Pain in the pubic region may arise from the symphyseal joint, usually as a result of instability. This may arise in pregnancy, with some sports or after acute trauma. It is possible to develop infection in or adjacent to the symphysis, especially in the immuno-compromised patient. Consider blood tests and further imaging (USS,MRI) if there is suspicion of infection.
When this condition occurs with repeated overloading (sport etc) it tends to be termed osteitis pubis.
This condition has been given a specific name when associated with pregnancy "Symphysis Pubis Dysfunction (SPD)". It is thought to affect up to one in four pregnant women to varying degrees, with 7% of sufferers continuing to experience serious symptoms postpartum. Although the condition was recognised by Hippocrates, incidences of SPD appear to have increased in recent years; it is unclear whether this is because the average maternal age is increasing, or because the condition is being diagnosed more frequently.
Symptoms and signs relate to pubic pain and tenderness, usually related to movement and activity. There are a number of structures attaching to the pubic bone, any of which can become inflamed. Inflamed muscular attachments will be tender and contraction of the muscle will provoke pain. The symphysis proper can be isolated by manual pelvic compression with all the muscle relaxed.
Clinical investigations, including x-ray and isotope scanning are useful in diagnosis but not in providing a prognosis. A high index of suspicion should direct additional investigations if there is any suggestion of rheumatologic disease of infection.
Management includes modified activity during recovery; physical therapy to correct dysfunction of muscles and faulty biomechanics of the back, pelvis, and lower limbs: judicious use of medications.
Tips for ladies with Pubic Symphysis Pain:-
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