unless absolutely necessary). Early diagnosis is the key to keeping pain at a minimum and avoiding long-term discomfort.
Treating SPD
SPD is managed similarly to other pelvic girdle pain, with exercises to strengthen spinal, abdominal, pelvic floor, pelvic girdle and hip muscles. This will increase the stability of the pelvis and back. A pelvic support belt may give relief, particularly during exercise or activity. Gentle hands on treatment to the hip, back or pelvis can also help to correct stiffness or imbalance, with massage (available here at Santi!) and hydrotherapy known to help. Osteopathy and other manual therapies may also be beneficial.
A physiotherapist can advise on the best course of action to help make everyday activities more achievable and less painful, and also how to make the birth of your baby easier, while your midwife can help you create a birth plan that takes your SPD symptoms into account.
Acupuncture may help to reduce the pain, and this is safe during pregnancy. Please make sure your practitioner is trained and experienced in treating pregnant women.
What can I do to ease the pain?
There are some measures that you can take to ease the pain of SPD and PRGP yourself. Even just small things such as keeping your knees together when you get up and sit down or sleeping with a pillow between your knees may help as they keep the pelvic in a neutral position, placing less pressure on the joints. Avoid positions which put you in an uneven position e.g. sitting cross legged and take stairs one step at a time.
Keeping active will also help, but only to a point; don’t push yourself too hard otherwise it will end up having a negative result and you may be in more pain. Pelvic floor and core stability work will help to stabilise the pelvis.
Take care to keep your legs no further apart than your pain-free range, especially when doing things like getting in and out of the car, bed or bath. Pulling your knees up as far as you can may help parting your legs easier, and if you are sitting, try and arch your back and stick your chest out before parting or moving your legs.
If you are going out and about and need to carry things, try and wear a backpack rather than carrying a large bag on one side as this sets your off balance and will put extra pressure on your pelvic joints. Try to avoid heavy lifting as far as possible and wear flat, supportive shoes.
Can SPD/PRGP harm my baby?
These conditions are NOT harmful at all to your baby, but it can make it uncomfortable for you to try and move around.
Will it affect my birth plan?
Many women with pelvic pain during pregnancy can have a normal vaginal birth but it is worth planning ahead and talking to your midwife about your options. For example, a water birth may be more comfortable as you can change positions more easily and there is less pressure on your joints. Occasionally if SPD is too severe, vaginal delivery may not be possible and a caesarean section will be encouraged.
Will I always have problems?
Generally, there is an improvement in symptoms and joint stability post-partum. Once the pregnancy hormone “relaxin” is no longer produced, joints will become more stable and you should begin to feel more comfortable. If you have had SPD in one pregnancy you are likely to suffer from it in the next pregnancy. Let your midwife known early on so that you can be referred to a physiotherapist. If the condition is managed from early on in your pregnancy, then it is possible that it may be less painful.
If you are concerned that you are suffering from SPD or PRGP, please see your GP or talk to your midwife.