SPD (Symphysis Pubis Dysfunction – pain at the front of the pelvis)
What is it and what can be done about it?
What is SPD?
SPD (Symphysis Pubis Dysfunction) is a painful loosening of the symphysis pubis
during pregnancy.
The symphysis pubis is a joint at the front of the pelvis that can be felt just
beneath the pubic area. Some people do not believe SPD exists but I can confirm
from personal experience that it does. The pain can be so extreme that the
sufferer may need to use crutches or a wheelchair to remain mobile during
pregnancy and also for a few weeks after delivery. A caesarian birth may be
advised by the sufferer
’s Obstetrician in very severe cases.
What causes SPD?
The symphysis pubis is normally a strong joint that only moves a little.
However, in pregnancy the pelvic ligaments and joints loosen due to a hormone
called Relaxin, which is produced by the body to aid childbirth. In some women
the symphysis pubis becomes strained so as to be painful whenever the pelvis is
moved in a certain way, this strain is what is known as SPD. The pain of SPD is
experienced mostly when particular movements are performed such as turning over
in bed, going up and down stairs or manoeuvering a supermarket trolley or
pushchair. The pain is felt directly over the pubic joint and can be severe.
Why do some women get SPD and others do not? In my experience SPD occurs most
often to women who have had previous back problems or who have had injuries
effecting their pelvis in some way. It may also be linked to a lack of fitness,
as I have noticed that far fewer athletic women seek treatment for it than
those who are sedentary.
In the majority of cases the underlying musculoskeletal problem is in the lower
back.
This is generally in a poor state, leaving the weight of the bump to drop
forwards straining the pubic symphysis. The
“hollow-back” posture that goes along with this, further compresses the lower back and
perpetuates the difficulty. In some cases the trouble seems to be in the hips,
sacro-iliac joints or the sacro-coccygeal joint.
If a woman suffers SPD in one pregnancy and does nothing to help their back in
between pregnancies they will tend to get it with each subsequent pregnancy and
generally with increasing severity.
What can be done to help SPD?
Your Doctor may refer you to a Physiotherapist. However, the help offered may be
limited to the provision of a support belt and some hydrotherapy.
The Osteopathic approach to SPD involves gently testing each lumbar and pelvic joint to diagnose
where the imbalances lie. Treatment consists of working gently on these joints
to restore them to good working order. The whole body will also be examined for
any further contributory causes. As well as specific treatment the patient will
be given advice on self-help. Simple cases respond quickly to treatment,
clearing up completely. In the most complex cases regular treatment throughout
the remainder of the pregnancy and, if necessary, for a few weeks after
childbirth significantly reduces pain.
What is the long-term outlook for an SPD sufferer?
The outlook is good as the pain almost always goes soon after the baby is born. In rare cases SPD may continue long term until the underlying distortions in the
pelvis and/or lower back are diagnosed and treated.
What can SPD sufferers do to help themselves?
“DO’s”
• Wearing a support belt around your body to hold in the “bump” and support the lower back can help. These come in several forms from a thin strap that just covers the symphisis
pubis to a broad Tubigrip which covers the whole bump.
You can buy tubigrip in chemists and straps and belts can be bought on the
internet. You could try
physiomedhomecare.co.uk.*
• Try putting a pillow between your knees in bed at night.
• Take the weight off your back for a while by floating in a warm swimming pool. The Hydrotherapy pool at your local hospital should be available to you at
specific times by arrangement with your Doctor or Physiotherapist.
• Antenatal yoga classes can help as they stretch the lower back and hip muscles
reducing the strain on the symphysis pubis.
• See an Osteopath who is experienced in treating this condition. If you have suffered SPD in a
previous pregnancy, have a course of treatment with an experienced Osteopath
before getting pregnant again to restore normal movement to your lower back and
balance up your pelvic joints.
• As far as you can, and considering how many weeks pregnant you are, try Pilates
exercises to increase your stomach muscle strength, which will support your
lower back.
• Homeopathy helps to reduce pain and inflammation safely during pregnancy when
orthodox drugs cannot be taken. Consult a qualified homeopath who has
experience in treating pregnant women.
“DON’T’s”
• Avoid sitting in low chairs – getting out of them will strain your symphysis pubis.
• Avoid heavy lifting and pushing supermarket trolleys.
• Be careful when pushing pushchairs, sudden jolts or going round corners can
strain your symphysis pubis.
• Do less heavy work and avoid long walks.
• Sitting or lying down too much can become painful so keep gently active with
frequent short rests sitting in an upright chair, perhaps with a cushion under
you.
Even if you have not suffered from SPD it is always advisable to be checked out
after the baby is born as distortions created during pregnancy or during labour
may persist, causing back aches, knee pain or coccyx tenderness.
There is a support group website and ‘phone number:
* These web addresses are provided as a courtesy, we accept no responsibility
for the quality of advice received or items purchased from them.
