SPD (Symphysis pubis dysfunction)

About 1 in 5 pregnant women get symphysis pubis dysfunction – a condition that causes excessive movement of the pubic symphysis. It can occur both at the front and back of your pelvis. SPD is also sometimes referred to as ‘pelvic girdle pain’.

The condition isn’t harmful to your baby, but it can be extremely painful for you and may even affect mobility. Although the symptoms of SPD don’t tend to disappear entirely until after you’ve given birth, there are lots of things that can be done to minimize the pain.

Causes

When you are pregnant, the body secretes a hormone called relaxin. This means that the joints of the body, especially in the pelvis, become more mobile to make childbirth easier. But it can also mean that the pelvis becomes unstable and the muscles have to work harder to support it, resulting in muscle pain.

There is an increased risk of joint dislocation in the event of a previous back injury or previous injury to the pelvis, multiple pregnancies and physically heavy work.

Symptoms

The main symptom is usually pain or discomfort in the pelvic region, usually centered on the joint at the front of the pelvis (the pubic symphysis). Some sufferers report being able to hear and feel the pubic symphysis and/or sacroiliac, clicking or popping in and out as they walk or change position. Sufferers frequently also experience pain in the lower back, hips, groin, lower abdomen, and legs. The severity of the pain can range from mild discomfort to extreme pain that interferes with routine activities, family, social and professional life, and sleep. There have been links between SPD and depression due to the associated physical discomfort. Sufferers may walk with a characteristic side-to-side gait and have difficulty climbing stairs, problems with leg abduction and adduction, pain when carrying out weight bearing activities, difficulties carrying out everyday activities, and difficulties standing.

SPD can occur at any time during pregnancy, but often begins in the middle of it. In most women, the pain gradually disappears after childbirth. But some may still be in pain for a few years afterward.

Prevention and protection

There is very little that you can do to prevent getting SPD in pregnancy. But trying to move, even if it hurts, is helpful. Physical activity causes the muscles to retain their strength and blood circulation, which can relieve pain. Try to keep your back straight. Feel free to ask a physiotherapist for advice on how to build muscle and relieve the pain.

Treatment

A promising treatment for chronic or post-natal dysfunction is PRP (Platelet-Rich Plasma) therapy. Other treatments include the use of elbow crutches, pelvic support devices and prescribed pain relief. NSAIDs are sometimes effective but should not be used after 30 weeks of pregnancy. The majority of problems will resolve spontaneously after delivery. Physical therapists—especially those specializing in pelvic floor physical therapy—can assist with pain relief techniques, provide manual therapy to alleviate related muscle spasms, and manage exercise protocols.

While most pregnancy-related cases are reported to resolve postpartum, definitive diagnosis and treatment are still appropriate in order to optimize comfort and function and ensure a good course of recovery.

Long-term complications can develop without proper care. Postpartum follow-up in cases of pregnancy-related SPD may include radiologic imaging, evaluation by a specialist such as an orthopedist or physiatrist, ongoing pelvic floor physical therapy, and assessment for any underlying or related musculoskeletal issues.