Pelvic Girdle Pain (SPD)

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There are a lot of unpleasant pregnancy symptoms that no one mentions until you're already pregnant. Bigger shoe sizes, heartburn, and a permanently stuffed nose to name a few. One of the most painful of these is Symphysis Pubis Dysfunction

It's also known as:

• pelvic girdle pain
• pelvic joint pain
• twisted hips
• pelvic relaxation
• pelvic arthropathy
• osteitis pubis

What is Symphysis Pubis Dysfunction?

The pelvis feels like a solid ring of bone but is actually four separate bones joined together - the sacrum and coccyx at the back and sides are the two hip bones which curve around to meet at the front. These are joined at the front by the Symphysis Pubis, which is connected by ligaments and cartilage which help keep the pelvic area stable but flexible.

During pregnancy, your body increases its hormone production. The hormones relaxin and progesterone work together to help loosen ligaments, allowing room for the baby to grow and for the flexibility needed to give birth. This is one of the reasons that women can develop a "waddle" towards the end of their pregnancy. 

"In around one in 35 women the hormone causes the ligaments to soften and stretch too much and become painful," says Ann Johnson, superintendent physiotherapist in women's health at Leeds General Infirmary

A side effect of this loosening is that the Symphysis Pubis has a wider range of movement. This can result in the grinding of the bones at the front of the pelvis, or pinching of nerves in the back.

How to recognise the symptoms of SPD

As your pregnancy progresses, you might start to feel a dull ache in your lower pelvic region. A lot of women describe it as a mild pain that feels like it's coming from inside the pubic bone. It's mild enough that many women probably write it off as one of the many small aches and pains that come with being pregnant. If the Symphysis Pubis becomes too loose, you can develop more severe pain in the lower pelvis, back, hips or even up and down your legs. Some women may have difficulty turning in bed, getting out of the car, climbing stairs or even walking.

Getting in and out of the car or turning in bed is also painful

If you are experiencing these symptoms, don't let your doctor or midwife dismiss them as 'part of being pregnant'. The condition is now more widely recognised than it was a few years ago, says Ann Johnson. It can be diagnosed by examining your pelvic joints and watching how you move. If it occurs after giving birth, as it does in a few cases, a pelvic X-ray or scan can be done. "You'll normally have a urine sample taken too to exclude any other causes of pain such as a urine infection," says Ann Johnson.

SPD normally happens from the second trimester of pregnancy onwards, but can occur at any stage in any pregnancy, even if you've never suffered before.

Managing the Pain and Treating SPD

If you find yourself experiencing pain, speak with your doctor or midwife right away. The best person to treat SPD is an obstetric physiotherapist, and usually, your GP or midwife can refer you.

There are a variety of things they might try, including:

• Warm baths (never take really hot baths while pregnant)
• The physiotherapist may give you a pelvic support garment to wear such as a belt or Tubigrip bandage, and crutches if walking is difficult.
• You can also be given gentle exercises to help strengthen the muscles supporting the joint and general advice about posture and activities to avoid.
• Your doctor can prescribe safe painkillers to take in pregnancy, usually paracetamol.

There are also some simple ways you can help minimise the strain on the ligaments and muscles. Pay special attention to how you move about during the day concerning your pelvis, hips, and legs:

• When getting into bed or the car, sit first and swing both legs together. Conversely, when getting out of bed or the car, swing both legs out and then stand up.
• Sit with both legs together. Never sit cross-legged or "Indian-style."
• Avoid strenuous walking or climbing. Ask for help with chores that require going up and down stairs. Rest as much as possible - it really helps!

Labour and Delivery

Make sure that the doctors, nurses and midwives working with you during labour and delivery are aware of your condition. There are a variety of positions you can use while giving birth and you'll want to choose those that place the least amount of stress on the Symphysis Pubis.

Ask them to avoid forcing your legs open and back while pushing as this can cause significant pain and even permanent damage. Your midwife should measure how far you can comfortably widen your legs at the onset of labour and ensure that you don't exceed this.

In very severe cases, an elective caesarean may be considered.

Lastly, make sure you have an advocate with you, who can speak on your behalf if you are too distracted. A spouse, parent, sibling or friend who is there to help you with your birth is a perfect choice.

Recovery

Symphysis Pubis Dysfunction typically goes away post-partum as the additional hormones leave your body. Most women feel fully recovered shortly after birth. In some cases, you may feel lingering discomfort. In rare cases, there is lasting damage which needs to be treated over time. This is highly unusual, but if you have concerns, you should definitely speak with your doctor.