What Is Symphysis Pubis Dysfunction (SPD)?

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During pregnancy, a woman's body goes through remarkable changes to accommodate the growing life within. While this journey is filled with anticipation and joy, it can also come with its share of physical discomforts. One such challenge that some expectant mothers face is Symphysis Pubis Dysfunction (SPD). 

In this article, we will delve into the world of SPD, examining its causes, symptoms, and management strategies.

What is the symphysis pubis?

The symphysis pubis is a joint located at the front of the pelvis, connecting the two halves of the pelvic bone. This joint plays a crucial role in various physical activities, such as walking, standing, and, most significantly, during childbirth. 

Symphysis Pubis Dysfunction, commonly referred to as SPD, is a condition that impacts this joint, causing pain and discomfort, particularly in pregnant women. 

However, it's important to note that SPD is not exclusive to pregnant women; it can affect non-pregnant individuals and, in rare cases, men. 

Understanding the causes of SPD

To understand SPD better, it's essential to grasp the underlying causes of this condition. While it is most frequently associated with pregnancy, other factors can contribute to the development of SPD.

  1. Hormonal Changes: One of the leading causes of SPD during pregnancy is the hormonal changes that occur. The body produces a hormone called relaxin, which is responsible for relaxing the ligaments in the pelvis to facilitate childbirth. However, this hormone can also lead to the instability of the symphysis pubis joint, resulting in pain and discomfort. 
  2. Weight Gain: As pregnancy progresses, the mother's body naturally gains weight to support the growing baby. This additional weight places extra pressure on the pelvic region and can exacerbate the strain on the symphysis pubis.
  3. Previous Pregnancy: If a woman has had SPD in a previous pregnancy, she is at a higher risk of experiencing it in subsequent pregnancies. The weakening of the ligaments and joints during the initial experience can make them more susceptible to SPD in future pregnancies.
  4. Joint Issues: Pre-existing joint problems, such as arthritis or conditions affecting joint stability, can increase the likelihood of developing SPD.

Recognizing the symptoms of SPD

Symphysis Pubis Dysfunction presents with a variety of symptoms, which can vary in intensity from mild discomfort to severe pain. The severity of symptoms varies from person to person. Here are some of the common signs of SPD:

  1. Pain in the pelvic region: Pain is the primary and most characteristic symptom of SPD. It typically occurs in the front of the pelvis and can radiate to the lower abdomen, gluteal area, groin, and even the thighs.
  2. Walking discomfort: Many individuals with SPD find walking particularly painful, especially when taking large steps or climbing stairs.
  3. Pain while turning in bed: Simple tasks like turning over in bed can become excruciating for those with SPD. The act of shifting the legs and pelvis can cause sharp pain in the pubic region.
  4. Audible clicking or popping: In some cases, there may be an audible clicking or popping sound when moving the legs. This can be accompanied by pain and discomfort.
  5. Pelvic instability: A sensation of instability in the pelvis is another common symptom. This feeling may give the impression that the pelvic bones are moving apart.

Diagnosis and assessment

If you suspect you have SPD or are experiencing any of the aforementioned symptoms, it is crucial to seek medical advice. A healthcare professional, typically an obstetrician or physiotherapist, can diagnose and assess the condition. 

The diagnosis typically involves a comprehensive physical examination, which may include:

  1. Palpation: The healthcare provider will press on various areas of the pelvis and muscles in the area to identify areas of tenderness and pain.
  2. Range of motion tests: Certain movements, such as leg lifts or standing on one leg, may be assessed to determine the extent of discomfort and mobility limitations.
  3. Imaging: In some cases, imaging studies like X-rays or ultrasounds may be used to get a more detailed view of the pelvis and confirm the diagnosis.

The impact of SPD on daily life

Symphysis Pubis Dysfunction can have a profound impact on an individual's daily life, especially for pregnant women who may already be dealing with the physical and emotional challenges that come with pregnancy. Some ways in which SPD can affect daily life include:

  1. Reduced mobility: The pain and discomfort associated with SPD can limit a person's mobility, making it challenging to perform routine activities like walking, standing, or climbing stairs.
  2. Disturbed sleep: Pain often worsens at night, making it difficult to find a comfortable sleeping position. This can lead to fatigue due to sleep disturbances.
  3. Emotional impact: The chronic pain and limitations imposed by SPD can lead to feelings of frustration, anxiety, and even depression, especially for pregnant women who may be experiencing additional emotional stress.

