Everyone knows that during pregnancy there is colossal hormonal restructuring in the body of a woman. As a result, under the influence of relaxin and progesterone hormones, softening of ligaments occurs. This leads to increased mobility of the symphysis pubis, which causes unpleasant pain. Normally, the mentioned above hormones are necessary to increase the flexibility of bone structures to help with the childbirth. But sometimes there is excessive mobility, which causes pain in the symphysis pubis. This is called the symphysis pubis dysfunction or SPD. The SPD pregnancy phenomenon is quite rare, but it still occurs. And if it takes place, it is necessary to take appropriate measures.
What Is SPD Pregnancy?
Symphysis pubis dysfunction (SPD pregnancy) is a condition that causes excessive movement of the pubic symphysis, either anterior or lateral, as well as associated pain, possibly because of a misalignment of the pelvis. Most commonly SPD is associated with pregnancy and childbirth. 1 out of 300 women faces SPD pregnancy. At the same time, according to other studies it happens more often – 1 out of 50 suffers from symphysis pubis dysfunction.
SPD during pregnancy means the ligaments that normally keep your pelvic bone aligned during pregnancy become too relaxed and stretchy too soon before birth. This, in turn, can make the symphysis pubis unstable, causing some pretty strange sensations and pelvic pain.
Predisposing Factors of SPD Pregnancy
Possible predisposing factors of symphysis pubis dysfunction include:
- The presence of symphysis pubis dysfunction in the anamnesis;
- Pelvic instability (asymmetry of the pelvis, anatomically narrow pelvis, osteochondrosis, marked lordosis);
- Enzymatic changes: increased level of hyaluronidase, reduced collagen synthesis;
- Hormonal causes: increased levels of estradiol, progesterone, relaxin;
- Metabolic causes: decrease in calcium, vitamin D;
- Pelvic pain in previous pregnancies, including trauma and surgery in this area;
- Early puberty;
- Prolonged intake of oral contraceptives;
- Second and subsequent childbirth, as each child in most cases has a slightly larger mass at birth, and, accordingly, the load is greater;
- Prolonged pregnancy;
- A large fetus or a narrow pelvis in a woman;
- Use of vacuum extraction or obstetric forceps during the delivery.
Undoubtedly, an important role is played by a lack of calcium or a violation of its metabolism in the body. As a result, bones and joints become less resistant to external influences.
With kidney pathology, an increase in the excretion of proteins and minerals from the body can be observed. Thus, in case of increased need, they are borrowed from bones, joints, teeth, etc. These structures are destroyed, and the probability of separation of the symphysis pubis increases.
In women with symphysis pubis dysfunction among extragenital diseases, prolapse of the mitral valve, varicose veins, diseases of the organs of vision (myopia) are often noted, which indicates the presence of phenotypic signs of connective tissue dysfunction and, indirectly, the possibility of developing a SPD pregnancy.
Complications of pregnancy in women with symphysis pubis dysfunction include:
- isthmic-cervical insufficiency,
- polyhydramnios, multiple pregnancies.
Symptoms of Pathology
The severity of the symptoms does not always depend on the degree of symphysis pubis dysfunction. It is assumed that the clinical picture is more dependent on the concomitant inflammation in this area. So, if there is an inflammation – a woman feels severe pain, and if there is none, even with a severe form of SPD pregnancy nothing bothers a woman until a certain point.
The Main Symptoms Include the Following:
- Most often, pregnant women complain of pain in the area of the pubic region and symphysis pubis. They can be different types of pain. Most often the pain takes place in the groin, perineum, back, and legs. Pains are aggravated by turning the body, standing or walking upstairs and downstairs, etc. At the same time, after rest, there is some improvement in well-being.
- Sometimes a woman may feel that “something is clicking” in this area.
- There may be pain during sexual intercourse. Also, urination and defecation are impaired.
- When examined, the soreness and swelling of the area above the pubic area is revealed. Sometimes the gap between the bones can even be palpated.
Any samples that require the use of the pelvis and limbs will be painful or even impossible.
What Is the Danger during and after Pregnancy?
In 99% of cases, a bright clinical picture of the disease manifests itself after childbirth. During pregnancy, a woman is only concerned about varying degrees of pain that go away after some rest. If you do not pay attention to them and do not take appropriate measures, you can face not only the symphysis pubis dysfunction after birth, the consequences may be trauma or even rupture of the bladder, urethra, clitoris, etc.
Treatment of pathology requires a long (sometimes several months) immobilization in a certain position, which makes the normal life of a young mother impossible. The condition often requires serious surgery to fix the symphysis pubis bones.
The diagnosis is based on the clinical picture, the patient’s complaints and examination by specialists. The following methods are used as ways of additional research:
- Ultrasound, that allows determining the presence or absence of SPD pregnancy, the approximate degree, and also checking the integrity of all other pelvic organs (bladder, etc.).
- X-ray study of pelvic bones. It is a budgetary and informative enough method for establishing a diagnosis.
- MRI allows revealing all defects of the bones with special accuracy.
- CT scan is more likely to show changes in soft tissues, as well as the cartilage itself in the symphysis pubis.
After performing at least two of these studies, you can definitively establish a diagnosis and determine the tactics of care of a pregnant woman.
Treatment of Symphysis Pubis Dysfunction
Normally no surgical and medicinal interventions are required. After successful delivery, the integrity and flexibility of the ligaments and joints comes back to normal.
Doctors recommend wearing a bandage, performing certain gymnastic exercises and explain how to correctly perform movements in order to reduce the burden on symphysis.
Doctors also prescribe drugs containing calcium, magnesium, and B vitamins.
Before delivery it is necessary to inform the obstetricians about the problem in advance. Thus, they take this into account during childbirth to prevent complications.
But if the SPD pregnancy passes to the second or third degree, doctors prescribe a complete bed rest to avoid the subsequent expansion of the distance between the bones. Otherwise, the joint may break. Also, doctors prescribe drugs with calcium, magnesium, B vitamins, as well as painkillers and, if necessary, antibiotics.
Today, there are special corsets that hold the pelvic bones. It is especially recommended to be worn in the first 3-5 days after delivery, when complications often occur.
Preventive Measures of SPD Pregnancy
It is not always possible to predict the development of any kind of symphysis pubis dysfunction. Often, women at risk do not experience any difficulties during pregnancy and after childbirth. But it is recommended to adhere to the following rules:
- It is necessary to plan pregnancy and undergo regular examination to identify other diseases, as well as conditions provoking SPD pregnancy.
- During pregnancy, you should include in the diet foods rich in calcium, iron and other vitamins and microelements. This is necessary not for the developing baby, but to make up for the losses of the woman.
- Fetal ultrasound should be performed in order to identify presumably large children in advance. This is especially true for women with diabetes.
- If you feel even the slightest unpleasant sensations in the area of the pelvis or a symphysis pubis it is necessary to inform your attending physician about it.
SPD pregnancy is a serious, sometimes disabling pathology. More often pregnant women face less dangerous forms of SPD – symphyseopathy, isolated symphysitis. These conditions do not require so serious treatment, but still bring a lot of inconvenience to the young mother. Correctly chosen tactics of prenatal care, including competent delivery, in many respects will help to avoid such dangerous situations.