What Is Pubic Symphysis Diastasis?
Pubic symphysis diastasis (PSD) is moderate to severe pubic bone pain due to the spreading or separation of the ligaments in the pubic symphysis area typically occurring in pregnant women. This condition may also be referred to as: Symphysis Pubis Dysfunction (SPD), Diastasis Symphysis Pubis (DSP), Pubic shear, or Pubic symphysis separation.
Causes of Pubic Symphysis Diastasis:
Pubic symphysis diastasis is thought to be caused by the excess production of the hormone relaxin during pregnancy. This hormone is important during pregnancy because it allows the ligaments and membranes that surround the pelvic joints to loosen (or relax) in order to allow a baby to pass through the pelvic opening during labor and delivery.
While some separation in the pubic symphysis area is normal, pubic symphysis diastasis occurs when an excess amount of relaxin causes the ligaments in the pelvic area to separate too much. Pubic symphysis diastasis generally occurs later in pregnancy, usually during the third trimester; however, it is not uncommon for some women to experience this condition much earlier (sometimes as early as 12-15 weeks).
Symptoms of Pubic Symphysis Diastasis:
Pregnant women experiencing pubic symphysis diastasis notice pubic bone pain while standing, walking, climbing stairs, or rolling over in bed (generally any time a pregnant woman moves her knees or legs apart). These motions result in the pelvic joint shifting on one side more than the other, causing severe pain localized in the middle of the pubic bone area directly above the mons pubis (the area where pubic hair grows).
Pregnant women may also notice pain in the lower back, hips, and/or buttocks because the sacroiliac joints (located in the back of the pelvis) are also affected by the pregnancy hormone relaxin.
Diagnosis of Pubic Symphysis Diastasis:
Pubic symphysis diastasis can only be definitively diagnosed with the aid of an X-ray or MRI scan of the pelvic region. Because X-rays and MRIs can be harmful to a developing fetus, your health care provider may diagnose the condition based on specific symptoms you are experiencing.
Treatment for Pubic Symphysis Diastasis:
Unfortunately, there is no “cure” for pubic symphysis diastasis. The good news is that the condition generally resolves itself quickly after pregnancy since the production of relaxin ceases; however, some find that it can take months or even years for the pain to completely subside.
For some women, especially those who experienced a traumatic delivery (forceps were used, or labor and/or delivery occurred in a lithotomy position with feet in stirrups), the pain caused by pubic symphysis diastasis may never go away.
Some women may find the following helpful in coping with the pain associated with this condition:
- Wearing a pregnancy or maternity belt to help stabilize the pelvic area
- Avoiding squatting as a labor/delivery position (because this position causes the pelvic joints to open more widely than normal and may cause even more pain or possible permanent injury)
- Avoiding certain movements that cause pain (those where the knees or legs move apart)
- Keeping the legs together as much as possible when moving (sitting down to get dressed, swinging both legs together at the knee to get into a bathtub or out of the car, and making sure to keep both knees together when rolling over in bed)
- Avoiding standing for long periods of time
- Avoiding lifting or pushing objects heavier than the weight of a newborn (i.e., not lifting anything more than 7-10 pounds)
- Sleeping with a pillow between knees/legs
- Taking smaller steps, avoiding stairs when possible, or even walking sideways can help if the pain is especially bad
- Using a rice sock or heating pad to apply heat to the pubic region
- Floating in a pool (some women find the “weightless” feeling to be very helpful)
- Gentle stretching (especially the hamstrings and lower back)
- Seeing a chiropractor that has experience with treating pregnant women
Unfortunately, these treatment options aren’t effective for many pregnant women and will only provide minimal and temporary relief. Occasionally, severe pain caused by pubic symphysis diastasis must be managed with pain medication.
It is very important for women to talk with their health care provider about what medications pose the least amount of risk to the developing fetus while still providing beneficial pain relief. Never take any medications unless your provider has prescribed them for you specifically.
Support For Those With Pubic Symphysis Diastasis:
Although pubic bone pain in pregnancy is quite common, there are health care providers who do not have much experience with treating and/or managing pubic symphysis diastasis and will dismiss complaints of severe pain as an unavoidable consequence associated with pregnancy.
Some providers may even suggest scheduling an elective cesarean section because they (erroneously) feel a vaginal delivery could cause permanent damage to the area.
If you feel as though your health care provider isn’t taking your pain seriously, speak up and/or find a new health care provider. Just because you are pregnant does not mean that pain is something you’ll just have to live with.
Listen to your body. If something hurts, then don’t attempt it.
Don’t be afraid to ask for help. Asking for assistance isn’t a sign of weakness.
Talk about how you’re feeling (both physically AND emotionally) to your partner/spouse, health care provider, and/or therapist. Being in constant pain can easily lead to depression and if you are feeling depressed or suicidal, reach out to someone who can help.
Additional Resources for Pubic Symphysis Diastasis:
The Pelvic Partnership is a UK-based charity that offers information, tips, and links to resources for pelvic girdle related issues.
Well Mother is an organization that supports and promotes the use of shiatsu, massage, ante- and post-natal exercise/education, infant massage, and relaxation as vital tools for proper maternity care. They provide educational materials and workshops to healthcare providers and parents. The website has an excellent overview on Pubic Symphysis Diastasis, and discusses how massage may help alleviate the symptoms.