What is Symphysis Pubis Dysfunction?

Symphysis pubis dysfunction is a condition which most commonly affects women during pregnancy and childbirth. This term refers to movement that occurs in the symphysis pubis, which is a cartilaginous joint located at the bottom of the pelvis. The joint is flexible enough that it can move during pregnancy and childbirth, allowing childbirth to proceed. When symphysis pubis dysfunction occurs, the amount of movement that the joint can undergo is excessive, leading to pain and impaired movement.

The symphysis pubis is held together and strengthened with ligaments and muscles which ensure the joint remains stable during movement. An adult woman has a gap of around five millimeters (0.2 inches) between the two bones of the joint. During pregnancy, this gap can increase to eight millimeters (0.3 inches) in width without causing any problems. If the gap widens to nine millimeters (0.35 inches) or more, the symphysis pubis joint can become unstable.

This condition is thought to occur as a result of secretion of a hormone called relaxin. Among other functions, relaxin is known to break down collagen in the symphysis pubis joint, which helps the joint soften and allows the gap between the bones to extend. It is not known exactly why the joint becomes overextended in some women. It may be that some women are more sensitive to relaxin, or may produce more of the hormone than normal. Other factors such as lack of exercise or over-exercising, excess weight gain, and poor posture, may also play a role in the development of the condition.

The most common symptom experienced by women with symphysis pubis dysfunction is pain in the lower pelvis. The nature of the pain can vary, with women reporting burning, stabbing, and shooting pains, as well as continual ache or discomfort. The pain may extend from the lower pelvis to the abdomen, back, groin, perineum, and thighs. As a result impaired walking is common. Women who suffer from this condition tend to have particular trouble climbing stairs, standing or leaning on one leg, and rising from a sitting position.

Up to 25% of women experience symphysis pubis dysfunction symptoms during pregnancy. For most women, symptoms disappear within days after birth, but approximately 7% of women with the condition continue to be affected. A woman who continues to suffer pain after giving birth may have difficulty caring for her newborn and is at risk of depression.

Treatment of symphysis pubis dysfunction during pregnancy usually involves a combination of pain relief medication and behavior modification. Medications such as codeine and acetaminophen, also called paracetamol, are usually recommended during pregnancy. Women may also work with a physiotherapist to help her with strategies to avoid pain and reduce pelvic stress. For women who continue to experience pain after giving birth, bed-rest followed by extended physiotherapy and pain management is usually advised. It is rare for a woman to require surgery to correct the problem.