Why does it hurt to roll over in bed?
Why does my pelvis feel like it's on fire when I'm trying to put on pants?
Why does every.single.step I take HURT?!
A lot of pregnant women are afraid their pelvis is going to split in half during labor. For most women, this is just a laughable, irrational thought. But for some women, it's a real possibility! Symphsysis Pubis Dysfunction (SPD) is a serious, and I would hazard to say grossly under-diagnosed and under-reported, issue. We'll start with the basics, then move on to solutions. If you've wondered any of the above, it's possible you might be dealing with SPD. If you're here because you know you have SPD and don't need the background, feel free to jump right down for SPD solutions.
What is symphysis pubis dysfunction?
First, some anatomy. Below, we've got a picture of a female pelvis (and, because this fascinates me, look at how big and round and open it is - babies fit perfectly!). The arrow points to the pubic bone (aka pubic arch). That point right in the middle is what you feel if you're poking around at the bones just above your crotch, and below or behind your bladder. If you do this while pregnant and dealing with SPD, don't poke too hard because it will probably hurt!
It's hard to tell in the picture above what exactly the pubic symphysis is, so I've added another picture below. See that tiny bit of cartilage in between the pubic bones? That's it! That's the pesky piece of anatomy keeping you up at night! Technically, this is a joint in your body, but unlike most other joints, it doesn't usually move or allow for much flexibility at all.
Usually, this cartilage stays nice and firm, allowing for hardly any movement of that joint. Once you are pregnant, though, your body does some miraculous work! With various hormones at play, everything starts to loosen up a bit. This allows for some amazing flexibility and "give" in the pelvis - great during labor, when you want to be able to open as wide as you can, but not so great during pregnancy, when it can contribute to ongoing pain and discomfort.
Depending on how loose everything gets, there are a few directions this could cause your joint to move. See the picture below for a visual of this.
The more common issue that the extreme separation will occur in the direction of the longer arrows, causing your pelvis to open up more in the front. It's also possible that the joint could move up or down, resulting in separation following the shorter arrows. Either way will hurt, and the solution to both is getting the joint back in place and stabilizing it. Remember, this joint is meant to have a little bit of give to it; issues arise when the joint separates too far.
Symptoms of SPD
The most obvious symptom of an issue is pain. With SPD, this is pubic pain, and can also include lower back pain. Specifically, this can feel like your pubic bone is on fire. You might feel a burning sensation, or even feel like the tissues are tearing. The pubic bone is often very tender. Even slight touch, such as that required to measure your fundal height, can be very uncomfortable.
You may experience difficulty or pain when rolling over in bed. Doing any activity that requires separation of the pelvis is often painful: stairs, getting out of the car, putting on clothes, standing on one foot, lifting, etc.
Some women feel a clicking in the pelvis while walking. SPD may also be the cause of the pregnancy "waddle," though waddling can occur without SPD.
Sometimes, the pain is referred to other areas, such as your knees or hips. It's also possible that round ligament pain could be related to SPD.
Another common issue somewhat related to SPD is pain near your sternum or xiphoid process. Stay tuned for a blog post with a trick for pain relief in that area!
Relief for SPD
- Pillows! Use pillows between your legs and under your belly when sleeping.
- Keep your legs together as you are turning or moving. A really great trick I learned from my midwife is illustrated below. This trick seems to "activate" the muscles supporting your pubic area, which allows you to then move them with less pain. Without activating the muscles/joint first, it seems to startle the joint to be suddenly put into action, and this causes more pain.
- Keep your legs as parallel as possible when you are rolling over in bed.
- Try to maintain symmetry in weight distribution and leg position as much as possible - when standing, sitting, getting dressed, etc
- Avoid movement like straddling or anything that splits apart the knees, such as squatting, tailor sitting, etc. Please note: these exercises might not hurt while you are doing them, but they can still cause a problem by stretching out the symphysis joint more than desired.
- Swing your legs together as a unit when getting in and out of your car.
- Ice directly on the pubic bone can feel really great!
- Move slowly and without sudden movement.
- If sex is uncomfortable, but you'd still like to give it a shot, remember the positioning advice mentioned above, and use lots of pillows to help support your legs and body.
- 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.)
- If you have a birth ball or exercise ball, leaning over backwards on the ball can help gently stretch your back, which will help alleviate lower back pain related to SPD. Make sure to remain as symmetrical as possible while doing this.
- Some doctors and online resources recommend using pelvic girdles to keep everything in place. Listen to your body with these, and if your body says to stop, don't use the girdle. Some women report more pain with these devices, probably because of a severe misalignment.
SPD & Pregnancy Dos
- Talk to your care provider about your experience.
- Visit a chiropractor who is experienced with this type of condition.
- Try the above-mentioned relief activities.
- Share your experience and ask questions in the comments below!
SPD & Pregnancy Don'ts
- Squat, tailor sit, or do other activities that cause your pelvis to stretch.
- Take stairs two or more at a time. Yes, it's faster, but it causes more potential for separation!
- Delay. The earlier you take action, the sooner you'll feel relief.
- Be afraid to talk about it. It's much more common than you think.
See my post about Laboring with Symphysis Pubis Dysfunction here.
What has been your experience with symphysis pubis dysfunction?
I'd love to hear your story! Did your provider recognize and diagnose SPD when you brought it up? What worked for you? What didn't help?