Symphysis Pubis Disorder

Can you even pronounce that!?!
Well, I have been on a MASSIVE hunt to find out what is wrong with me and it looks like I have finally nailed this sucker! Everything that SPD describes is what I am and have been suffering with. I can barely get upstairs and then forget about climbing into bed, I need a step ladder!
So this is what SPD is...

What is Symphysis Pubis Dysfunction?
The symphysis pubis is the name given to where two bones meet at the front of the pelvis. The pelvic bone is roughly in the shape of a heart, and is actually formed by three bones, which are held together by very strong ligaments.

The bones meet to form three 'fixed' joints - at the front (the symphysis pubis) and at each side of the bottom of the spine (the sacro-iliac joints).

Normally, these joints are not designed to allow movement. However, when a woman becomes pregnant, a hormone called relaxin is produced which loosens all the pelvic ligaments in order to allow the pelvis slight movement at the time of birth.

For some reason, the ligaments occasionally loosen too much and too early before birth. This means they can't keep the pelvic joints stable so the pelvis moves, especially on weight bearing. All this is made worse by the increased weight of the growing baby and sometimes the symphysis pubis joint actually separates slightly. The result is mild to severe pain, usually in the pubic area, and is called SPD.

What are the symptoms?
The most common is pain and difficulty when walking. Some women describe the feeling of their pelvis coming apart. The pain is made worse when turning in bed or doing something that involves standing on one leg, such as climbing up stairs, getting dressed and getting in and out of a car.

The pain is generally felt in the pubis and/or the sacro-iliac joints, but can also be experienced in the groin, the inner side of the thighs, the hips and in one or both buttocks.

SPD can occur towards the end of the first trimester or after delivery. Many women notice their symptoms for the first time around the middle of their pregnancy. If you experience SPD in one pregnancy, it is more likely that it will reoccur in your next pregnancy. The symptoms may also come on earlier and progress faster, so it is important to seek help as early as possible. It can help if you allow the symptoms from one pregnancy to settle before trying to conceive another child.

What are the symptoms?
Pain in the pubic area and groin are the most common symptoms. You may also suffer from back pain in pregnancy, Pelvic Girdle Pain (PGP) or hip pain. It is common to feel a grinding or clicking in your pubic area and the pain may travel down the inside of the thighs or between your legs. The pain is usually made worse by separating your legs, walking, going up or down stairs or moving around in bed. It is often much worse at night and can stop you getting much sleep. Getting up to go to the toilet in the middle of the night can be especially painful.

How is it diagnosed?
SPD is becoming more widely understood by GPs, obstetricians and midwives. Your doctor or midwife should refer you to a physiotherapist from the Association of Chartered Physiotherapists in Women's Health, who will have experience in treating this complaint. It is diagnosed by a combination of your own description of symptoms and a series of tests designed to look at the stability, movement and pain in your pelvic joints.

How is it treated?
A pelvic support belt can often give quick relief. Exercises -- especially for the tummy and pelvic floor muscles -- form a large part of the treatment and are aimed at improving the stability of your pelvis and back. You may need mobilisation (a gentler form of manipulation) of your hip, back or pelvis to correct any underlying movement dysfunction. Hydrotherapy (exercise in water) and acupuncture can sometimes be useful. Surgery is only used to treat the most severe DSP cases and is often unsuccessful.

You should also be given advice on how to make normal daily activities less painful and on how to make the birth easier. Your physiotherapist or midwife can help you to devise a birth plan which takes your SPD symptoms into account.

Other therapies that may be useful include osteopathy and chiropractic but it is essential that you see a registered practitioner who is experienced in treating pregnant women.

Self-help tips

• Avoid pushing through any pain. If something hurts, if possible don't do it. If this type of pain is allowed to flare up, it can take a long time to settle back down again.

• Move little and often. You may not feel the effects of what you are doing until later in the day or after you have gone to bed.

• Rest regularly by sitting reasonably upright with your back well supported.

• Avoid heavy lifting or pushing (supermarket trolleys can be particularly painful).

•When dressing, sit down to put on clothing such as your knickers or trousers. Pull the clothing over your feet and then stand up to pull them up. Don't try to put your legs into trousers, skirts or knickers whilst standing up.

• When climbing stairs, go up them one step at a time. Step up onto one step with your best leg and then bring your other leg to meet it. Repeat with each step.

• Avoid separating your legs and making straddling movements -- such as when getting in and out of the car or bath. If you need to separate your legs, do so slowly and carefully and keep your back arched.

• Avoid swimming breaststroke if you can and take care with other strokes. Swimming can often feel like it is helping whilst you are in the water but cause an increase in pain when you get out.

• Performing regular pelvic floor exercises and lower abdominal exercises can help to reduce the strain of the pregnancy on your pelvis. To perform a safe and easy lower abdominal exercise, get down onto your hands and knees and level your back so that it is roughly flat. Breathe in and then as you breathe out, perform a pelvic floor exercise and at the same time pull your belly button in and up. Hold this contraction for 5-10 seconds without holding your breath and without moving your back. Relax the muscles slowly at the end of the exercise.

• Follow the advice in our protecting your back and pelvis article.

• You can get in touch with other women in your situation by contacting The Pelvic Partnership, a charity which was set up to offer support to women with SPD. The National Childbirth Trust also offers information and support to women with a range of pelvic dysfunctions.

How soon will I recover from my SPD symptoms after the birth?
A recent study showed that around 60% of women with SPD still experienced some symptoms after delivery. Most women find that their symptoms improve after the birth of their baby although a small percentage still have pain when their babies are a year old. You should continue with physiotherapy after the birth and get help with looking after your baby during the early weeks if you can. Some ex-sufferers find they experience pain every month just before their period is due, which is caused by hormones which have a similar effect to the pregnancy hormone relaxin.