Symphysis Pubis Dysfunction (SPD) in Pregnancy and How to Cope
|Expert Reviewed||Lyndsay Hirst, Chartered Physiotherapist|
As time, medicine, and technology have advanced, so has the social perception of pregnancy. Pregnant women are no longer considered sick, frail, or hysterical.
Most pregnant women enjoy healthy, active lifestyles right up until delivery. They are encouraged to continue their careers and participate in exercise programs.
Unfortunately, not all women experience this ideal pregnancy. Thousands of women suffer discomforts and conditions that affect their daily lifestyle.
What Is Symphysis Pubis Dysfunction?
Symphysis pubis dysfunction (SPD) is a problem that occurs during pregnancy, when swelling and pain make the symphysis pubis joint less stable. Doctors and physiotherapists classify this type of pain, and any type of pelvic pain during pregnancy, as pelvic girdle pain (PGP). SPD is one type of pelvic girdle pain that is experienced during pregnancy.
These problems are not as well understood as they should be. One of the least researched and understood pregnancy complications is SPD. This crippling condition has only recently become recognized by American physicians. Its cause is attributed to the softening and loosening of the cartilage and ligaments that normally support the pelvic girdle. The result is moderate to severe pain that can severely hinder a pregnant woman's movements.
Unfortunately, many women go undiagnosed or misdiagnosed for this condition. Even more unforgivable, these women often have their concerns brushed aside by clueless doctors who may think their patient is merely overreacting to the normal aches and pains of pregnancy.
What Are Some Coping Techniques for Pelvic Dysfunction Pain?
Even though there are not many treatment options for a sufferer of SPD, there are some daily coping techniques that can ease the discomfort. These may include:
- Using Kegel exercises to tone the pelvic muscles
- Practicing good posture to distribute weight properly on the pelvis
- Use of a maternity belt or band
- Avoiding heaving lifting
- Avoiding straddling motions
- Avoiding any scissor-like motions of the legs
- Using a step or support to get in and out of the tub
- Climbing stairs by placing both feet on one step before proceeding to the next step
- Warm showers or baths
- Sitting on a yoga or birthing ball rather than a chair
- Gentle exercises or pilates
- Not crossing the legs when sitting
- Sleeping on the side with a pillow between the knees. Applying heat to localized pain
- Avoiding bending or twisting from the waist
- Avoiding pushing or pulling anything heavy (such as the vacuum)
- Wearing supportive athletic shoes (avoid shoes such as heels or flip-flops that can cause stumbling)
- Dressing in a seated position to avoid standing on one leg
- Being careful using your legs or feet to push or move objects
- Finding a support group or forum
- Asking a partner, family, or friends to help with heavy tasks, or tasks requiring painful movements
- Trying to avoid standing for long periods of times
Maternity belts help by lifting some of the weight from your pelvis. It helps to wear one for 6-12 weeks postpartum while your body is returning to normal and needs some extra stabilization.
Useful Products for Managing SPD
How It's Useful
GABRIALLA Elastic Maternity Belt
Recommended by doctors as an excellent abdominal support to reduce lower back pain by providing compression and support to weakened hip area. Ease your aching joints.
Atlas A-Band Combo
Supports pregnant belly, which reduces physical trauma of the third trimester. It also lessens back pain, fatigue, swelling, and stretch marks.
V2 Supporter by Prenatal Cradle
Recommended by doctors and nurses for compression therapy for vulvar varicosities and to reduce swelling related to pubic and perineal edema.
Motherhood Maternity Support Belt
Relieves pain in the back, legs, and abdomen. Provides gentle, firm support.
Can You Manage SPD During Labor and Delivery?
What should you expect from SPD when it is time to deliver your baby? Again, this varies from woman to woman.
The mother may wish to opt for an elective c-section, or an early induction to gain relief. Unless she chooses otherwise, or there is a valid medical concern, natural birth is highly possible.
Things to Take Into Consideration for a Vaginal Birth
- The caregivers and birth team should be aware of the mother's condition. Positions that force unnatural abduction of the hips should be avoided as they can place stress on the joints. Therefore the use of stirrups and un-natural birthing positions are highly contraindicated.
- The use of epidurals is debated in cases of SPD. One of the concerns is that the lack of pain response can lead to further damage of the pelvis or even a rupture of the pubic junction if there is mismanagement of the pushing phase.
