Symphysis Pubis Dysfunction…a really fancy medical term for pelvic girdle pain in pregnancy. A really fancy medical term for something that has plagued me three times now, starting earlier in pregnancy each time. It’s often shortened to SPD or PGP. The medical definition goes something like this:
Your pelvis is constructed by two pubic bones that curve, forming a cradle shape. The two bones come together at a firm joint called the symphysis pubis, located in the front of your pelvis. The joint is made strong by dense ligaments.
Symphysis Pubis Dysfunction means that the ligaments keeping your pelvic bone aligned – normally tough and dense – become relaxed, too soon.
During pregnancy, your body produces the hormone relaxin. The hormone softens the ligaments, making it easier for your baby to pass through.
As delivery nears, things should be loosening up, making childbirth easier.
With SPD, this loosening or stretching happens too early during the pregnancy. As a result, it makes the joint unstable, causing pelvic pain and other odd sensations.
Symphysis Pubis Dysfunction or pelvic pain can be brought on by:
• the uneven movement of your pelvis
• changes in the way your muscles support your pelvic girdle joints
• one pelvic joint not working as it should, causing knock-on pain in the other joints nearby1
• pain in the pubic region, lower back, hips, groin, thighs or knees
• clicking or grinding in the pelvic area
• pain made worse by movement, for example:
• walking on uneven surfaces/rough ground or for long distances
• moving your knees apart, like getting in and out of the car
• standing on one leg, like climbing the stairs, dressing or getting in or out of the bath
• rolling over in bed
I’ve had SPD now in every pregnancy and in my own words, it feels like your pelvis, lower back, upper thighs, hips and tailbone are going to give out at any moment all while feeling like they’re cracking and breaking apart. When you stand up from sitting, or try and roll over in bed, it can feel like someone is stabbing you in several different places in the pelvic area and pubic bone, like your pelvis is in a vice grip, like your bones are breaking beneath the weight of everything (imagine that scene in Twilight Breaking Dawn when pregnant Bella stands up and her bones crack completely beneath her, that’s how I feel) or like it’s all just going to rip apart. It’s really difficult to deal with and I’m so sad it’s happening to me again, only earlier this time around. Everything is kind of moving independently of each other, fighting with each other and causing all sorts of inflammation. Some days are more manageable than others, but when it’s bad, it’s excruciating and debilitating. Here’s a great diagram of exactly where the pain resides, sometimes in just one spot and sometimes every spot all at once.
I require both significant rest and ample movement to cope with the pain. Work is my greatest hurdle right now (OMG I can’t imagine trying to jump over hurdle right now! Just lifiting my legs to get dressed is awful!). I’m trying to make adjustments to my workspace, which I’ll outline shortly, but I also find that I have to remind myself to get up and take short walks throughout the day to keep everything moving. Walking can very difficult, but also very helpful. Some days, just a few steps seem like too much to handle, wincing in pain with each step. And other days, I can handle it okay. It really depends on what I’ve had going on throughout the day. You can take pain meds, ice, heat, etc, but I’ve found not much helps.
There’s no exact cause of SPD, it’s really just too much hormonal change too early in pregnancy, but there are a few risk factors for it including previous pelvic issues/pain and/or previous injury to the back or pelvis. Both of which I’ve had in the past. When I was around 12, I injured myself jumping on a friend’s trampoline. It was the kind of moment when you’re all bouncing and trying to bounce the others off balance. I can remember the moment SO vividly. There were three of us and somewhere in the mix, I lost my balance, laughing, and jerked to my knees. When my knees hit the trampoline, my upper torso bent violently backwards due to the jerking motion of the trampoline. You could hear cracking and instant pain. I fell to my side and just laid there, until they realize I was hurt and stopped jumping. I was able to get up and move, but I can remember waking up the next day in horrible pain and had soreness from my neck all the way down my legs. I had spent the night at the friend’s house, but later the next day after I was home, I can remember laying on the floor, crying out in pain. My mom, who’d had an injury not long before, gave me like half of a pain pill because nothing was cutting it. Long story short, I severely injured myself. I had jammed and twisted my entire pelvic area and lower back, jammed and twisted my neck, affecting the rest of my spine and managed to fracture my right femur (upper thigh bone) from hip to knee . It was unreal and awful. I didn’t have a cast or anything, but was limited to the amount of walking and activity I could do for weeks, because I was at risk of breaking the fractured bone completely. I saw a couple of doctors, but the one that helped the most was an angel of a chiropractor who was able to keep me aligned, for the most part, but the injury has laster throughout my life, limiting my mobility, causing chronic pain and now, affecting my pregnancies. I’ve had several OBGYN’s suggest that this could be the reason for the pain issues in pregnancy.
