Pubic and pelvic pain in pregnancy

Does anybody out there have experience with pubic symphisis and pelvic pain during pregnancy? If you had this problem, did it magically disappear when you gave birth? I've recently been told a horror story about a woman who can hardly walk post-birth because her pubic symphisis ligament is so messed up (she had an epidural, and thinks that maybe she pushed too hard at the wrong time and couldn't tell because of the drugs). I'm trying to decide how much this needs to be addressed, beyond basic pain management. If it really just goes away after labor then I will worry about this less, but I'd like to get some more anecdotal reports (the BPN posts I've been able to find are at least 5 years old).

Here's my situation: My pains began at about 18-20 weeks and were mostly centered on an ability to abduct my right leg. Well, I had SI joint pain starting at about 12 weeks, but only when I lay on my back. The burning pain in my pubic area started at about 23-24 weeks, and at 28 weeks I'm finding it absolute torture to turn in bed or walk to the bathroom at night. I have historically (prior to pregnancy) had SI joint pain and hip issues, so it's hard to tell what's pregnancy and what's not, or if it even matters at this point.

So, what do you think? Should I be seeing a chiropractor who specializes in pregnancy issues? (And does this necessarily mean someone trained in Webster technique or not?) Should I seek out an OB who considers SPD to be a real problem and who can monitor this for me? Are there doulas out there with knowledge of this syndrome? Should this be something I put onto my list of things to worry about at labor? I suppose the bottom line is, should I worry about this or just get through it? I look forward to your replies. Niki

I didn't do anything as far as treatment goes. Many people recommend some kind of support belt. There is also anecdotal evidence that a chiropractor may help, but I can't speak to that. From my personal experience and understanding, there is nothing to really ''worry'' about - it is more of a pain management issue and it is indeed temporary. I had an epidural for both labors and the SPD wasn't an issue during labor for me. But I have read that you should minimize spreading your legs widely during labor. I've also read that it's true that an epidural might not allow you to feel if you are over-straining the pubic symphysis. I would definitely try to find an OB that recognizes SPD as a real condition and doesn't just chalk it up to general pregnancy aches and pains like mine did. In the long run, it didn't matter, but it would have been nice to have someone that was sympathetic. Good Luck!

Pubic Symphasis Dysfunction is certainly real, and if your OBGYN is blowing you off, then maybe you should be seeing someone who can help you deal with the pain and disability.

Both PSD and sacroiliac instability are caused by pregnancy hormones that soften ligaments. This allows for movement in joints that normally have little to no movement. The effects of ligament laxity can last up to 20 weeks postpartum, so I would not expect your problems to magically disappear with childbirth. Some women only experience these issues after childbirth.

You might get some relief by wearing a support belt that would help support the weight of your belly. At this point your goal should be to get out of the acute phase, where you have a lot of pain and swelling.

Avoid all movements that place shear and/or tensile forces on those joints. NO twisting and bending at the same time. Avoid lifting heavy objects. Don't vacuum, change the sheets, or dig in the garden. No yoga, Pilates, and most traditional ab work. No straddle stretches, groin stretches, deep side bends, or any lower back openers, like seated tailor stretch. Don't cross your legs when seated.

Always log roll when getting out of bed or off the floor. With you head, chest and pelvis moving as one, roll to one side, then use your arms to push your torso upright, then come to standing. BeFit-Mom, www.befitmom.com

During labor, the baby was really low in my pelvis for a lot of transition, and it was extremely painful, but I did it without drugs. My doula and midwife were both aware of the issue, but it really didn't seem to affect my labor, so they didn't need to address it. My recovery was great and I felt back to normal completely after delivery.

The only recurrence of this pain at three months later is doing a really specific move during pilates (bridging while lifting one leg at a time). I heard all the horror stories of the pain lasting long after delivery, and I'm so happy to say it went away immediately after my daughter came out. Good luck to you!

Post Partum Symphisis pubic disfunction

Hi, Does anybody have suffered of post partum symphisis disfunction? Any tips or recommandation? Do you know anybody who treats this conditions? thanks

Painful pubic bone postpartum

I gave birth to an 11+lb. baby naturally about 2 months ago. My pubic bone (front of my pelvis) has'nt been the same since. When I lie on my back and turn over in either direction the pain is almost unbearable. It is difficult to get out of bed and slightly painful to raise one foot at a time while standing. My midwife suggested that the pain would get better over time. That has not happened. My pelvic floor muscles were very sore and painful toward the end of my pregnancy, much worse than now, but I am concerned that I have an ''unstable pelvis'' and I am not sure what to do about it. Anyone know of a chiropractor or physical therapist that has dealt with this issue before? No diagnosis or x-rays as I do not have a gynecologist and have yet to make an appointment to see my GP (I hate Drs. : ). Any recommendations? Thanks.

In the mean time, you need to be careful not to stress the area. When rolling over in bed, do a ''log roll'' to keep your body in one piece. To do this, roll your entire spine and legs to one side, taking care not to twist your body in any way. Then simultaneously use your arms to help push your torso to vertical as you lower your legs off the side of the bed. If you do these moves together your torso will not bend or twist.

