Pelvic pain in pregnancy – PSD/PGP

The causes of pelvic pain in pregnancy are many and varied, but here I’m going to concentrate on a cause of pelvic pain not uncommonly associated specifically with pregnancy: Pelvic Girdle Pain (PGP), or Symphysis Pubis Dysfunction (SPD).

The pubic symphysis or symphysis pubis is a structure made of cartilage which connects the left and right pubic bones. It is in front of the bladder and above the vulva. You can see it here near the bottom of the picture…

imageRef Wikipedia

PSD/PGP affects up to 25% of pregnant women. It is also known as peripartum pubic symphysis separation, pubic diastasis, symphysiolysis, osteitis pubis. The condition sounds WAY more serious in Latin… Potential risk factors include large baby (foetal macrosomia), rapid second stage of labour, intense uterine contractions, previous pelvic pathology, trauma to the pelvic ring, or previous instrumental (eg. forceps) delivery. However in many cases there are no risk factors present.

It presents as suprapubic pain, tenderness, swelling, and oedema (swelling) with pain radiating to the legs, hips, or back. The pain is often made worse by weight-bearing, especially with walking and climbing stairs. Turning in bed, lifting, or getting up from a chair may also cause pain. Some women report waking up during the night because of pain. There may be an association with depression if the pain is prolonged and significant.

Women most often report their symptoms to their GP, physiotherapist, midwife or obstetrician. A proper medical assessment should rule out other potential causes of pelvic pain – eg. Relating to the spine, urinary tract, uterus, etc.

In a non-pregnant woman, the normal symphysis gap is 4-5 mm, however with pregnancy the gap increases by at least 2-3 mm. The diagnosis of diastasis is ‘properly’ based on the persistence of symptoms and a separation of more than 10-13 mm on imaging, however in reality X-rays aren’t needed to diagnose this condition, and it can be diagnosed on the basis of symptoms and response to therapy. It is important to keep in mind that X-rays are (in general) contraindicated in pregnancy, and the degree of separation on X-ray does not correlate with degree of disability. Just FYI though, below is an X-ray showing widening of the pubic symphysis.

imageRef e-radiography.net

Treatment is conservative: rest lying down on your left side, pelvic support (brace, girdle), and medications. Some women may require a walker or crutches in order to help them move around. Given that the patient is often pregnant, options for pharmacological pain relief are limited – during pregnancy Paracetamol is the safest option. If the pain is occurring post delivery, you may also want to consider non-steroidal anti-inflammatory drugs and opiate-based medications (beware their plethora of side-effects). More severe cases may require injections of pain killers into the symphysis pubis and some studies have looked at the effectiveness of surgical stabilisation of the symphysis pubic for very severe cases, however this is rarely needed and in general has a poor outcome.

The pelvic usually returns to normal by 1-3 months post delivery, and the pain resolves in most women within a month. The symptoms may recur in subsequent pregnancies (and may even be worse) but this doesn’t mean the patient cannot delivery vaginally.

If you want an easy-to-read summary, have a look at Wikipedia.

References
http://www.uptodate.com
http://www.pelvicpartnership.org.uk

Ok, those symptoms sound pretty much like what I had… so based on that I plan to pop a few paracetamol, lay off the running for a day (or two!?) and see how I go… and be thankful that, thus far, all my internal organs are still intact.

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4 Comments

  1. Pingback: Workout @ 17 weeks pregnancy | Push Ups, Pull Ups & Pregnancy

  2. Bonjour. Je m appelle NKE OBAMA ALVINE SIMONE, camerounaise âgée de 34 ans. J ai souffert de symphisiolyse pendant ma dernière grossesse l année dernière. J’ai accouché par induction à 40s1j. Mon médecin m avais prévenu que le travail allait être très douloureux et que je devais choisir entre la péridurale et la césarienne. J’ai choisi la péridurale. Mais une autre équipe a choisi de m induire et me faire accoucher par voie basse. C était extrêmement douloureux et j en suis resté traumatisee au point où je ne veux plus accoucher. Après l accouchement on ne m’a mise sous traitement anti inflammatoire en cas de douleurs. Je voudrai savoir si pendant le travail j aurait pu mourir vu que la douleur était très intense. Mon bébé a 14 semaines à présent et je ne suis pas encore complètement rétablie et j’ai repris le boulot malgré les douleurs qui reviennent de temps en temps à des degrés différents. En passant j ai repris la gymnastique alors que mon bébé n avais que 4 semaines. L exercice physique est il conseillé dans mon cas ?

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