Pubic Bone Pain in Pregnancy

Understanding Symphysis Pubis Diastasis

Pregnant woman in pain on phone
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Pubic bone pain in pregnancy is fairly common. A condition known as symphysis pubis diastasis (SPD) often causes this pain. 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.

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 when 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). Interestingly, the waddle often associated with pregnant women is also often a result of the relaxin and loosening of the pelvic ligaments.

How Is 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. It is more common, however, to simply begin treatment after making a diagnosis based on your symptoms alone. If you have already had your baby and you are still having pain, an x-ray is the best diagnostic test available.

Symptoms of SPD

The most common symptom of SPD is the pubic bone pain.

You may also note some swelling in the area of your pubic bone and experience some waddling in the way you walk, or notice that your legs don't quite come together. You may notice that you can feel or hear a clicking noise when walking or moving your legs.

For some women, certain movements can be painful.

In particular, getting out of bed, getting into the bathtub or car, putting on pants, sitting for long stretches, or performing repetitive tasks are signs that you may be experiencing SPD. Your doctor or midwife can help you best understand your symptoms.

Treatments for SPD and Pubic Bone Pain

Although SPD is usually relieved once you have your baby, there are some treatments available for when you're still pregnant.

  • 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 your visits to the office.

  • Avoid situations that cause pain. For example, sit down to put pants on, or sit on the side of the tub and swing over both legs together.
  • It is best to avoid standing for long periods of time. If you must stand, wear sensible shoes and try to move around, 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.
  • Heat can be a source of pain relief. 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 can help. Ask your doctor, midwife, or physical therapist for moves you can do. The buoyancy involved in swimming, for example, can provide pain relief.
  • Occasionally, pain medication is appropriate and your practitioner can help you decide what would help most. The most common forms of pain medication include analgesics and anti-inflammatories.

Risk Factors for SPD

You may be more likely to experience pubic bone pain 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. 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 pubic bone area.

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 involves 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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