What Is Osteitis Pubis

  • Afifah Aslam Doctor of Pharmacy- Pharm D, Jinnah University for Women, Pakistan

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Introduction

Osteitis pubis is an aching, provocative, noninfectious condition of the pubic symphysis and encompassing structures. A large portion of the early writing on this subject arose out of the area of urology and was related to complexities like contaminations and surgical injury.1

Pelvis

The pelvis is characterized as the centerpiece of the human body between the lumbar district of the midsection superiorly and the thighs inferiorly. It provides support and capability of movement. It includes:2

  • Hard pelvis: the hard pelvis consists of 2 sections: front and back. The foremost part is known as the pelvic support which is made out of the pubis, the ischium, and the ilium. It is associated posteriorly to the pelvic spine which comprises the coccyx and sacrum
  • Pelvic pit/cavity: the space inside the pelvic bones is known as the cavity of the pelvis. Superiorly, the pelvic cavity is continuous with the abdominal cavity. Lowly, the pelvic cavity is surrounded by the Pelvic floor. The pelvic pit acts as a lodging space for different organs.
  • Pelvic floor: it isolates the pelvic hole superiorly from the perineum which lies sub-par compared to the pelvic floor. It is the limit of the pelvis and stomach pit while supporting the heaviness of the internal organs.
  • Perineum: the perineum is situated between the pubic symphysis and the coccyx. It is a precious stone molded region that resides at the rear end of the vagina for females and the scrotum in guys.2

Anatomy and function of the pubic symphysis

The main task of the pubic symphysis is to hold the right and left pelvic bones up. It causes little developments that assist your pelvis with retaining weight from your chest area. Your pubic symphysis joint is made of two sorts of ligament and four tendons that make the association between your pelvic bones solid but not inflexible. It permits development and assists your pelvis with engrossing shock while you're strolling or running. This joint is particularly significant assuming you're pregnant as it turns out to be extra adaptable with the goal that your pelvic bones can broaden and a child can go through the birth waterway.3

Causes of osteitis pubis

The following are the common causes of osteitis pubis:4

  • Physical exercise / playing sport: recurrent burden on muscles, tissues and encompassing designs of their pubic symphysis can aggravate the joint.
  • Pregnancy: during or after pregnancy osteitis pubis can develop because of the extreme pressure
  • Surgery: urological issues related to surgery can cause osteitis pubis
  • Other health conditions which affect the walking style

Symptoms and clinical presentation

  • Lower abdominal pain
  • Pain in thigh muscles as a result of walking 
  • Strain over your pelvis
  • Patients will feel tormented by fast hip flexion such as moving from a seated to a standing position4

Diagnosis of osteitis pubis

Diagnosis includes the following strategies:

Physical examination

  • A careful history and actual assessment ought to be performed, focusing on any new or remote urologic or pelvic surgeries, or any nearby or redundant injury to the area being referred to
  • Physical findings include delicacy over the pubic symphysis or horizontal toward the pubic symphysis5

Physical pain test

  • Pubic spring test:  the spring test is performed by putting concurrent descending strain on both pubic rami. On the off chance that torment is duplicated at the pubic symphysis this is viewed as a positive sign of osteitis pubis
  • Lateral compression test: it happens when the patient is in the horizontal lying position and descending strain on the predominant iliac wing produces torment at the pubic symphysis5

Imaging test

It includes X-ray, MRI and CT scans that are useful in ruling out osteitis pubis and other conditions as well.

  • X-ray: An X-beam study (likewise called a radiograph) is a kind of clinical imaging (radiology) that takes photos of your bones and delicate tissues, like organs. X-beams utilize safe measures of radiation to make these photos. The pictures assist your doctor with diagnosing conditions and planning medicines6
  • Magnetic Resonance Imaging (MRI): this is an effortless test that produces extremely clear pictures of the organs and designs inside your body. X-ray utilizes an enormous magnet, radio waves and a computer to deliver these itemized pictures. It doesn't utilize X-beams (radiation)7
  • CT scan: a CT (processed tomography) filter is a sort of imaging test. Like an X-beam, it shows structures inside your body. However, rather than making a level, 2D picture, a CT filter takes a handful to many pictures of your body. To get these pictures, a CT machine takes X-beam pictures as it spins around you. Medical services suppliers use CT outputs to see things that ordinary X-beams can't show8

Treatment

Osteitis pubis treatment consists of non-medicated, medicated and surgical strategies:

Non-medicated approaches

  • Rest and afterward go back to normal daily life, if osteitis pubis occurs due to some physical injury
  • Physiotherapy can assist with fortifying the muscles around your pubic issues that remain to be worked out better. It can likewise address any broken development designs that might have made little burdens on your joints over the long haul4
  • Picking non-painful and non-impact practices is key for the underlying treatment. On the off chance that the action causes torment, it ought to be reduced1
  • Shock-retaining footwear may likewise lessen the shear pressure across the symphysis pubis
  • To diminish adverse muscle pressure at the pubis symphysis, stability, strength, and muscle force adjusting are at the center of any great physiotherapy program1

Medicated treatments

  • Over-the-counter medicines such as NSAIDs can assist with decreasing irritation and any aggravation you're encountering
  • A few investigations have tracked that corticosteroid infusions and prolotherapy can diminish irritation brought about by osteitis pubis4

