Pubic symphysis dysfunction (SPD) in pregnancy

What is symphysis pubis dysfunction?

Symphysis pubis dysfunction (SPD) – or pubis symphysis dysfunction – is a kind of pelvic pain that happens during pregnancy. It's also called pelvic girdle pain (PG).

The pubic symphysis is a joint that sits centered between your pubic bones, right above your vulva. When you're pregnant, the ligaments around this joint become more elastic and flexible, so that your baby can pass through during delivery. When the ligaments become too relaxed before then, though, it can cause instability and pain.

SPD can range from discomfort to severe pain that hampers your mobility. It can happen in the front and the back of the pelvis. SPD may be worse at night or after you've been very active. It may feel as if your pelvis is unstable.

How common is SPD in pregnancy?

SPD is common. About one third of pregnant women have reported symphysis pubis dysfunction. As it becomes increasingly recognized, the documented numbers are increasing.

What does SPD feel like?

SPD pain is often a stabbing, wrenching pain. You may feel the pain in the front middle of your pubic bone, in your lower back on one or both sides, and/or in your perineum (the area between your vagina and anus). The pain may radiate to your upper thighs.

The pain may worsen when you widen your legs or when you put weight on one leg. Activities that may make SPD worse include:

• Walking
• Climbing stairs
• Getting dressed
• Turning over in bed
• Getting in and out of a car 

Because they increase abdominal pressure, sometimes coughing or sneezing can make pelvic girdle pain worse, too. 

What causes pubic symphysis pain?

Your body produces the hormone relaxin as early as 10 weeks of pregnancy. As you might guess by the name, this hormone relaxes your ligaments, including the ones that hold the pelvic bones together. While this is helpful when it comes time to deliver your baby, if the ligaments stretch too far, or if they allow the pelvic bones to move too easily before then, it can cause instability and pain. SPD can get worse as your pregnancy progresses because of the weight and position of the baby.

SPD can also happen when you're not pregnant, from osteoarthritis or injuries, though it's uncommon.

You are at higher risk for SPD if you:

• Had SPD in a previous pregnancy 
• Have had multiple pregnancies
• Have had pelvic trauma, like a  motor vehicle accident involving the pelvis, or a back injury
• Are overweight
• Are having multiples
• Are having a very large baby (macrosomia)
• Experience rapid descent of the baby’s head during the pushing stage of labor

Will pubic symphysis dysfunction affect my pregnancy or labor and delivery?

Pubic symphysis dysfunction won't hurt your baby, but it can certainly make your pregnancy and possibly your labor and delivery more uncomfortable, or even painful. And if it occurs primarily during labor and delivery, you may experience a more painful postpartum recovery.

Talk with your caregiver about your pain so that you can be prepared for any difficulties that arise during labor and delivery. You may want to experiment with different labor and birth positions that provide more support for your pelvis, for example. 

And if you choose to have an epidural or spinal anesthesia, you'll want to be careful not to overstretch your ligaments while you're numb. Spreading your thighs widely during pushing, and/or grabbing your legs behind your knees and pulling back, is often recommended by labor and delivery nurses but would not be a good idea, especially if you have an epidural and can’t feel the strain on your joints and ligaments. 

What is diastasis symphysis pubis?

Diastasis symphysis pubis (DSP) means that the pubic joint is separated too far. The space between the pelvic bones normally widens about 2 to 3 millimeters (mm) during pregnancy, but sometimes it widens even further and becomes unstable. DSP is when the joint opens more than 10 mm. This can happen before delivery, during delivery, or postpartum. 

DSP is rare and very painful. Treatment usually involves stabilizing the pelvis with a brace or belt and exercises to strengthen the surrounding muscles. Most cases of DSP resolve within a few months, though some women need longer-term physical therapy. 

Treatment for SPD in pregnancy

If you have SPD pain, it may help to avoid:

• Putting your weight on one leg. Sit down to get dressed, for example.
• Twisting movements or movements that involve spreading your legs. Turn your whole body rather than reaching one leg when you get out of the car, for example. (To get in, sit your bottom on the seat first, then move both legs forward at once.)
• Lifting and pushing heavy items. When you do lift anything, don't twist. Don't carry another child on your hip. Try not to push a heavy shopping cart.
• Sitting on the floor or in a twisted position (with your legs crossed).
• Standing or sitting for long periods.
• Vacuuming.
• Carrying something in one hand.

To alleviate pain, try:

• Cold or heat. Apply an ice pack to the pubic bone. Or try a heating pad. (Apply it to the pubic area, not your abdomen, for 10-15 minutes at a time.)
• Kegels and pelvic tilt exercises to strengthen the muscles in the area.
• Pregnancy pillows to help you find a comfortable sleeping position. Tucking a pillow between your knees may avoid stress on your hips and lower back. 
• A pelvic support belt or girdle. These can help support the pelvic bones, reducing pain during movement.
• Safe pain relievers. Ask your caregiver which medications would be safest and in what doses.
• Physical therapy. Ask your caregiver for a referral. A physiotherapist may be able to recommend strengthening exercises for your pelvic floor, back, stomach, and hips. She can also suggest comfortable positions for daily tasks, for sex, and for labor and delivery.
• Acupuncture. There is some evidence that acupuncture may help with pelvic girdle pain during pregnancy. Make sure you work with an acupuncturist who is experienced with treatment during pregnancy. 

SPD pain usually subsides when your body stops producing relaxin after your baby's birth and your ligaments return to their non-pregnant state. Rarely, it continues or even worsens after delivery. Talk with your doctor if your symptoms don't improve after your baby arrives. 

As your body grows and your center of gravity shifts during pregnancy, you may experience different kinds of pelvic pain. Our article on pelvic pain during pregnancy talks about the causes and solutions for different types of pelvic pain, including SPD, DSP, sacroiliac joint pain, and round ligament pain.

Learn more:

Low back pain during pregnancy

Round ligament pain

Lightning crotch

Pregnancy symptoms you should never ignore

Pelvic organ prolapse