Pubic Symphasis Dysfunction

Many pregnant women experience pubic pain during pregnancy. Although not a common symptom, I do see about two cases a month, or about 25 cases a year. The pain can be extremely uncomfortable and patients often think there is no hope for relief because their doctors has dismissed this pain as either “inconsequential,” “unfixable,” or “just one of those pregnancy discomforts that have to be endured”.

Occasionally, some uninformed doctors have even erroneously told women that such pubic pain means that they would need an elective cesarean section to avoid permanent damage to that area during birth, or as a result of prior damage to the area.

None of this is true. Pubic pain in pregnancy is certainly not “inconsequential”; it can also be very difficult to deal with. Many women are able to get improvement or relief with chiropractic treatment, acupuncture, massage or a combination of these modalities. It is not something that you “just have to live with.” And although extra care should be taken during labor and birth in order to prevent trauma, it absolutely does NOT mean that you must have a cesarean delivery.

Although not every provider has a name for this condition, it is most commonly called Symphysis Pubis Dysfunction (or SPD), especially in Britain. Other names for it include: pubic shear (an osteopathic term), symphyseal separation, symphysis separation, separated symphysis, pelvic girdle relaxation of pregnancy, and pelvic joint syndrome.

The symptoms of SPD vary from person, but almost all women who have it experience substantial pubic pain. Tenderness and pain down low in the front is common, but often this pain feels as if it’s inside. The pubic area is generally very tender to the touch; many moms find it painful when the doctor or midwife pushes down on the pubic bone while measuring the fundal height of the uterus.

Any activity that involves lifting one leg at a time or parting the legs tends to be particularly painful. Lifting the leg to put clothes on, getting out of bed or a car, bending over, sitting down or getting up, walking up stairs, standing on one leg, lifting heavy objects, and walking can be difficult at times. Many women report that moving or turning over in bed is especially excruciating.

Many of our patients with SPD also report very strong round ligament pain (pulling or tearing feelings in the abdomen when rolling over, moving suddenly, sneezing, coughing, getting up, etc.). Some chiropractors feel that round ligament pain can be an early symptom of SPD problems, and indicate the need for adjustments. Other providers consider round ligament pain normal, part of the body adjusting to the growing uterus. If experienced with pubic and/or low back pain, round ligament pain is probably associated with the SPD.

Indeed, although pubic pain often does go away after pregnancy, many women find that it sticks around afterward, usually diminished, but still present. If the underlying causes are not treated, long-term pain usually sticks around. Anecdotally, this often seems to be associated with long term low back pain or reduced flexibility in the hips.

Most of our patients experience some relief of their pubic bone pain. About 50% say they feel drastic improvement, although regular visits throughout the remainder of pregnancy are often necessary to maintain the relief. Nearly all of our patients report that after our care the SPD did not cause them pain or dysfunction in labor.

If you or someone you know suffers from pubic pain during pregnancy, please call for more information or to set up an appointment (323) 549-0070.