If the birth team is aware of the SPD and takes care to support rather than aggravate the joints, there should be no reason for a mother not to receive anesthesia. On the other hand, a diagnosis of SPD should not discourage a woman from an un-medicated delivery if that is her desire.
For some women, myself included, the extreme relaxation of the pelvic outlet can be beneficial during birth, leading to a quick delivery. Sometimes assisted delivery (such as forceps) can cause pelvic trauma if the legs aren't positioned carefully beforehand. Be sure to vocalize any discomforts or concerns before and during labor.
Birthing positions are the main problem with SPD during labor. Staying in a position with both legs abducted can cause further problems with the symphysis pubis. I recommend women consider alternative birthing positions such as kneeling to avoid undue strain on the pubic bone.— Lyndsay Hirst, Chartered Physiotherapist
What Causes Pelvic Dysfunction?
Before I became pregnant, I had read very little information about SPD. From the brief mention it earned in pregnancy books, I was led to believe that SPD was a ''discomfort'' that pregnant women rarely suffered. Before my pregnancy was over, it would become my biggest nightmare.
In a nutshell, SPD is thought to be caused when your body produces the hormone relaxin, which is supposed to loosen the pelvis in preparation for baby's passage. It is theorized that too much relaxin can cause the ligaments to loosen too fast, which creates an instability. This means that pelvic bones can shift independently of each other with every movement.
It can also lead to diastasis symphysis pubis (DSP), which is a wide gap where the pubic bones meet. This is rare, but not an indication of pain level. Even a woman without a noticeably larger gap can feel excruciating pain and tenderness. Sometimes the pubic bone can be tender to the touch, other times it is only painful with certain movements.
As I said above, SPD is also referred to as Pelvic Girdle Pain in some texts. However, they are not always one and the same. Pelvic Girdle Pain is a term applied to pain occurring at the back of the pelvis, localized around the sacroiliac joint.
Even though the two terms are used interchangeably, I am going to use the term SPD for this article, because I am focusing more on the frontal discomfort associated with the pubic joint.
There are times when a woman can experience both issues at the same time. For instance, I experienced the PGP symptoms often, but infrequently during pregnancy. However, I endured SPD from my twentieth week of pregnancy until my daughter was a year old.
SPD can make you feel as though you are being pulled apart like a wishbone. Even without pain, the joints may become totally unable to function or support your weight.
Explanation of Symphysis Pubis Dysfunction
What Are the Symptoms of Symphysis Pubis Dysfunction?
The most common symptoms of SPD include:
- Pain or tenderness in the groin
- Painful sensation near pubic bone
- Clicking or popping sensation with movement
- Unusual manner of walking (shuffling or waddling to prevent hip pain)
- Ripping and/or grinding sensation when moving in any manner that separates your legs (walking, climbing stairs, stepping out of a car)
- Pain running down the insides of the thighs
- Sensation that your hip is out of place
Are There More Symptoms Associated With This Dysfunction?
Along with symptoms associated with SPD, a woman may also experience these symptoms:
- One-sided pain centered in the buttock or lower back area
- Shooting pains that travel down the legs or through the pelvis and abdomen
- Hip pain
- Weakness in the legs
- Grinding or popping of joints
What Is the Frequency and the Effects of SPD Symptoms?
For both conditions, the pain is usually worse at night and first thing in the morning. Pain at night is usually more intense after an active day.
Increased pain in the morning may be from unintentionally jerking the legs during sleep, or from holding too still to avoid moving the joints. Soreness in the morning could also be a result of the previous day's activities.
It doesn't sound too bad, does it? The personal descriptions of the symptoms gleaned from conversations with women who have had SPD or PGP are much more accurate.
One of the most common descriptions used by women to explain SPD is: "Feeling like a wishbone."
What does that mean? It means that anytime you roll over in bed, try to stand, walk up stairs, bend to lift something, try to toe off your shoes, or get out of a car you feel like you are being pulled apart like a wishbone.
For myself, this description was entirely accurate. The ripping pain was accompanied by a sharp stabbing pain down the inner legs.
For some women, this is a mild discomfort, and for others, it becomes impossible to lift one leg independently of the other (even if it's just a few inches). By the time I was 29 weeks along, I could no longer move my foot from the gas to the brake pedal without lifting my leg with my hand.