How am I managing my pain?
Well, that’s tough to say, because some days it doesn’t feel managed at all…
• I’m trying to make modifications at work, like using ergonomic and orthopedic cushion options. One that helps with stability and one that takes pressure off of the tailbone area. Both help in different ways, so I’ve been alternating them. Sitting in my chair alone makes everything so much worse!
• My employer offered me a sit/stand station, which allows you to quickly to turn your desk into a standing desk. I’m hesitant to try that because another modification I’ve had to make is being conscious of how I’m distributing my weight. I’m bad about leaning all of my weight to one side, which can aggravate the condition and is the reason I’m afraid to try standing at work.
• I’m also trying to be sure I take short walks throughout the day. The more movement I get in, the better.
• I do yoga stretches here and there at home, but some get difficult just due to my belly getting bigger.
• One technique a doctor taught me after I had Lark was a maneuver, I have no idea what it’s called, but you make a fist, place it between your knees and squeeze your knees and thighs together. It helps strengthen your pelvic floor. Two other great exercises for this same reason are pelvic tilts and kegels.
• Speaking of the pelvic floor, I’ve also gotten a referral for a Pelvic Floor Physical Therapist that I’ll be seeing in December. Ladies, this is something that’s recommended in both pregnancy and beyond that most women don’t know about and most doctors won’t recommend unless you ask. One of my favorite resources for this subject is the Vagina Whisperer over on instagram!
• Chiropractic care is helpful as well and I saw one in my pregnancy with Lark. I didn’t with Arlo, only because I didn’t have one in the area we had just moved to, plus I spent the last two months of pregnancy with him on bedrest so I got my rest that way.
• Other items I’ve been using a belly support! So important and so helpful! I have a support band and support leggings from BLANQI, but there’s also other, more intense maternity belts that can help with the weight of your growing womb in taking pressure off. It really does help a ton!
• I also make sure I’m sleeping with some sort of pregnancy pillow to support my back/belly and I also place a standard pillow between my ankles and lower legs to be sure my legs are resting parallel while I sleep.
• I also just have to modify how I complete regular tasks. Even lifting my legs to complete mundane tasks, like putting on pants, is difficult. Sometimes I’ll sit to get dressed and one tip I’ve received is to do everything as if you’re wearing a mini skirt, because you’ll naturally keep your knees together, which helps avoid some of the pain, like making sure your knees are together when you roll over in bed.
• I try not to lift items that are too heavy, though that’s difficult with two small children at home, and ice, warmth and rest make a world of difference as well.
• I’ve read up a ton about the use of kinesiology tape to support the belly as well, like mentioned here, but I haven’t tried it yet. I’ll update when I do!
So a lot of it is managing symptoms when you can. It can’t really be “cured,” per say, but you can definitely alleviate some of the pain by adding in items that help keep you aligned, or seeing alternative doctors like physical therapists and chiropractors. I’ll be sure to update after I see the Pelvic Floor Specialist to explain how it went and how it’s helping…or not helping…but I’m hopeful! Mine went away after both previous pregnancies, for the most part, but because of that previous injury I had, it’s something I deal with manage indefinitely. Here’s some links to some of the items I’ve suggested and I hope this is helpful for others dealing with the same kind of pain. It can be excruciating and debilitating and feel like your pelvis is ripping apart. By the end with Lark, I couldn’t walk an inch without being in severe pain. I’m hoping I’m being proactive enough this time around to avoid that kind of pain in the coming weeks. I wouldn’t wish it on anyone and I truly hope you don’t ever have to deal with it!