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Symphysis Pubis Dysfunction (SPD)  


What exactly is Symphysis Pubis Dysfunction?
During pregnancy or birth, about one in 35 women will experience intense pelvic pain and may find it difficult to walk, climb stairs, and other movements that involve the pelvic bones. This pain is a result of separation of the symphysis pubis which is a joint in the very front part of the pelvic bone structure. There is cartilage that fills the gap in the bones. During pregnancy, hormones such as relaxin soften this cartilage allowing the pelvic bones to be more flexible for delivery. Some women, however, have too much play in the pelvis causing a large gap between the bones. This makes the symphysis pubis area extremely sensitive to touch.

When does separation of the symphysis pubis occur?
Some women will notice pain beginning as early as the first trimester of pregnancy while others experience this separation during the birth or even a few days postpartum. Women who have experienced SPD with previous pregnancies will not necessarily have the problem with subsequent pregnancies however, some will.

How will I know if I have SPD?
If you have SPD, you may notice pain in the front of the pelvis that hurts when touched. You may also feel pain in the lower abdomen, hips, inner thigh and groin areas. Marked increased pain with activities such as walking, climbing stairs, lifting your legs, or any other large movements involving the pelvis are key symptoms. You may even experience a clicking type noise with movement as well. If you experience any of these symptoms, you should contact your caregiver for further testing.

What type of testing can I expect if my doctor/midwife and I suspect SPD?
The type of testing depends on when you experience the symptoms. If you are still pregnant, the likely test would be an ultrasound. Other diagnostic tools that can be used after delivery are pelvic x-rays or an MRI.

Is there any treatment for SPD?
The doctor may prescribe painkillers and refer you to a physiotherapist for additional help. The physiotherapist may suggest the use of TENS, Transutaneous Electronic Nerve Stimulation, to help with the pain. Other items such as support belts or crutches can be used as well. Additional specialists also offer potential benefits: acupuncturists, reflexologists, chiropractors, aromatherapists, osteopaths, hypnotherapists, and herbalists. Each in their own way may provide treatment options to minimize the pain of SPD. There is no way to prevent SPD from occurring; however, once the hormones cease production after pregnancy, the condition will gradually subside.

If you are pregnant with SPD you should minimize large pelvic movements throughout your pregnancy. This includes swimming breaststroke, even though normally this is a great means of exercise. Choose other strokes if you are a swimmer. Try to continue to get exercise, just be sure to do exercises that will not aggravate the SPD.

Should I be worried about the delivery?
Birthing vaginally is certainly attainable and preferable even with SPD. Spreading of the legs, however, should not be extreme. Perhaps the best positions for pushing when you have SPD is either "all-fours" (hands and knees) or side-lying. Squatting may be painful as well as the most common birthing position, the sitting position with legs wide apart. Be sure that you explain to the nurses and other caregivers that you have symphysis pubis separation and need to minimize spreading your legs widely. One of the drawbacks of receiving an epidural during the birth is the pain of separation may be masked and therefore you may be put into positions that are only making the problem worse. Unfortunately, you wouldn't find this out until the anesthesia wears off and you have the extreme pelvic pain. Therefore, it is imperative that the caregivers know of your condition and do not suggest positions that could exacerbate the situation.

The final word...
Remember, symphysis pubis dysfunction is a condition that affects pregnant and/or postpartum women. It is a temporary situation and one that will resolve itself once the cartilage softening hormones decrease. Although there is no "cure" and it cannot be prevented in subsequent pregnancies, it does not mean that you will automatically experience SPD each pregnancy or birth. If you do, however, seek help to minimize the pain and worsening of the situation.




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