My Pregnancy and Symphysis Pubis Dysfunction (SPD)

As I said yesterday, my pregnancy was difficult for me. It wasn't a difficult pregnancy in that there were complications with respect to the baby, but it was very tough on me.

The first trimester was awesome. I had sciatic pain but it was manageable and only occurred every once in a while. I exercised regularly and had no morning sickness. I couldn't have been happier.

Around the 20 week mark or so, I started having pains in my lower abdomen. I thought at first that it was sore muscles, since that's kind of what it felt like, but it turned out to be something called Symphysis Pubis Dysfunction. The last 20 weeks were the opposite of pleasant. They were torture for me and the main reason I decided to not have anymore children. I just don't think I could do it again, especially with a small child to care for. (At the end I was snapping at the cats for crying out loud.)

So, what is Symphysis Pubis Dysfunction (SPD)?
According to Birth Source, "During pregnancy or birth, about one in 35 women will experience intense pelvic pain and may find it difficult to walk, climb stairs, and other movements that involve the pelvic bones. This pain is a result of separation of the symphysis pubis which is a joint in the very front part of the pelvic bone structure. There is cartilage that fills the gap in the bones. During pregnancy, hormones such as relaxin soften this cartilage allowing the pelvic bones to be more flexible for delivery. Some women, however, have too much play in the pelvis causing a large gap between the bones. This makes the symphysis pubis area extremely sensitive to touch."

According to Plus-Size Pregnancy (PSP), other names for it include:

• pubic shear (osteopathic term)


• symphyseal separation


• pubic symphysis separation


• separated symphysis


• pelvic girdle relaxation of pregnancy


• pelvic joint syndrome.

Diastasis Symphysis Pubis (DSP) is the name for the problem in its most severe form (where the pubic symphysis actually separates severely or tears).

So what did that mean for me? Any activity that involved lifting one leg at a time or parting the legs was particularly painful. Lifting my leg to put on clothes, getting out of the car (and driving my stick shift), bending over, sitting down or getting up, walking up stairs, standing on one leg, lifting heavy objects, and walking in general were difficult (at times) in the beginning and all the time at the end.

Symptoms of SPD often include one or more of the following:

• pubic pain


• pubic tenderness to the touch; having the fundal height measured may be uncomfortable


• lower back pain, especially in the sacro-iliac area


• difficulty/pain rolling over in bed


• difficulty/pain with stairs, getting in and out of cars, sitting down or getting up, putting on clothes, bending, lifting, standing on one foot, lifting heavy objects, etc.


• sciatica (pain in buttocks and down the leg)


• "clicking" in the pelvis when walking


• waddling gait


• difficulty getting started walking, especially after sleep


• feeling like hip is out of place or has to pop into place before walking


• bladder dysfunction (temporary incontinence at change in position)


• knee pain or pain in other areas can sometimes also be a side-effect of pelvis problems


• some chiropractors feel that round ligament pain (sharp tearing or pulling sensations in the abdomen) can be related to SPD

Having this condition led me to stay home on medical leave for the last three weeks of my pregnancy, it was that bad.

My advice to you if you have any of those symptoms? Ask your doctor about them right away and make sure to let your family, friends, and co-workers know about your condition. I did, and people at work were especially helpful and considerate.

The problem with the whole thing? No one knows the cause. According to PSP, No one knows why SPD occurs for sure, or why it happens in some women and not in others. Some ethnic groups report a high incidence, especially Scandinavian women and perhaps Black women. Other risk factors may include having lots of kids, having had large babies, pre-existing problems with this joint, past pelvic or back pain, or past trauma (car accident, obstetric trauma, etc.) that may have damaged the pelvic girdle area. It also seems logical that women who have broken or injured their pelvis in the past would probably be prone to this problem.

Some sources view SPD simply as a result of pregnancy hormones. As noted, the pregnancy hormones relaxin and progesterone tend to loosen the ligaments of the body in preparation for birth. One theory is that some women have high levels of hormones before pregnancy, and then additional pregnancy hormones cause excessive relaxation of ligaments, especially in the pelvis.