You can do a similar move to get up from the floor. But this time log roll all the way onto all-fours, then holding on to a piece of furnitiure or a wall with one hand for balance, step one foot then the other to standing.

Don't try to stretch your grion as this can make the situation worse. Don't do any exercises that open the legs or twist the spine. No impact exercise.

Do lots and lots of Kegels, or pelvic floor contactions. For a complete discription of how to do effective Kegel contractions visit my web site at: www.befitmom.com, select Prenatal and Postpartum Fitness and Exercise, then select Pelvic Floor. Helene Byrne, BeFit-Mom

Chiropractors are scary for some people. However, there are good doctors out there, who are gentle and don't wrench your body about, and who won't try to rope you in for endless follow up appointments. (I know I have had a negative experience of my own with a doctor in NY who needed to see me twice a week indefinitely!) I highly recommend Claudia Kindler at Valley Chiropractic in Noe Valley, SF. 415-550-1200. Hannah

I saw a chiropractor at the time, but relief was nominal. The best thing I could do was spend 4 hours a day in our big bathtub and float... seriously. I know you are dealing with a newborn so you may not have that same kind of time, but maybe an hour a day?

The pain persisted after they were born. I believe nursing will also make it last longer as your hormones are still producing relaxin. Give it time -- hard to do when you can't take a decent stride or roll over in bed--it will pass.

I had moments up to 1yr where I would sort of pull something if I lunged, but the hardcore pain left when my nursing decreased (6 months solids) (again, I had twins so I was doing DOUBLE nursing with that much more hormonal activity -- it may not take as long for you to feel better).

Try Dr. Audrey Egan in SF (chiropractor)- I know she's dealt with this before and she really takes extra special time with people. Very caring chiropractor! It may offer some relief. Good luck. I wish you the best quickly! Nancy

I don't have any answers for you, but wanted you to know there was someone else out there is very glad you asked the question. THANK YOU! catherine

i work inpatient, but even i know a few exercises. try lying on your back, knees bent, and squeeze a basketball between your knees, or something else that size or a few inches smaller, that is firm but slightly yielding. you can pad it a bit with a folded washcloth if it feels too bruising on your knees. squeeze as hard as you can for 5-10 seconds. at the same time, try to do a slight kegel (tightening your pelvic floor muscles, you may have learned this prenatally?), focusing on the forward muscles, ie the ''pee'' area, but not the anus, or not as much towards the back. repeat 5 or so reps.

if you are lucky, you will feel a shift, as the sacroiliac joint and pubic symphysis realign into a better fit.

then get up and try some of the things that bother you (gently, just to the onset of pain), to see if there's an improvement. if so, you know you're on the right track. repeat the exercise as necessary while waiting for a PT appt.

and definitely see a PT, since one can evaluate you specifically to see what direction the misalignment is (upslip, rotation, etc.), and do manual resistance to help you pull things into proper alignment. anon

SPD/DSP are essentially bone injuries and so take a long time to heal, especially with the relaxin pregnancy hormone still lingering in your body. Avoid as much as possible any movements that hurt, which may include all motion that involves separating your legs and/or that is weight-bearing. For me this has included standing for prolonged periods and just plain walking. It may seem impossible to limit yourself that much, but with a supportive husband I have managed to feed and soothe my newborn and verbally entertain my toddler all from the confines of a Lazy-boy chair. Try to keep your hips in the same plane at all times (i.e. don't cross your legs, sit on the floor sideways, etc.). I found it extremely helpful to sleep with a pillow between my legs at night. You may need to experiment with pillow number and/or thickness (don't overextend your legs).

Keep in mind that DSP sometimes cannot be detected by X-ray since pregnancy already scars the joint, so don't get dejected if you go to an MD of some sort and s/he can't help. However, it is downright ridiculous (someone needs to chide you) for you to be in severe pain for two months and have not gone to a doctor! Get off your butt and get over your fear/reluctance -- the best case scenario is that they refer you to a helpful health care practitioner that is covered by your insurance and you might feel better in days.

Although time is a factor, there are other anecdotal things you can do to actively manage the pain and heal more quickly. Many women have been helped by chiropractors and physical therapists, as well as by osteopaths and postpartum-specialized exercise instructors (e.g. Pilates). When searching for a practitioner, it is important to find one who has experience treating SPD/DSP. Below are some resources to find practitioners (I have found that it's most useful to play dumb when you are calling to determine their experience level): 1) Chiropractors -- go to the International Chiropractic Pediatric Foundation website at www.icpa4kids.org and search for providers with experience in the Webster technique (used to turn breech babies) 2) Physical therapists -- go to the American Physical Therapy Association website at www.apta.org and search for providers specializing in women's health and orthopedics 3) OB/GYNs -- ask the physical therapists for doctors who refer their clients 4) Various practitioners - check the provider list for your area on the International Pelvic Pain Society website at www.pelvicpain.org.