Surgical options

  • It consists of curettage, arthrodesis, and wedge and wide resection of the pubic symphysis
  • These methods are intrusive and not without issues. For instance, wide resection of the pubic symphysis can cause auxiliary problems requiring extra surgeries. Resection of the front pelvis can cause issues with pelvic flimsiness.
  • In general, surgical intervention is the last resort after non-medicated or medicated treatments. In postsurgical patients with extreme side effects, earlier surgical involvemen tcan be proposed after proper patient counseling5

Summary

Osteitis pubis is a painful, inflaming situation related to pubic symphysis of the pelvis. The human pelvis mainly consists of 4 parts which are made up of different sub-structures that are majorly involved in movement and weight-carrying purposes. The pubic symphysis is a part of the hard pelvis that has a major role in stability, balancing and weight-bearing functions. Osteitis pubis occurs due to strenuous physical activity of the pelvis, pregnancy pressure during /after labor, surgical trauma etc. During osteitis pubis patients feel pain in the lower side of the abdomen, in the thighs and the pelvis side. Its diagnosis is a little difficult as it is confused with other conditions. Healthcare providers diagnose this condition by taking a history of the patient and some physical pain tests such as the spring pubic test and lateral compression test. Doctors also recommend some imaging tests (X-ray, MRI, CT scan) as these give a clear picture of the pubic symphysis. This condition can be treated by several strategies such as non-medicated treatment (i.e. avoid strenuous activities, rest, physiotherapy and shock-bearing shoes) medicated strategy includes the use of over-the-counter pain and inflammation relief medications such as (NSAID and corticosteroid). Surgical procedures are taken when the medicated and non-medicated strategies fail to treat osteitis pubis. Mostly, patients do not require surgical treatment and they can recover within a few months with proper rest and physical therapy such as stretching and strengthening exercises.

FAQs

Who does osteitis pubis influence?

Anyone (male or female) can be affected by pubic symphysis. Notwithstanding, osteitis pubis as a rule influences particularly dynamic individuals or competitors who utilize their center and hips to turn, kick or unexpectedly take a different path a great deal. Individuals who are pregnant, who recently had labor procedures or who've had a new medical procedure close to their mid-region are likewise bound to encounter osteitis pubis.

How might I forestall osteitis pubis?

The most ideal way to forestall osteitis pubis is to try not to abuse your pubic symphysis joint.

During sports or other proactive tasks:

  • Wear the right defensive gadgets
  • Try not to "play through it" on the off chance that you feel tormented during or after actual work
  • Give your body time to rest and recuperate after extraordinary action
  • Effectively stretch and warm up before playing sports or working out
  • Cool down and stretch after active work

How long does it take to recover from osteitis pubis?

The recovery time is within a few months.

How to manage osteitis pubis?

The most effective way to deal with your osteitis pubis side effects is to keep away from the exercises that caused them. Further weight on your pubic symphysis joint can exacerbate your side effects.

References

  1. Mandelbaum B, Mora SA. Osteitis pubis. In: Miller MD, Wiesel SW, editors. Operative Techniques in Sports Medicine. Lippincott Williams & Wilkins; 2005. p.62-7.
  2. Chaudhry SR, Nahian A, Chaudhry K. Anatomy, Abdomen and Pelvis, Pelvis. InStatPearls [Internet] 2021 Aug 1. Stat Pearls Publishing.
  3. Pubic Symphysis: What Is It, Function & Anatomy. Cleveland Clinic [Internet]. Available from: https://my.clevelandclinic.org/health/body/23025-pubic-symphysis.
  4. Osteitis Pubis: What It Is, Symptoms & Treatment]. Cleveland Clinic [Internet. Available from: https://my.clevelandclinic.org/health/diseases/24610-osteitis-pubis.
  5. Gomella P, Mufarrij P. Osteitis pubis: A rare cause of suprapubic pain. Reviews in urology. 2017;19(3):156.
  6. X-Ray: What It Is, Types, Preparation and Risks. Cleveland Clinic [Internet]. 2022. Available from: https://my.clevelandclinic.org/health/diagnostics/21818-x-ray
  7. MRI (Magnetic Resonance Imaging): What It Is, Types & Results. Cleveland Clinic [Internet]. 2022. Available from: https://my.clevelandclinic.org/health/diagnostics/4876-magnetic-resonance-imaging-mri.
  8. CT(Computed Tomography) Scan: What It Detects. Cleveland Clinic [Internet]. 2020. Available from: https://my.clevelandclinic.org/health/diagnostics/4808-ct-computed-tomography-scan

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Afifah Aslam

Doctor of Pharmacy- Pharm D, Jinnah University for Women, Pakistan

Afifah Aslam is a dedicated pharmacist, passionate medical article writer and MBA candidate where she honoring her leadership and strategic skills to further elevate her career.

She embarked on a fulfilling career as a pharmacist, working diligently in various healthcare settings such as in Hospital and Retail sector. Her commitment to patient care, attention to detail, and innovative approach to pharmaceutical solutions made her a trusted figure.

However, her passion for research and desire to share her knowledge with a broader audience led her to the field of medical writing. Her journey exemplifies the power of adaptability, determination, and the pursuit of knowledge and her impact on the healthcare industry, both as a practitioner and a communicator, continues to inspire and shape the future of healthcare.

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