Pubic Bone Pain in Pregnancy

Symphysis Pubis Dysfunction

Pregnant woman in pain on phone
Photo © Jonathan Galione/Getty Images

Pubic bone pain in pregnancy is also known as Symphysis Pubic Diastasis (SPD). This is where, usually in later pregnancy, the hormone relaxin causes the pelvis, particularly at the pubic bone, to loosen. In general, this is a good thing as it makes birth easier for mom and baby. However, sometimes the separation is exaggerated and can become quite painful for the mother at the end of pregnancy or in the early postpartum period.

While pregnant women have been known to waddle, the relaxin and loosening of the pelvic ligaments is the reason behind the waddle. When there is too much laxity there can be instability and pain. You may notice this pain when walking, standing or trying to move your legs apart like stepping into pants or the bath tub. Most of the pain is typically centered up front in the pubic bone area, above your mons pubis (below pubic hair).

"I felt like I was being pulled in two," remembers a mother, pregnant with her fourth baby. "I would have to fall out of bed because I couldn't separate my legs.  The belt is what really helped me get through pregnancy. We had to special order it but it was worth it."

"My doctor suggested swimming for exercise because I could not walk. It was weird at first, but once I got the hang of what I called, mermaid swimming, swimming with my legs together, it worked really well," said Amanda, a second time mother.

There are a couple of treatments for pubic bone pain:

  • Stabilize your pelvis as much as you can via a pregnancy/maternity binder like the Prenatal Cradle. You may also try using a Rebozo Mexican Shawl. Studies recommend that a flexible belt or binder works better than a rigid one.
  • Ask your doctor or midwife about physical therapy. This may help in the long term. While it may be time intensive, many say it's worth it. You could also ask for advice on what you could do at home to decrease the frequency with which you attend.

  • Avoid situations that cause pain. For example, sit down to put pants on, sit on the side of the tub and swing both legs together. This will help take some of the pain away.
  • Avoid standing for long periods of time. Wear sensible shoes, if you have to stand.
  • Use a rice sock to help provide moist heat to your pelvis. This is perfectly safe and does not involve medications.
  • Occasionally, pain medication is appropriate and your practitioner can help you decide when and what.

The good news is that shortly after delivery you should be feeling much better as the production of relaxin stops.

Sources:

Depledge J, McNair PJ, Keal-Smith C, Williams M. Phys Ther. 2005 Dec;85(12):1290-300. Management of symphysis pubis dysfunction during pregnancy using exercise and pelvic support belts.

Flack NA, Hay-Smith EJ, Stringer MD, Gray AR, Woodley SJ. BMC Pregnancy Childbirth. 2015 Feb 15;15:36. doi: 10.1186/s12884-015-0468-5. Adherence, tolerance and effectiveness of two different pelvic support belts as a treatment for pregnancy-related symphyseal pain - a pilot randomized trial.

Pennick V, Liddle SD. Cochrane Database Syst Rev. 2013 Aug 1;8:CD001139. doi: 10.1002/14651858.CD001139.pub3. Interventions for preventing and treating pelvic and back pain in pregnancy.

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