Symphysis pubis dysfunction

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Location of symphysis pubis.

Symphysis Pubis Dysfunction (SPD) is most commonly associated with pregnancy and childbirth. It is a condition that causes excessive movement of the symphysis pubis, either anterior or lateral, as well as associated pain.

1 Introduction
2 Pregnancy
3 Symptoms
4 Postpartum
5 Pelvic girdle pain
6 References

[edit] Introduction

The symphysis pubis is the joint where two of the four pelvic bones, the sacrum and coccyx at the back, and the two hip bones at the sides meet at the front of the pelvis. These pelvic joints are held together by very strong ligaments that are designed to prevent movement. The fibrocartilage holding the symphysis pubis together lengthens during pregnancy to prepare for the forces of childbirth. If the joint does not function sufficiently this could result in pain and or instability; this is symphysis pubis dysfunction. SPD affects approximately one in 35 women. ^[1]

[edit] Pregnancy

During pregnancy various hormones fluctuate altering levels of hormones such as relaxin and estrogen. The influence of these hormones help remodell collagen that assists in the changes in soft tissue, cartilage and ligaments. This gradually loosens all the pelvic ligaments to allow slight movement at the time of birth. Occasionally, the ligaments loosen too much and too early before birth, thereby causing pain to occur. This loosening can be due to injury, strain or hypermobility. The non-pregnant gap is 4-5mm but in pregnancy there will be an increase of at least 2-3mm, therefore, it is considered that a total width of up to 9mm between the two bones is normal for a pregnant woman. An abnormal gap is considered to be 1cm or more, sometimes with the two pubic bones being slightly out of alignment.

[edit] Symptoms

SPD can be either mild, moderate or severe.

Mild - There is some degree of discomfort but with rest the symptoms settle somewhat.

Moderate - The woman will notice pain and maybe movement of the symphysis pubis. The symptoms may worsen during the day and cause disruption during sleep.

Severe - The pain and maybe movement of the symphysis pubis is of such a high degree that the woman is unable to perform most daily activities and could be limited to a wheelchair.

Symptoms of Pelvic Girdle Pain

Symphysis Pubis pain, extremely tender to the touch.
Present swelling and/or inflammation over joint.
Difficulty lifting leg.
Pain pulling legs apart.
Unable to stand on one leg.
Unable to transfer weight through pelvis and legs.
Pain in hips and/or restriction of hip movement.
Transferred nerve pain down leg.
A feeling of symphysis pubis giving way.
Stand with a stooped over back.
Struggle to sit or stand.
Pain may also radiate down the inner thighs.
You may waddle or shuffle.
Aware of an audible ‘clicking’ sound coming form the pelvis.

These symptoms can begin as early as the first trimester of the pregnancy with symptoms increase towards the 3 trimester.

[edit] Postpartum

Within days after delivery hormones levels change again and for many women this results in an improvement of symptoms. For other women it can take several weeks or months for symptoms to resolve. In rare cases, approximately 1%, it can become permanent.