The joints simply wouldn't work anymore. It wasn't just an issue of pain, the ligaments were so lax that they could no longer function properly.
Like most other symptoms and discomforts in pregnancy, SPD symptoms vary from woman to woman. Some women find relief in exercise, while others find that movement exacerbates the condition, or is impossible due to the hips being too "floppy." Some women are able to continue their daily activities, others are limited, and still others will have to use crutches or wheelchairs by the end of their pregnancy.
Even a woman with moderate SPD may find it difficult to walk normally. The loosened pelvic bones will create a waddling gait, and the instinctive tendency to keep the knees as close together as possible can lead to imbalance and the appearance of clumsiness. This grows more noticeable as the weight of the baby increases.
When and Where Will You Notice Symptoms?
- Going up or down stairs
- Trying to rise from a chair or the floor
- Rolling over in bed
- Getting out of bed
- Getting into or out of a vehicle
- Trying to push an object with your foot
- Lifting one leg to step into pants
- Bending over from the waist
- Sitting for too long
- Standing for too long
- When lifting something heavy
- Walking quickly, or if your steps are too far apart
- Pushing or pulling something heavy
- When attempting intimacy
How Do They Diagnose and Treat SPD?
Most SPD is diagnosed simply based on patient symptoms. X-rays and MRI scans have been used to try to determine the amount of separation, but can be inaccurate, as sometimes there is no visible cause for the pain. Tests that are harmful to the baby have to be performed after delivery and, by this time, the pelvis may look normal on scans. There may be examinations to rule out other causes such as sciatica and premature labor as well.
Treatments for the pain are limited. Your care provider may suggest you wear a maternity belt to help lift the weight from the pelvis. They may also suggest physical therapy, exercise programs, OTC painkillers such as Tylenol, hydrotherapy, massage, chiropractic treatment, yoga, and water aerobics. These options may or may not fully alleviate the symptoms, but they can offer some welcome relief for many women.
SPD is a sneaky condition. It may not show up on any diagnostic exams, meaning that treatment will be solely based on your symptoms.
How Good Is Your Care-Provider?
Does your doctor/midwife listen to your concerns and try to help?
What Emotional Impact Does Symphysis Pubis Dysfunction Have?
In a society where we are all expected to be super-moms breezing through pregnancy while balancing a job, family, household and social life; the crippling effects of SPD can cause emotional chaos.
Hormonal changes are already creating an overwhelming and unpredictable range of feelings in the pregnant woman. Add to that turmoil the realization that she is slowly losing parts of her independence, and she can quickly become overwhelmed.
She may need help now with her household chores. She may no longer be able to exercise, which can lead to self-consciousness about her pregnancy body. She may not be able to care for or play with other children she may have, and she may have to take time off from work, which can put a financial strain on the family.
If she can no longer drive, she may feel trapped and isolated, which can lead to resentment for the pregnancy. Severe SPD has been linked to depression both during and after pregnancy.
During this time, the woman needs the support of family and friends, as well as an understanding caregiver. She may be frightened too. Not being able to move your legs to climb a step or get out of the shower can leave you feeling paralyzed and vulnerable. Adequate support during this trying time is crucial to her health and well-being.
SPD does not mean an automatic c-section. Women with SPD still stand a normal chance of delivering vaginally, with or without anesthesia.
Frequently Asked Questions About Symphysis Pubis Disorder
Remember, it's important to ask questions. You're not whining or complaining, you're seeking the help that you deserve. No one should have to suffer from such pain when you're already doing so much work. Below are some answers to the most frequently asked questions about SPD.
Will SPD Make Labor and Delivery More Painful or Difficult?
During labour, being active and choosing the positions that feels best for you are wonderful ways to relieve pain and achieve a natural birth. Not surprisingly, women with symphysis pubic dysfunction are often concerned that SPD pain will affect their ability to labour naturally, and might even cause lasting damage to the symphysis pubic. Listening to your body during labour, and finding a position that feels right to you, can prevent SPD from having too much impact on your labour and causing any long-term damage.
The amount of pain caused by SPD during labour is dependent on the individual and the scale to which that person is suffering from SPD. Many women say that they did not experience extra pain due to SPD during labor, while other women have chosen to have cesarean sections in order to avoid having long-term damage. If you are diagnosed with SPD, it's best to consult doctors and midwives with questions about the potential damage it could cause. Your midwife should be able to refer you to a physiotherapist who has experience treating pelvic joint pain. In fact, many women are able to get improvement or relief with chiropractic treatment or osteopathic manipulation. It is not something that you “just have to live with.”