Treatment options for symphysis pubis dysfunction

The good news is that there are several treatment options available to manage SPD. The choice of treatment will depend on the severity of the condition and the individual's specific needs. Here are some common approaches to treating SPD:

  1. Physiotherapy: Physiotherapy is often a primary treatment for SPD. A physiotherapist can provide exercises and stretches that help strengthen the pelvic region, improve joint stability, and alleviate pain. Physiotherapists can also help you with coping strategies and educate you on which positions to avoid and how to manage your SPD each day.
  2. Supportive Belts: Maternity support belts, also known as pelvic support belts, are designed to provide external support to the pelvic area. These belts can help reduce pain and discomfort by stabilizing the pelvis.
  3. Pain medication: In more severe cases, healthcare providers may recommend over-the-counter or prescription pain medications to manage the pain associated with SPD. It's essential to consult with a healthcare provider before using any medication during pregnancy.
  4. Relative rest and modification of activities: Relative rest is crucial for managing SPD. Avoiding activities that exacerbate the pain and adopting strategies to minimize strain on the pelvis can help alleviate symptoms.
  5. Heat and cold therapy: Applying heat or cold packs to the painful area can offer relief. Heat can help relax tight muscles, while cold can reduce inflammation and numb the area.
  6. Acupuncture: Some individuals find relief from SPD through acupuncture, a traditional Chinese medicine practice involving the insertion of thin needles at specific points on the body.

Coping strategies for SPD

In addition to medical treatment, there are several coping strategies that individuals with SPD can employ to manage the condition effectively:

  1. Listen to your body: Pay attention to your body's signals. If an activity or position starts to cause pain or discomfort, avoid it and change position as soon as you can.
  2. Use supportive aids: Utilize tools and devices that can make daily tasks easier. For example, using a stool to help you get in and out of the shower or using a pillow between your legs while sleeping can reduce discomfort.
  3. Antenatal yoga: Antenatal yoga classes may offer gentle exercises and stretches that can help alleviate some of the discomfort associated with SPD.
  4. Emotional support: Seek emotional support from friends, family, or a therapist. Managing the emotional toll of SPD is just as crucial as addressing the physical symptoms.

Preventative measures

While not all cases of SPD can be prevented, some measures can reduce the risk of developing this condition during pregnancy:

  1. Maintain a healthy weight: Controlling weight gain during pregnancy can help reduce the stress on the pelvic region.
  2. Strengthen core and pelvic floor muscles: Engaging in exercises that strengthen the core and pelvic floor muscles can help improve pelvic stability.
  3. Practice good posture: Maintaining proper posture can help distribute the body's weight more evenly, reducing pressure on the pelvis.
  4. Gentle movement: Doing gentle stretches and mobility exercises can help keep the pelvis and muscles looser and prevent pain.

Complications and long-term outlook

For most individuals, SPD can be effectively managed with the appropriate treatment and lifestyle modifications. However, if left untreated or in severe cases, SPD can lead to complications such as chronic pain and mobility issues. In some instances, it may persist even after childbirth.

Conclusion

Symphysis Pubis Dysfunction is a condition that primarily affects pregnant women, causing pain and discomfort in the pelvic region. However, it can also impact non-pregnant individuals and, in rare cases, men. Understanding the causes, symptoms, and treatment options for SPD is crucial for individuals dealing with this condition.

By seeking a healthcare provider's diagnosis and guidance, implementing appropriate treatments, and adopting coping strategies, those affected by SPD can manage their symptoms effectively. With the right support and a proactive approach to care, individuals with SPD can continue to lead fulfilling lives during and after pregnancy.

References

  1. Owe KM, Nystad W, Bø K. Association between maternal age, parity and pelvic girdle pain. Acta Obstet Gynecol Scand. 2016;95(4):463-469.
  2. Aldabe D, Ribeiro DC, Milosavljevic S, Bussey D. Is pelvic pain in pregnancy a welfare complaint? BMC Public Health. 2012;12:111.
  3. Rost CC, Jacqueline L, Kaiser A, Verhagen AP, Koes BW. Pelvic pain during pregnancy. Clin J Pain. 2006;22(1):32-38.
  4. Larsen EC, Wilken-Jensen C, Hansen A, et al. Symptom-giving pelvic girdle relaxation in pregnancy. II: Symptoms and clinical signs. Acta Obstet Gynecol Scand. 1999;78(2):111-115.
  5. Vleeming A, Albert HB, Östgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J. 2008;17(6):794-819. https://pubmed.ncbi.nlm.nih.gov/18259783/
  6. Bjelland EK, Stuge B, Vangen S, Stray-Pedersen B, Eberhard-Gran M. Mode of delivery and pelvic girdle pain in pregnancy: a prospective cohort study. PLoS One. 2013;8(12):e78768.
  7. Gausel AM, Kjærmann I, Malmqvist S, et al. Pelvic girdle pain 3-6 months after delivery in an unselected cohort of Norwegian women. Eur Spine J. 2015;24(5):1011-1018.
  8. Kanakaris NK, Roberts CS, Giannoudis PV. Pain relief and improved physical function in acute and chronic pelvic ring fractures following kyphoplasty. Injury. 2011;42(5):526-531.
  9. Östgaard HC, Andersson GB, Karlsson K. Prevalence of back pain in pregnancy. Spine. 1991;16(5):549-552. https://pubmed.ncbi.nlm.nih.gov/1828912/

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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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Sarah Engelbrecht

BSc Physio (Hons), University of Cape Town, South Africa

Sarah Engelbrecht is a practicing physiotherapist, who qualified in 2003. She has many years of experience in healthcare and helping patients with their health, fitness, and wellness. Her writing has been featured on various websites in the UK and the US.

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