Symphysis Pubis Dysfunction (SPD)
In every pregnancy there is an increase in the width of the symphysis pubis (pubic bone joint in the front of your pelvis) due to softening of the tissues under hormonal influence. Later in pregnancy, as the baby grows, there are also increased mechanical forces stressing this joint. This can cause the joint to move excessively, and give pain in the pubis, groin or inside of the thigh, usually from about 20 weeks onwards. Labour puts even more strain through this joint, and in some cases, can cause joint separation (Diastasis of the Pubic Symphysis).
Your Osteopath will examine and treat any problems you may have with your low back, pelvis or sacro-iliac joints and surrounding muscles, to take the pressure off the symphysis pubis. They may also recommend specific exercises to strengthen the area, or the use of support belts.
Advice for SPD/PGP sufferers:
Avoid activities which cause the hips and knees to open eg. breast stroke swimming, squatting, turning over in bed. Try to keep your knees together when getting in and out of cars. In fact, if something hurts, stop doing it if you can. Also avoid sitting with your legs crossed as this puts torsion through the joint.
Spend time in the relaxation position shown in the picture - this posture: lying on your back with knees together and feet apart, puts the pubic joint in a stress free position. If you can't lie on your back, do the same thing with your legs but prop yourself up to semi sitting position with some cushions.
Sleep with a pillow between your knees, sit down to put on your knickers or trousers and try to limit the number of times you walk up and down stairs.
Orthopaedic support belts can be very useful - get your Osteopath's advice and help on these - there are lots on the market but one size does not suit all!.
If you suffer from pelvic girdle or pubic joint pain in one pregnancy it can become worse in subsequent pregnancies. Make sure you get it treated and seek professional advice as to how best manage the condition both before and after the birth. Strengthening your 'core' and pelvic floor muscles before or after pregnancy may help to prevent this kind of pain re-occuring. However the main issue is usually asymmetry of the complex muscles and soft tissues which support this joint rather than generalised weakness of your abdominal muscles. It is therefore essential to have a proper assessment from an Osteopath with specialist knowledge of this area before starting an exercise program.
If you are unlucky enough to suffer with severe pain you may need crutches or a wheelchair. You may also be entitled to a disabled parking permit available through the DSS.
During Labour and Birth:
Make sure that it is clear on your notes and birth plan that you have PGP/SPD and make sure doctors and midwives are aware of this.
You may also want to measure your pain free gap and write it on your notes before labour. If you have a partner present at the birth get them to make sure your legs are not opened too wide especially if you have an epidural and can't feel your lower body.
Delivery on all ours opens the legs less and may be a good option. Avoid stirrups |