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What is Symphysis Pubis Dysfunction (SPD)?

Now known as Pelvic Girdle Pain (PGP) Pelvic pain and mobility problems are two common symptoms of this increasingly recognised pregnancy complication


Posted: 28 February 2009
by Maria Muennich

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 Pelvic Girdle Pain (PGP) - previously known as Symphysis Pubis Dysfunction (SPD), a fairly common pregnancy-related condition in which the pelvic joints become unstable, causing mild to severe pain. The pain of SPD/PGP can be incapacitating, and in the worst cases you may need to rely on crutches, a walking frame or a even a wheelchair.

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 PGP the gap may widen a little more than this, though it's not clear whether this necessarily involves greater pain for the PGP 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.

What are the symptoms and when do they appear?

Symptoms of PGP 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.</p><p>
The foremost symptom of PGP 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.</p><p>

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 PGP, 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 PGP 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 PGP 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.

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Discuss this story

hello, i had  Symphysis Pubis Dysfunction when i was pregnant with my second child which was undiagnosed by my midwife, although she had seen that i was obviously in lots of pain even walking. I never enjoyed that pregnancy and he was 9lb when he was born which probably didn't help! i was in agony getting out of bed in the morning and during the night for my frequent visits to the toilet, and had to slowly crawl to get to where i wanted to go. My older son was still in a buggy as there are only two years between them, and pushing him around was very painfull especially if i was going up a kerb. It took me a lot longer to get to places because i could only manage to take small footsteps. My pelvis always cracked all the time too, and there many other things i were limited to doing because of the pain i would get. I was adament i would never get pregnant again because it was virtually unbearable, my midwife just said it was because it was my second pregnancy but i knew pregnancy was not naturally that painful and a pregnancy book enlighened me of the condition, from this i learnt that sleeping with a pillow inbetween my legs would help but i was still in lots of pain. My labour went ok, and after a short period my pelvic pain went although it still clicks and cracks to this day four and a half years later. I just want to let anyone know who has the condition that i have since had another baby and had a SPD free enjoyable pregnancy. I am now pregnant again and am hoping and praying that i don't get it again, and apart from the clicking and cracking of my pelvis, i have no sign.

Posted: 30/08/2007 at 22:31

Hi Alison

I had severe back ache last week & my hips kept clicking so I went to see my chiropracter, thinking it was an old back problem flaring up. Then this week I had what felt like a cramp just under my belly above the pubic area, I had trouble getting out of the chair at work and walking but put this down to my ligaments stretching. Am in my 16th week expecting twins so not sure what my body should or should not be doing - no point asking my midwife she's far too busy. It eases off when I lie down so think gravity makes it worse!

Hope you have a better pregnancy this time round.

Fay


Posted: 01/09/2007 at 07:09

Hi Fay

Thankyou, im sure this pregnancy will go smooth, no signs as yet thankfully! Im in my 16th week of pregnancy too. I don't know if this is your first pregnancy, but if so then dont let the psd put you off having any more - i had a great pregnancy after that one. It is very painful and when you tell other people, they dont understand and i was sure they just thought i was exaggerating and being soft. Hope people are understanding with you and maybe it would be worth your while telling your midwife - she might be understanding with experience and knowledge of you're conition. I agree that gravity makes it worse but whan you get up from lying down the pain is almost unbearale. i have heard of support belts that are designed for this condition, i think it would definately be worth looking into, also with the cold weather soon approaching an electric blanket would act a massive water bottle in bed and may make getting up easier for you. Also, have plenty of warm baths if you can. Hope some of this helps you and im sure your chiropracter has given you lots of great advice.

Best look to you during your pregnancy.

Alison x


Posted: 01/09/2007 at 13:23

Thanks Alison. Yes this is my first pregnancy so its all new to me. It's eased off now but will remember your tips when the colder weather comes.

Are your children looking forward to having another sibling? My nieces & nephew are looking forward to having babies to play with, which is sweet.

Take care & God bless!

Fay


Posted: 04/09/2007 at 06:55

Hi Fay,

I have had SPD from about 20 weeks and I found that Bowen therapy really helped with the pain as well as having a warm bath in the morning as it helped to ease the pain so I could walk the rest of the day.  I have just been referred to the physiotherapist and he is going to give me acupuncture too as he has had a great success rate with SPD in his practice, ask your midwife or Dr to refer you to the physio for help.  I have got a pelvic belt but while it helps with the back pain I don't feel it helps much with the pain at the front and find tying a scarf tightly around under my bump helps a lot more.  Also resting a lot helps too rather than being on my feet all day.

The SPD eased off until a few weeks ago when it started to get bad again (I am now nearly 37 weeks) I think it's to do with baby getting heavier, the last couple of nights have been really painful to turn over in bed, so I'm really hoping that the physio and acupuncture will help to ease that - will let you know how I get on.

The homoeopathic remedy Sepia 30 really helped too - if you want to give that a go.

Take care, love Kate x


Posted: 16/11/2007 at 17:56

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