During pregnancy, many musculoskeletal changes happen in a woman’s body. For example, widening of the pubic symphysis and sacroiliac joints occurs before childbirth. However, the process can cause pubic symphysis pain for some women and impair their activities of daily living.
How Does the Pubic Symphysis Change During Pregnancy?
The pubic symphysis is a unique joint at the midline union of the pubic bone. It resists tensile and frictional forces and can move minimally —2 mm shifts and 1-degree rotation. However, this joint is capable of remarkable changes during pregnancy. Relaxin and other hormones cause structural changes that increase the joint’s width and mobility. Separation between 4 to 9 mm is normal during pregnancy. We expect the pelvic girdle to return to normal before five months postpartum.
What Causes Pubic Symphysis Pain?
The hormone relaxin softens the ligaments and joints to ease labor and delivery. Movement of the loose joint can be painful for the mother. In addition, excessive widening beyond 10 mm leads to a rare condition called pubic symphysis diastasis. Risk factors include:
- Obesity
- Hypermobility
- Large fetus
- Rapid second stage labor
- Intense uterine contractions
- History of pelvic trauma
- Forceps used during delivery
What Does Pubic Symphysis Pain Feel Like?
The pain is different for each person. Some women may feel a pinch or ache. For others, severe symphyseal pain causes difficulties with activities of daily living such as walking, climbing stairs, or turning over in bed. In some cases, the patient feels sore in the creases of the groin rather than over the pubic bone. Pubic symphysis pain can be debilitating to mothers, especially if it doesn’t resolve postpartum. It can get so bad that some women require crutches or bed rest.
How Do You Treat Symphysis Pubis Dysfunction?
Several treatment options are available to relieve symphysis pubis pain and provide for postpartum recovery. Many patients benefit from supportive devices such as a pelvic support belt, a pregnancy pillow for sleep, or using a wheelchair or walker for reduced mobility. Other treatments include strengthening the back and core, soft tissue therapy, applying ice or heat, and simulation with a TENS unit. A physical therapist can design a safe and effective treatment program to meet patients’ needs.
Referring Patients for Pubic Symphysis Pain
Physical Therapy is a first-line treatment for Symphysis Pubis Dysfunction. The PT can develop non-invasive therapies to relieve pain and help restore mobility and function. Call our office for referrals at 201-833-1333.