Symphysis pubis dysfunction (SPD) is a group of symptoms that cause discomfort in the pelvic region. It usually occurs during pregnancy, when your pelvic joints become stiff or move unevenly. It can occur both at the front and back of your pelvis. SPD is also sometimes referred to as pelvic girdle pain (PGP).
The condition is not harmful to your baby, but it could be extremely painful for you. In some women, the pain may be so severe that it affects mobility.
The symptoms of SPD can vary for different women, both in terms of severity and presentation. The most commonly experienced symptoms are:
- pain in the front center of your pubic bone
- pain in your lower back on one or both sides
- pain in between your anus and vagina (perineum)
The pain sometimes travels to your thighs, and you might also hear or feel a grinding or clicking sound in your pelvis.
The pain is often more obvious when you’re:
- using stairs
- putting your weight on only one leg
- turning over in your bed
It might also be challenging to widen your legs. This can make daily tasks such as getting out of bed, getting dressed, or getting in and out of a car difficult.
The most common cause of SPD is pregnancy. It’s thought that SPD affects up to 1 in 5 pregnant women to some extent.
During pregnancy, hormones such as relaxin are released to loosen the ligaments and muscles in your:
- pelvic floor
This loosening is intended to increase your range of motion in order to help you birth your baby, but it also means that your joints can become unbalanced and more mobile than they usually would be. This can cause discomfort or pain.
Although this slackening is intended to help with birth, sometimes you can start producing these hormones in early pregnancy. You may experience the symptoms of SPD long before it’s time to birth your baby.
The baby’s weight and position are also thought to affect pelvic pain. The symptoms of SPD tend to worsen as the pregnancy progresses.
It’s much less common for SPD to occur outside of pregnancy, but it does happen. Other causes of SPD range from pelvic injuries to conditions like osteoarthritis. In some cases, there is no known cause.
Diagnosing SPD early can be really helpful in managing the condition. If you’re pregnant and experiencing pelvic pain, talk to your doctor or midwife. They will be able to refer you to a physiotherapist who can make an assessment of the stability and strength of your joints and pelvic muscles. They will also be able to help you plan what activities you will be able to do.
SPD is not medically harmful to your baby, and most women with the condition are still able to deliver vaginally. However, chronic pain can lead to sadness or even depression, which is sometimes thought to negatively affect your baby. Although the symptoms of SPD don’t tend to disappear entirely until after you have birthed your baby, there are lots of things that can be done to minimize your pain. That’s why it’s important to seek help.
The U.K.-based group Pelvic, Obstetric and Gynaecological Physiotherapy (POGP) suggests that you try to avoid these activities if you’re experiencing SPD:
- putting your weight on only one leg
- twisting and bending while lifting
- carrying a child on your hip
- crossing your legs
- sitting on the floor
- sitting in a twisted position
- standing or sitting for long periods of time
- lifting heavy loads, such as wet washing, shopping bags, or a toddler
- pushing heavy objects, such as a shopping cart
- carrying anything in only one hand
Physiotherapy is the main course of treatment for SPD. The aim of physiotherapy is to minimize your pain, improve your muscle function, and improve your pelvic joint stability and position.
A physiotherapist can provide manual therapy to ensure that the joints in your pelvis, spine, and hips move normally. They will also be able to offer you exercises to strengthen the muscles in your pelvic floor, back, stomach, and hips. They may recommend hydrotherapy, where you do the exercises in the water. That’s because being in the water can take the stress off your joints and allow you to move more easily. The physiotherapist will be able to give you suggestions on comfortable positions for sex, labor, and birth.
In severe cases of SPD, pain-relief medications, such as paracetamol and codeine, or TENS therapy may be prescribed. You may also be provided with supportive equipment such as crutches or pelvic support belts.
There is very little that you can do to prevent yourself from getting SPD in pregnancy. However, it is more common if you’ve had a previous pelvic injury, so it’s always important to take whatever measures possible to protect this vital area of your body.
SPD does not directly affect your baby, but it may lead to a more difficult pregnancy due to reduced mobility. Some women may also have difficulty having a vaginal delivery.
Symptoms of SPD should go away after giving birth. Talk to your doctor if your symptoms still don’t improve. They may be the result of another underlying condition.