Q: “I am 26 weeks pregnant. For the last 10 days I have been suffering from excruciating pain in the front of my pelvis. I can hardly walk. Getting out of bed or up from a chair is agony. My consultant just said that this is a problem that some pregnant women get – but I don’t know if I can last another 14 weeks like this.”
A: From the information you give in your message, I think you may be suffering from separation of the symphysis pubis joint or “diastasis symphysis pubis” (DSP).
The symphysis pubis (or joint) is the point at which your two pubic bones join. Your pubic bones are the narrow, curving bones at the front of your pelvis. They join at the front of your body, right in the middle – under your pubic hair.
Normally, this joint moves very little. However, the hormones of pregnancy cause softening and loosening of the narrow ligament (muscle) that holds the joint together. This means that the joint may “give” a little, and the space between the two pubic bones tends to widen by several millimetres. Normally, this is good – because it allows more room for the baby to pass through the pelvis.
However, for some women this normal change becomes abnormal. This tends to happen in the second half of pregnancy. The joint may widen by several centimetres and there may be swelling and, as a result, a lot of severe pain over the joint – especially when walking, getting in and out of bed, and climbing stairs. You may also feel pain in your back, between your legs and down your thighs, as the whole pelvis is put under strain.
Separation of the symphysis pubis is a rare problem – only about one woman in 500 to 800 suffers in this way. (Some women develop the condition after delivery, rather than during pregnancy.) We do not know why this happens to some women, and not to others. It is not, in any way, your “fault”. The diagnosis is usually confirmed by x-ray or ultrasound scan – which will show clearly the abnormal gap between the two pubic bones.
Treatment may include resting in bed, and/or wearing a firm tubular bandage around your hips to give support to the joint. A few women find they need to use crutches for a while. Painkillers are usually needed. Using TENS (transcutaneous electrical nerve stimulation) may also give relief. Some experts think that ice therapy or ultrasound therapy may help relieve the swelling and pain. For most women, the pain starts to improve after the birth – but a full recovery may take up to six months.
A specialist obstetric physiotherapist can usually help a lot, by advising on exercise, safe movement, and the best positions for labour. In the meantime, it will help a lot to concentrate on keeping your legs together. Hold your knees together and swing them carefully out of bed together (rather than moving first one leg, then the other). And go up and down stairs one step at a time (like a toddler!)
Your baby will not be directly effected by separation of the symphysis pubis – she will continue to grow and thrive as normal. However, as she gets bigger and heavier, the pain may become worse as the pressure on the joint is increased.
You may find it very helpful to get in contact with The British Diastasis Symphysis Pubis Support Group. They can give you further information, and (if you wish) put you in touch with other people with the same problem. Sharing your experience with others, and hearing they have managed can really help.
The British DSP Support Group have a web site at: http://dsp.future.easyspace.com/Address: 2 Chapel Place, Ramsgate, Kent CT11 9RY. Telephone: 01843 587523.
Another useful site is: http://www.kamish.com/dsp/index.asp