9 June 2011 | Dr Stephen Sandler | Consultant Osteopath | The Portland Hospital
Pubic pain is a common problem during pregnancy, affecting up to one in four expectant mothers to some extent.
The condition is medically known as Symphysis Pubis Dysfunction (SPD) or pubalgia of pregnancy or pelvic girdle pain and is caused by pregnancy hormones such as relaxin increasing the range of movement in the pelvis.
Women with SPD have excessive movement in the pubic symphysis – also known as the pelvic arch - at the bottom of the pelvis, causing the pelvis to become misaligned.
The problem commonly occurs for the first time between the fifth and eighth month of pregnancy and causes pain in the symphysis bone as well as in the lower back, hips, groin, sacroiliac joint, lower abdomen and legs.
It can also lead to women ‘waddling’ when they walk, having difficulty climbing stairs, standing or carrying out weight bearing activities.
While for most women symptoms will disappear after childbirth, for around seven per cent serious problems will continue afterwards.
SPD is not a new condition – it was first recognised thousands of years ago by Hippocrates.
However, incidence of SPD appears to have increased in recent years, possibly as a result of women having babies later or simply because the condition is being diagnosed more frequently. It is more common in women who already have children and who do jobs that strain the back. It recurs in up to 70 per cent of women.
There are several ways to treat SPD. Physiotherapists who have a special interest in women’s health, can give their patients a pelvic support garment to wear such as a belt or Tubigrip bandage, and crutches if walking is difficult.
Patients may also be given gentle exercises to help strengthen the muscles supporting the joint and general advice about posture, activities to avoid and delivery options and positions (it is usually recommended that women with SPD give birth in the upright position to prevent further damaging the pelvis or have a water birth as this supports the joints and assists with pain relief).
From an osteopathic point of view, patients with this problem need to have the whole pelvic ring evaluated not just the pubic symphysis alone.
Assessment of the pelvis is done through tests while the patient is standing, lying down and on their side. If pelvic ring syndrome is diagnosed, the restricted joint is treated using gentle manipulation. Pregnant women can also carry out a series of exercises to ease the condition.
The use of belts or binders for women to give support to women with SPD remains contentious. Some belts work for some patients, and some are better for others.
What is important is that the belt is worn low down - it should never compress the abdomen – and they tend to work better outside the patient's clothing.
For further information Dr Stephen Sandler, Consultant Osteopath at The Portland Hospital, can be contacted on 07659 593509.