What happens to the symphysis pubis
The symphysis pubis is a low-moving connection between two pubic bones with a cartilaginous disc and strong ligaments. During pregnancy, it physiologically softens and expands slightly: this is a normal process that facilitates the passage of the child. Problems begin when mobility becomes excessive and the bones move relative to each other when walking, irritating the ligaments and periosteum. Doctors often talk not about inflammation, but about pelvic pain associated with pregnancy, since there is usually no true inflammation. The extreme option is rupture of the joint during childbirth, which is rare.
- Physiological softening of the pelvic ligaments
- Excessive mobility of the symphysis pubis
- Irritation of ligaments and periosteum when walking
- Most often there is no inflammation as such
- Articulation rupture during childbirth is rare
Causes and risk factors
The main factor is hormonal changes, which affect all pregnant women, but not everyone experiences severe complaints. The initial condition of the muscles matters: weak muscles of the pelvic floor, abdomen and buttocks stabilize the pelvis worse. The large weight of the child, multiple pregnancies, rapid weight gain and previous pelvic injuries contribute. In women who had symphysitis in a previous pregnancy, it often recurs, and earlier in term. Lack of vitamin D and calcium aggravates the situation, but is not the cause in itself.
- The effect of relaxin and progesterone on ligaments
- Weakness of the pelvic floor and core muscles
- Large fetus and multiple births
- Fast weight gain
- Symphysitis in a previous pregnancy
- Previous injuries and diseases of the pelvis
Symptoms and how to distinguish them from other pains
The classic picture is an aching or shooting pain just above the pubis, aggravated by walking, climbing stairs, turning in bed, and standing on one leg, such as when putting on pants. The pain can radiate to the groin, perineum and inner thigh, sometimes clicking sounds are heard. At night it makes it difficult to roll over. In contrast, pain with lumbar osteochondrosis is associated with the back and radiates down the leg, and with cystitis it is accompanied by pain and frequent urination. Training contractions are felt as tension in the uterus, not as pain in the bone.
- Pain above the pubis that gets worse when walking
- Difficulty turning in bed
- Pain when climbing stairs and standing on one leg
- Irradiation to the groin and inner thigh
- Clicking or crunching noises when moving
- In severe cases, a waddling gait
Survey
The diagnosis is mainly clinical: the doctor assesses the nature of the pain, performs careful functional tests and checks whether the woman can lift her straightened leg while lying down. Ultrasound of the symphysis pubis allows you to measure the width of the gap and see tissue swelling; it is safe and repeatable. X-rays and computed tomography of the pelvis are not used during pregnancy and are postponed until the postpartum period, when it is necessary to exclude rupture of the joint. Be sure to take a urine test so as not to miss a urinary tract infection, which gives similar pain in the lower abdomen.
- Inspection and functional tests
- Assessing the ability to raise a straight leg while lying down
- Ultrasound of the symphysis pubis
- General urine test to rule out infection
- X-ray of the pelvic bones - only after childbirth
- Consultation with an orthopedist for severe instability
What helps and how does childbirth go?
The main principle is to reduce the load on the joint without becoming completely immobile. A pelvic band worn while walking helps; It is better to sleep on your side with a pillow between your knees, get up from a lying position on your side, keeping your knees together. Exercises for the pelvic floor and buttock muscles, selected by a specialist, as well as gentle physiotherapy after childbirth are useful. Painkillers during pregnancy can only be prescribed by a doctor. The method of delivery depends on the severity: if there is a significant discrepancy in the articulation and it is impossible to separate the legs, a caesarean section is discussed.
- Pelvic bandage during walking and exercise
- Sleeping on your side with a pillow between your knees
- Standing up from your side, knees together
- Exercises for the pelvic floor and buttock muscles
- Avoid spreading your legs wide and walking for long periods of time
- The method of delivery is determined by the doctor based on the degree of discrepancy
