Many pregnant women find walking and other weight-bearing movement difficult or uncomfortable at some time during pregnancy, but some pregnant women experience recurring pain and mobility problems caused by a condition known as Symphysis Pubis Dysfunction, or SPD, a fairly common pregnancy-related condition in which the pelvic joints become unstable, causing mild to severe pain. The pain of SPD can be incapacitating, and in the worst cases you may need to rely on crutches, a walking frame or a even a wheelchair.
What causes SPD?
When you aren't pregnant, the bones of your pelvis are so densely connected that they look like a single bone and are held in a more or less fixed position by three joints: The sacro-iliac joints at each side of the base of your spine, and the symphysis pubis joint at the front. These joints need to loosen during pregnancy in order to allow your baby to pass through the pelvis at birth and it's the job of the hormone Relaxin to soften the ligaments of the joints to allow for movement.
Sometimes, however, Relaxin softens the ligaments too much and they may overstretch, causing the joints to become unstable and misaligned. This instability puts a strain on all the joints of the pelvis and prevents the symphysis pubis from properly supporting the pelvic bones during movement, causing pain. The strain on the pelvic joints is made worse by bearing the increasing weight of your baby, as well as the knock-on effect this weight increase has on your centre of gravity.
As the pelvic joints loosen during a normal pregnancy the usually small gap between the two pelvic bones (4-5mm) widens by 2-3mm. With SPD the gap may widen a little more than this, though it's not clear whether this necessarily involves greater pain for the SPD sufferer. In the quite rare event that the gap between the pelvic bones reaches 10mm, this is known as Diastasis Symphysis Pubis (DSP), a related but distinct condition.
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What are the symptoms and when do they appear?
Symptoms of SPD can appear anytime from the end of the first trimester, and the condition may even occur after birth. It's common though, for the first symptoms to appear around mid-pregnancy.
The foremost symptom of SPD is pain or discomfort in the pelvic region, usually concentrated around the pubis symphysis at the front. Pain can also extend to the sacro-iliac joints at the base of the spine, the groin, thighs, hips and lower abdomen.
The amount of pain women with SPD feel varies greatly. At one end of the spectrum some women only ever feel occasional mild discomfort, while in more extreme cases pain can be severe, and for prolonged periods. Whatever the level of pain, it usually worsens when you walk, put weight on one leg -(such as when going up or down stairs or getting in and out of the car), stand up, stand for a period of time, shift position in bed or part you legs. In some cases you may hear your pelvic joints click as you move about.
Diagnosing SPD
The first step to treating SPD is to get a diagnosis from your GP, obstetrician or midwife. These have all become generally more aware of SPD over the last few years, but you may find that your symptoms are dismissed as part and parcel of being pregnant. If this is the case you'll need to insist that your symptoms are investigated by an examination of the pelvic joints and tests observing how you move. When consulting your practitioner make sure that you give them a full list of your symptoms and don't play down the pain if you want to be helped.
Once diagnosed your practitioner should refer you to an obstetric physiotherapist to treat the SPD.
Treating SPD
The treatment you receive for SPD will vary according to the severity of your symptoms.
- Painkillers - Your doctor can prescribe painkillers that are safe to use in pregnancy.
- Physiotherapy - Your physiotherapist will demonstrate exercises designed to rebuild pelvic strength, advise you on what you should avoid doing and give you information on how the SPD might impact on your labour. She may also recommend hydrotherapy.
- Joint support - The physiotherapist should offer you the most appropriate from of joint support for your degree of SPD. It's quite common to be given some kind of pelvic support belt or bandage, but you might also need crutches, and in the most severe cases, a wheelchair.
- Alternative therapies - Some women find may find Osteopathy, hydrotherapy, acupuncture and Chiropractic treatment effective in relieving their symptoms.
- Occupational therapy - In severe cases of SPD you may need to be referred to an occupational therapist to see whether you need any special equipment at home to help you cope.
- Surgery - SPD does continue for a while after birth for may women, and it may even worsen, but it usually clears up within a few months of the birth. In some cases of DSP, however, surgery may be needed to repair the joints.
Recovery tips
- Try to avoid movements and activities that put pressure on your pelvic joints - You'll know what these are because they'll be painful (but be aware that swimming, particularly the breaststroke, may not hurt at the time but can aggravate pain later). You won't be able to avoid everything, but you can reduce pressure on your pelvis by changing the way you move in many cases:
- Avoid pushing or lifting heavy loads
- Avoid twisting movements
- Go up steps slowly, one step at a time
- Move both legs together when getting in and out of bed, off the sofa or in and out of the car
- At night-time it may help to support your joints with a rolled towel or pillow between your legs
- Rest - Frequent periods of rest are important to give your joints time to heal.
- But try to keep active - Try to move often while keeping within the limits of what is comfortable as far as possible.
- Respect your limits - You may feel a lot of pressure to continue pretty much as normal, particularly if you already have children. It's really important, however, that you don't push yourself to disregard the pain and carry on, as you are likely to worsen matters by doing so
How does SPD affect labour?
Having SPD doesn't necessarily limit your birthing options nor does it necessarily mean that you're best off having a caesarean section. It does, however, require some more careful planning and discussion with your midwife and / or consultant. You can experiment with birthing positions before the birth to work out which are likely to be more comfortable and once labour is underway make sure that your midwife knows how far you can comfortably open your legs.
Everyone caring for you during the birth should be made aware that you have SPD, particularly regarding your comfort during examinations and the pushing phase and for keeping within the comfortable limits if you have any form of spinal pain relief.
I had SPD with my last pregnancy, will I have it with the next one?
If you've suffered with SPD before then you won't necessarily suffer it with a subsequent pregnancy, but unfortunately you are more likely than average to develop it. If you do have SPD again, it may also appear earlier and worsen more quickly the next time around, so it's important that you see your doctor or midwife as soon as you have any symptoms.
