Pubic Symphysis Dysfunction (PSD)

Are you pregnant and having difficulty rolling in bed, getting in and out of your car, climbing stairs, or walking due to pelvic pain? You may be suffering from a common condition called pubic symphysis dysfunction.

The pubic symphysis is located at the front of the pelvis where the two sides of the pelvis meet. This is typically a fairly stable joint. Changes in hormones levels during pregnancy relax the ligaments and allow for increased movement. The movement can result in misalignment and more importantly pain. Pubic symphysis dysfunction is thought to affect up to 1 in 4 women during pregnancy. It can range in severity from mild discomfort during daily activities to inability to bear weight on the legs.

The main symptom of pubic symphysis dysfunction is pain at the front of the pelvic girdle. Many women also complain of lower back pain, leg pain, or lower abdominal pain. Women who are experiencing pain may also walk with a waddling gait and have pain with walking, lifting and carrying objects, rolling in bed, climbing stairs, getting in and out of the car, and standing. Any activity that requires asymmetrical movement of the legs is likely to cause pain due to shearing forces at the pubic symphysis.

Diagnosis can usually be made on symptoms alone as many imaging techniques are not recommended during pregnancy. Ultrasound may be used during pregnancy, and if symptoms persist after pregnancy, a pelvic x-ray or MRI may be indicated.

Chiropractic as a Treatment Option

Many women suffering from symphysis pubis dysfunction during pregnancy respond favorably to treatment. Treatment may include soft tissue mobilisation/massage, strengthening and stabilisation exercises to improve support of the pelvic girdle, pelvic floor strengthening exercises, postural exercises, and education on body mechanics and strategies to minimize pain with activities of daily living. Anti-inflammatory medication is not recommended during pregnancy, but applying ice to the pubic symphysis regularly may help with pain and inflammation. Heating surrounding musculature may decrease muscle spasm and tightness to decrease pain. Bracing or external supports may also be beneficial in providing additional stability and decreasing pain with activity.

Discussing a birth plan with your obstetrician or midwife is important to minimize pain and further damage to the ligaments during labor and delivery and postpartum pain. It is important to tell nurses and others assisting with your delivery that you have symphysis pubis dysfunction so that aggravating positions such as squatting and reclined sitting with the legs wide apart are minimized. Realise that if you have an epidural you will not be able to feel the pain during labor and delivery, which you may believe is good, but you may be causing further irritation/damage to the area that you will certainly feel once the anesthesia wears off. Alternative pushing positions such as hand and knees or side-lying may be utilised.

Tips to Manage Pain Associated with Everyday Activities:

  • Sit down to perform activities when possible.
  • Avoid periods of prolonged weight bearing.
  • Avoid deep squatting.
  • Avoid lifting and carrying heavy objects when possible.
  • Avoid stepping over objects.
  • Avoid stairs if possible or try going up sidewards.
  • When rolling in bed, place a pillow between the knees and keep the legs together as you roll.
  • When getting in bed, sit on the side of the bed with the legs close together, lie on your side first and then bring both legs up sideways.
  • When getting in to the car, sit down on the seat first and then bring the legs whilst together into the car.
  • When getting out of the car, bring both legs out of the car first and then stand up pushing equally with both legs.
  • Avoid twisting movements of the body.
  • Before performing activities that are painful, contract the pelvic floor muscles to give additional pelvic stability.

The good news is that if you can manage your symptoms during pregnancy, the majority of symphysis pubis dysfunction resolves after pregnancy as the hormones return to pre-pregnancy levels. If you believe that you have symphysis pubis dysfunction, discuss with your doctor or midwife.

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Posted in Back Pain, Pain, Pregnancy Joint Pain Clinic

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