Another theory is that some women manufacture excessive levels of relaxin during pregnancy, causing pelvic laxity. However, although still popular, this theory seems to have been disproven by recent research. Another theory is that women whose joints are especially flexible before pregnancy may be more susceptible to the effect of hormones, or that some women's bodies are just more affected by hormones than others. Traditional medical sources tend to view the problem of pelvic/pubic pain (when they acknowledge it at all) as simply a hormone problem.

A different theory holds that the problem is structural instead, and usually results from a misalignment of the pelvis. In this view, if the pelvis gets out of alignment, the bones don't line up correctly in front, and this puts a lot of extra pressure on that pubic symphysis cartilage. If the two sides are not aligned, it restricts full range of motion, pulling on the connecting pubic symphysis, and making it quite painful. The more out of alignment it is, the more painful this area becomes. It also tends to affect the back, especially in the sacroiliac area, since the pelvis and back are interconnected and work as a unit. And since many areas are affected by back problems, pain can also extend to other areas too.

Although there is no real treatment options for SPD (you know, so you can get rid of it altogether), there are still some things you can do to try and ease the pain and discomfort.

Tips for Coping with Pubic Symphysis Pain

Although the best idea may be to resolve chronic SPD pain through realigning the pelvis girdle and soft tissues, most women have at least some residual pubic and low back pain stick around for pregnancy and the early postpartum weeks because of hormones. Therefore, tips for coping with pubic pain tend to be a focus of many SPD websites. Many of the suggestions include:

• Use a pillow between your legs when sleeping; body pillows are a great investment!


• Use a pillow under your 'bump' (pregnancy tummy) when sleeping


• Keep your legs and hips as parallel/symmetrical as possible when moving or turning in bed


• Some women also find it helpful to have their partners stabilize their hips and hold them 'together' when rolling over in bed or otherwise adjusting position


• Some women report a waterbed mattress to be helpful


• Silk/satin sheets and nighties may make it easier to turn over in bed


• Swimming may help relieve pressure on the joint (many sites recommend avoiding breaststroke but Kmom did not find it to be a problem at all for her; see what works for you)


• Deep water aerobics or deep water running may be helpful as well (there are flotation devices to help you stay afloat easily during this; you do not need to know how to swim in order to do this)


• Keep your legs close together and move symmetrically (other sources recommend a very small gap between the legs with symmetrical movement)


• When standing, stand symmetrically, with your weight evenly distributed through both legs


• Sit down to get dressed, especially when putting on underwear or pants


• Avoid 'straddle' movements


• Swing your legs together as a unit when getting in and out of cars; use plastics or something smooth and slippery (like a garbage bag) on the car seat to help you enter car backwards and then turn your legs as a unit


• An ice pack may feel soothing and help reduce inflammation in the pubic area; painkillers may also help


• Move slowly and without sudden movements


• If sex is uncomfortable for you, use lots of pillows under your knees, or try other positions


• If bending over to pick up objects is difficult, there are devices available that can help with this


• Really severe cases may need crutches, although these should probably only be used as a last resort


• Sciatica may be helped by stretching the hamstring muscles with a stirrup around your foot (long piece of rope, two neck ties tied together, etc.)
  


• Back pain can often be helped by resting backwards over a large gymnastic or 'birth' ball
  


• Some women report that pelvic binders/maternity support belts are helpful for pelvic pain; brands in the U.S. include Prenatal Cradle or BabyHugger or the Reenie Belt. However, if the pelvic bones are really misaligned, some women report more pain with these. Listen to your body on whether to use these

If you are having problems in your pregnancy and you weren't sure what they were but now you know, I am glad to have helped you!! If you are suffering from SPD, you have my complete and total sympathy. If you suffered through this and are pregnant again, good luck. From what I have read, it is supposed to get worse in subsequent pregnancies. I have been seeing a chiropractor, so I have a little hope that if I were to get pregnant again (by some kind of fluke) it would be less than it was with Willow but something tells me that that is wishful thinking.