Pubic Symphysitis

Introduction

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.

Diagnosis

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.

Treatment

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:-

Use a pillow between your legs when sleeping; body pillows are a great investment!
Use a pillow under your 'bump' (pregnancy tummy) when sleeping
Keep your legs and hips as parallel/symmetrical as possible when moving or turning in bed
Some women also find it helpful to have their partners stabilize their hips and hold them 'together' when rolling over in bed or otherwise adjusting position
Some women report a waterbed mattress to be helpful
Silk/satin sheets and nighties may make it easier to turn over in bed
Swimming may help relieve pressure on the joint avoiding
Deep water aerobics or deep water running may be helpful as well (there are flotation devices to help you stay afloat easily during this; you do not need to know how to swim in order to do this)
Keep your legs close together and move symmetrically (other sources recommend a very small gap between the legs with symmetrical movement)
When standing, stand symmetrically, with your weight evenly distributed through both legs
Sit down to get dressed, especially when putting on underwear or pants
Avoid 'straddle' movements
Swing your legs together as a unit when getting in and out of cars; use plastics or something smooth and slippery (like a garbage bag) on the car seat to help you enter car backwards and then turn your legs as a unit
An ice pack may feel soothing and help reduce inflammation in the pubic area; painkillers may also help
Move slowly and without sudden movements
If sex is uncomfortable for you, use lots of pillows under your knees, or try other positions
If bending over to pick up objects is difficult, there are devices available that can help with this
Really severe cases may need crutches, although these should probably only be used as a last resort
Some women report that pelvic binders/maternity support belts are helpful for pelvic pain