Pubic Bone Pain in Pregnancy

Symphysis Pubis Diastasis

Pregnant woman in pain on phone
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Pubic bone pain in pregnancy is fairly common, but there is also a potentially painful condition that may cause this pain, known as Symphysis Pubis Diastasis (SPD). 

What Causes Pubic Bone Pain in Pregnancy?

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). 

How is Symphysis Pubis Diastasis (SPD) Diagnosed?

During pregnancy, because x-rays are not recommended, your practitioner may order an ultrasound. The ultrasound is meant to look at the space between the bones of the pelvis at the pubic bone. Though it is more common to simply begin treatment after making a prenatal diagnosis based on your symptoms alone.

If you have already had the baby and you are still having pain, an x-ray is the best diagnostic test available.

Symptoms of Symphysis Pubis Diastasis (SPD)

The most common symptoms of SPD is the pubic bone pain. Though you may also note some swelling in the area of your pubic bone. You may also have experienced some waddling in the way you walk and even notice that your legs don't quite come together.

This may or may not be related to SPD and may simply be a product of regular pregnancy side effects. Your doctor or midwife will help you make the determination. You may also notice that you can feel or hear a clicking noise when walking or moving your legs.

You may also notice that certain movements are painful. Some of the common things that pregnant people cite are:

  • Getting out of bed
  • Getting into the bathtub or car
  • Putting on pants
  • Sitting for extended for long stretches
  • Repetitive tasks

Basically anything that causes you to separate your legs can be painful. Though walking is not always painful.

Treatments for Pubic Bone Pain in Pregnancy

The good news is that there are some things that do tend to help the pain. Though the cure is usually to simply have the baby. 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. This can also help you prevent further injury from having a less stable pelvis. 
  • 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. The goal of physical therapy is to help build or restore muscle strength in the area.

  • 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.
  • It is best to avoid standing for long periods of time. If you must stand, wear sensible shoes and try to move around some to avoid standing in one place, even if this means you simply shift from foot to foot every so often. You can also use a small stool or box to prop a foot up as you stand, switching sides.
  • Heat can also be a source of pain relief for the area. Use a rice sock or hot water bottle to help provide moist heat to your pelvis. This is perfectly safe and does not involve medications. It can also be done multiple times a day.
  • Certain forms of exercise. This might be specific movements or exercises prescribed by your doctor, midwife or physical therapist, or it could be a generic instruction to do something like swimming to provide pain relief because of the buoyancy. There are also some physical therapists that will work with you in the pool. One such exercise frequently suggested is known as mermaid swimming, swimming with your legs held together like you had a mermaid tail.
  • Occasionally, pain medication is appropriate and your practitioner can help you decide when and what. The most common forms of pain medication include analgesics and anti-inflammatories.

Risk Factors for Symphysis Pubis Diastasis (SPD)

You may be more likely to experience pubic bone pain or Symphysis Pubis Diastasis (SPD) if you are carrying multiples, if this is not your first baby, if you have a very large baby, or if you have had SPD in a prior pregnancy.

The good news is that shortly after delivery you should be feeling much better as the production of relaxin stops. Though if you do not feel notably better after a few weeks, you may want to ask your practitioner for an additional screening. You may need to add additional therapies, like physical therapy to help build muscle strength in the area as well.

A Word From Verywell

Pubic bone pain in pregnancy can make some of the most basics tasks of life a bit more difficult. Talking to your doctor or midwife can help you figure out what you can do to minimize pain and resume a normal life more quickly. Most of the time this is about lifestyle adjustments and waiting until the baby is born, but there may also be other forms of help available, including physical therapy, and sometimes, medications.

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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