Finding and exercising this crucial area. What is symphysis pubis dysfunction? Symphysis pubis dysfunction (SPD) is a problem with the pelvis. Your pelvis is mainly formed of two pubic bones that curve round to make a cradle shape. The pubic bones meet at the front of your pelvis, at a firm joint called the symphysis pubis. The joint's connection is made strong by a dense network of tough tissues (ligaments). During pregnancy, swelling and pain can make the symphysis pubis joint less stable, causing SPD. Doctors and physiotherapists classify any type of pelvic pain during pregnancy as pelvic girdle pain (PGP). SPD is one type of pelvic girdle pain. Diastasis symphysis pubis (DSP) is another type of pelvic girdle pain, which is related to SPD. DSP happens when the gap in the symphysis pubis joint widens too far. DSP is rare, and can only be diagnosed by an X-ray, ultrasound scan or MRI scan. What are the symptoms of SPD? Pain in the pubic area and groin are the most common symptoms, though you may also notice: Back pain, pain at the back of your pelvis or hip pain. Pain, along with a grinding or clicking sensation in your pubic area. Pain down the inside of your thighs or between your legs. Pain that's made worse by parting your legs, walking, going up or down stairs or moving around in bed. Pain that's worse at night and stops you from sleeping well. Getting up to go to the toilet in the middle of the night can be especially painful. SPD can occur at any time during your pregnancy or after giving birth. You may notice it for the first time during the middle of your pregnancy. What causes SPD? During pregnancy, your body produces a hormone called relaxin, which softens your ligaments to help your baby pass through your pelvis. This means that the joints in your pelvis naturally become more lax. However, this flexibility doesn't necessarily cause the painful problems of SPD. Usually, your nerves and muscles are able to adapt and compensate for the greater flexibility in your joints. This means your body should cope well with the changes to your posture as your baby grows. SPD is thought to happen when your body doesn't adapt so well to the stretchier, looser ligaments caused by relaxin. SPD can be triggered by: the joints in your pelvis moving unevenly changes to the way your muscles work to support your pelvic girdle joints one pelvic joint not working properly and causing knock-on pain in the other joints of your pelvis These problems mean that your pelvis is not as stable as it should be, and this is what causes SPD. Physiotherapy is the best way to treat SPD, because it's about the relationship between your muscles and bones, rather than how lax your joints are. You're more likely to develop SPD if: you had pelvic girdle pain or pelvic joint pain before you became pregnant you've had a previous injury to your pelvis you've had pelvic girdle pain in a previous pregnancy you have a high BMI and were overweight before you became pregnant hypermobility in all your joints How is SPD diagnosed? Your doctor or midwife should refer you to a women’s health physiotherapist. Your physiotherapist will test the stability, movement and pain in your pelvic joints and muscles. How is SPD treated? SPD is managed in the same way as other pelvic girdle pain. Treatment includes: Exercises to strengthen your spinal, tummy, pelvic girdle, hip and pelvic floor muscles. These will improve the stability of your pelvis and back. You may need gentle, hands-on treatment of your hip, back or pelvis to correct stiffness or imbalance. Water gymnastics can sometimes help. Your physiotherapist should advise you on how to make daily activities less painful and on how to make the birth of your baby easier. Your midwife should help you to write a birth plan that takes into account your SPD symptoms. Acupuncture may help reduce the pain and is safe during pregnancy. Make sure your practitioner is trained and experienced in working with pregnant women. Other manual therapies, such as osteopathy may help. See a registered practitioner who is experienced in treating pregnant women. A pelvic support belt may give relief, particularly when you're exercising or active. What can I do to ease the pain of SPD? Be as active as you can, but don't push yourself so far that it hurts. Stick to the pelvic floor and tummy exercises that your physiotherapist recommends. Ask for and accept offers of help with daily chores. Plan ahead so that you reduce the activities that cause you problems. You could use a rucksack to carry things around, both indoors and out. Take care to part your legs no further than your pain-free range, particularly when getting in and out of the car, bed or bath. If you are lying down, pull up your knees as far as you can to make it easier to part your legs. If you are sitting, try arching your back and sticking your chest out before parting or moving your legs. Avoid activities that make your pain worse or that put your pelvis in an uneven position, such as sitting cross-legged or carrying your toddler on your hip. If something hurts, stop doing it. If the pain is allowed to flare up, it can take a long time to settle down again. Try to sleep on your side with legs bent and a pillow between your knees. Rest regularly or sit down for activities you would normally do standing, such as ironing. By sitting on a birth ball or by getting down on your hands and knees, you'll take the weight of your baby off your pelvis. Try not to do heavy lifting or pushing. Pushing supermarket trolleys can often make your pain worse, so shop online or ask someone to shop for you. When climbing stairs, take one step at a time. Step up onto one step with your best leg and then bring your other leg to meet it. Repeat with each step. Avoid standing on one leg. When getting dressed, sit down to pull on your knickers or trousers. Will I recover from SPD after I’ve had my baby ? You’re very likely to recover within a few weeks to a few months after your baby is born. If you can, carry on with physiotherapy after the birth. Try to get help with looking after your baby during the early weeks. You may find you get twinges every month just before your period is due. This is likely to be caused by hormones that have a similar effect to pregnancy hormones. If you have SPD in one pregnancy, it is more likely that you’ll have it next time you get pregnant. Ask your midwife to refer you to a physiotherapist early on. SPD may not necessarily be as bad next time if it is well managed from the start of pregnancy. You could consider giving yourself a bit of time from one pregnancy to the next. Losing excess weight, getting fit and waiting until your children can walk may help reduce the symptoms of getting any type of pelvic pain next time. Where can I get help and support? Pelvic, Obstetric and Gynaecological Physiotherapy can provide a list of physiotherapists in your area. You can get in touch with other women in your situation by contacting The Pelvic Partnership, a charity that offers support to women with pelvic girdle pain, including SPD. Visit our community If you're struggling with SPD, exchange tips and advice or just vent frustration in our friendly BabyCentre community. More tips and advice: Original article and pictures take http://www.babycentre.co.uk/a546492/pelvic-pain-spd site
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