Your pubic symphysis is located anteriorly where your two pelvic bones meet. It is held together by a fibro-cartilaginous interpubic disc.
Pain is present when there is excessive movement of this joint either forwards or side to side.
What Causes Pubic Symphysis Pain?
This condition is more common in pregnant women, as their body starts to produce high levels of relaxin a hormone responsible for increased flexibility of joints and ligaments. Pain is present when your body doesn’t adapt well to these changes caused by the hormone relaxin.
Pubic symphysis pain can occur anywhere throughout your pregnancy.
Pubic pain can be caused by:
- Changes to the support around your pelvis due to changes in your muscles (flexibility/strength)
- Joint dysfunction in your pelvis causing it to move unevenly
- One of your pelvic joints not functioning properly, causing a knock-on pain in other surrounding joints
Risk Factors:
- Previous history of lower back or pelvic pain prior to pregnancy
- Pelvic pain in past pregnancies
- Obesity – or higher body mass index prior to pregnancy
- Hypermobility in all your joints
Symptoms:
- Pain presentation: burning, grinding, stabbing or shooting
- Can range from mild to quite debilitating pain.
- Pain over the front of the pubic bone, low back, inside of your thighs or between your legs (perineum)
- Relieved by rest
Aggravating Factors:
- Standing on one leg (getting changed, putting shoes on)
- Turning/Rolling over in bed
- Getting up from a chair.
- Getting in/out of the car.
- Walking up/downstairs
- Walking for extended periods of time.
- Discomfort while crossing legs.
When should I seek help?
It is imperative that you seek help from your Physiotherapist as soon as symptoms start to occur, or you notice an increase in discomfort. Your Physiotherapist will be able to test the stability of your joints, assess the surrounding muscles and provide specific exercises and advice.
Treatment Options:
- Specific exercise prescription – by your Physiotherapist to help stabilise your pelvis and back.
- Pelvic floor/core exercises – to gently maintain strength and stability.
- Aquatic Exercise – can be beneficial in maintaining fitness without putting undue stress on your joints.
- Taping/Braces – to help support the pelvis to promote stability.
- Devices – in severe cases; a wheelchair or crutches may be prescribed.
- Dry Needling/Acupuncture – is a safe way to release tight dysfunctional musculature and decrease pain levels.
- Advice and education – regarding labour positions and what movements to avoid exacerbation as pregnancy progresses.
- Massage – can help reduce muscle tension and pain to promote better movement of your pelvis
- Heat/Ice – can be an effective treatment modality that can be used to ease discomfort at home or at work.
Tips to cope with Pubic Symphysis Pain in Pregnancy:
- Avoid activities that place too much stress on the pelvis
- Squatting
- Prolonged standing positions
- Lifting and carrying of heavy objects
- Strenuous exercise
- Sleep with a pillow in between your legs
- Try to avoid stairs, if this is unavoidable, take on step at a time.
- Get changed or put shoes on while sitting
- Try to keep fit and exercise outside painful limits