I am naturally suspicious of chiropractors, but I am seeing one for the first time and it is helping with the pain. The osteopathic poster whose said that SPD/DSP does not involve your spine is incorrect -- your symphysis pubis is the front joint of your pelvis and your sacrum (the bottom of your spine) is the back of your pelvis. Thus if something is wrong with your sacrum (spine), it will also affect your SP joint and vice versa. A chiropractor may not help long term, but if they adjust your sacrum and shift your pelvic alignment, this allows your muscles and ligaments a chance to heal with the pelvis in better alignment. My PT sister explained (to convince me not to chase after my toddler too much) that there should not be much movement in a functioning SP joint, so while you are healing, minimal activity and proper pelvic alignment (i.e. with PT or chiropractic adjustments) are helpful to ensure that the muscles and ligaments surrounding the joint heal tightly.

You don't have to "just wait" for your relaxin hormone to dissipate, like allopathic medicine recommends. At the minimum do pelvic floor exercises. If you are not sure you are doing pelvic floor exercises effectively, get a consultation from a Pilates/yoga/PT/etc. person so they can guide you through various exercises -- the personal feedback is much better than watching a video or looking at a website. In addition, I have gotten the same isometric exercise that the PT poster recommended (squeezing a ball between your legs) from multiple health care practitioners so it is probably safe and possibly helpful. I have been doing it in conjunction with chiropractic adjustments and pelvic floor exercises with slow but sure success. It is probably true that SPD/DSP will eventually heal on its own with no active management, but anything that makes the healing process go faster is essential for maintaining sanity and for being able to care for your new baby. Good luck! jp

Near-constant pelvic pain on the public bone

I'm about 20 weeks into my second pregnancy and have been experiencing near-constant pelvic pain, especially on the pubic bone. It's not so intense that I can't go about most of my usual routine but it's still bothersome. I talked to my doctor about it, who kind of shrugged it off as ''one of those pregnancy things'' (absent other symptoms). I also experienced this with my first pregnancy but it wasn't as intense or long-lasting. Any advice on how to relieve the pain or specific activities to avoid so as not to make it worse? (is walking good or bad? I'm not clear.) I'm trying to rest more and avoid squatting and picking up my 2-yr-old, but would appreciate other remedies and suggestions. thanks!

From my experience, many people mistake groin pain for pubic pain. If your pubic bone is unstable, you will feel pain directly on the center of the joint, right in the middle, where the two bones connect. Groin pain is more commonly felt just off to one side. And groin pulls/injuries are notoriously slow to heal.

I'd suggest that you see a specialist, either a PT or chiropractor who specializes in pregnancy, to sort out what is actually going on in your body. You shouldn't have to suffer with this level of discomfort at only 20 weeks. Dr. Elon Bartlett in Berkeley is a good choice.

As for what to do and not to do...

Avoid picking up all heavy objects. When your toddler needs to cuddle up, sit down in a chair, and then have her climb up onto your lap.

Always sit in a neutral spine position, with lower back support, thighs parallel to the floor, knees bent at a right angle, both feet flat on the floor.

Avoid all sitting positions that bend or twist your pelvis and spine. Do no try to stretch the area to relieve pain. Unstable joints should never be stretched.

To relieve flare-ups, use an ice pack for 10 - 15 minutes, to reduce inflammation. When using ice, always wrap the ice pack in a thin towel or other material. Never place an ice pack directly in contact with skin.

For more in depth advice on pelvic pain during pregnancy, consult my web site: www.befitmom.com. Click on Prenatal and Postpartum Fitness and Exercise, select Common Pregnancy Discomforts, and then click on Pelvis. Helene Byrne, BeFit-Mom

You don't say where your pelvic pain is (in the front? in the back?) but chances are it is loosening ligaments, which is definitely a pregnancy thing. Mine is in the sacro-iliac joint. I don't know about what you can do if it's in the front (symphesis pubis - maybe try googling it?) but for me a couple of things helped for the SI joint pain. I sleep with a much thicker pillow between my knees or under my knee... I think that did the most good. There is also an exercise my yoga teacher showed me involving lying on your side with the painful side up, top leg a little forward, and having your partner gently pull on your leg on your exhale, and release on your inhale. I think this also helped a bit. Between those two things my pelvic pain is really manageable now.

Aside from that, a hot pad kind of worked when it was really painful. People recommended massage but I didn't pursue that. anon

Terrible pelvic and groin pain in week 24

I am now 36 weeks pregnant.Starting in about week 24 I have had terrible pelvic and groin pain.I am not able to walk half a block w/o feeling a ripping sensation in my pelvis and groin. The pain became more intense as my belly grew. Now I'm a total mess. Together with this I have been having braxton hicks contractions, fairly strong and painful also starting around week 24. I've been told by my OB that what I've been experiencing is round ligament pain along with early and apparently nonproductive contractions.By the way,(kienahora) everythings is fine with the baby. I was just wondering if anyone out their went through something comparable? Lynne

The suggestion about getting a disabled licence placard for your car is an excellent one and I wish I'd thought of that for myself! Another friend with the same issue says now that she wishes she had just worn Depends to bed. I think she's kidding but I'm sure you can relate to that sounding like a good option at this point. Good luck. been there