What Position Can I Give Birth in to Reduce the Pain?
The front part of your pelvis is called your pubic symphysis. During Labor, the pubic symphysis naturally. You probably won’t have any problems as a result of this, but if you have SPD, you can try these positions to stay comfortable during labor:
- Kneel or stand, with support, to prevent strain on your pelvis.
- Lean on your partner, over a pile of pillows, a tilted bed end or a birthing ball.
- Position yourself on all fours, so the weight is on your hands and knees. This may also help your labour to progress.
- If you are tired, lie on your side, with your midwife or partner supporting your upper leg.
Did I Do Something to Cause SPD?
These pelvic problems mean that your pelvis is not as stable as it should be. However, that doesn't mean that you are to blame. In fact, there many reasons women develop SPD, including:
- having had pelvic girdle pain or pelvic joint pain before you became pregnant
- having had a previous injury to your pelvis
- having had pelvic girdle pain in a previous pregnancy
- having had a high BMI and were overweight before you became pregnant
- having hypermobility in all your joints
Most women do not have SPD as a result of any conscious decision. Unfortunately, most women who suffer from it do not have any obvious reason to suspect they'd have it prior to experiencing it.
Will Pelvic Pain Go Away After the Baby Is Born?
Recovery time varies from person to person. It can go away almost immediately, it can take a few days, a few weeks, or up to 2-3 months. If it's really bad, you should be seeing your physiotherapist after birth.
Can I Take Anything to Help With This Pelvic Pain?
Regular analgesia in the form of paracetamol and codeine-based preparations may be prescribed during pregnancy, with close monitoring of effectiveness and side effects. Non-steroidal anti-inflammatory drugs (NSAIDS) should only be used after delivery.
A specialist obstetric physiotherapy review should be arranged. The physiotherapist can advise on back care and strategies to avoid activities that put undue strain on the pelvis. Transcutaneous electrical nerve stimulation, ice, external heat or massage may also be of value.
Remember, You Are Not Weak
Since little is known about SPD and its causes, it is important that women speak up about any pain or discomfort they may experience during pregnancy. Everyone has different thresholds for pain tolerance, but if your daily lifestyle is severely disrupted your complaints should not be ignored. The more women who speak up, the more likely SPD is to be seriously and thoroughly researched.
Never allow your caregiver, your family, your partner, or your employer to brush off your concerns lightly. You are not "weak."
Don't be afraid to be aggressive in demanding better care. If don't feel you are getting the medical attention you need, seek out a more sympathetic care provider who is willing to work with your individual needs to create a more comfortable pregnancy and birth.
Being confrontational from the beginning may prevent needless suffering and irreparable damage in the long run. Every woman deserves a joyful birth experience.
Good News and Bad News About Pelvic Pain
The good news about SPD is that it usually goes away or lessens dramatically in the hours following the birth of the baby. It will still take weeks for the pelvic bones and ligaments to return to their pre-pregnancy condition, but this is the case even without SPD.
For some women, the first few weeks postpartum may feel as uncomfortable as during pregnancy. The pain may begin to lessen gradually.
The bad news is that sometimes it may take up to a year or more for the discomfort caused from SPD to disappear. Some women have reported that it lasted longer if they breastfed.
Other women who did not experience symptoms of SPD/PGP may develop it after delivery. The reason for this is unclear, but thought to be a result of trauma due to pressure exerted on the joints by the baby during labor.
The worst news for SPD sufferers is that the chance of developing it again with subsequent pregnancies is increased. The pain can also be experienced sooner and more severely with each pregnancy, sometimes to the point of being crippling. Needless to say, this can be disheartening for many women wishing to expand their families.
The information in this article is based on personal experience, advice from personal caregivers, internet research, and information from other sufferers of SPD. It is not meant as a substitution for appropriate medical advice.
Please talk to your doctor or care provider about any symptoms. It is not advised to perform any exercises or take any medications without the guidance of a doctor, midwife or physical therapist specializing in prenatal care.
This hub is meant to help raise awareness about SPD and PGP during and after pregnancy. I would love to hear from you about any additional information you would like to share as well as your personal experiences.
- The article has been modified since this review was written.