Symphysis pubis dysfunction

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Symphysis pubis dysfunction (SPD) is a condition that causes excessive movement of the pubic symphysis, a joint located at the front of the pelvis, and associated pain. It is commonly seen in pregnancy and can significantly impact a person's mobility and quality of life.

Anatomy

The pubic symphysis is a cartilaginous joint that sits between the left and right pubic bones. It is connected by a fibrocartilaginous disc and is reinforced by several ligaments, including the superior pubic ligament and the inferior pubic ligament. This joint allows for slight movement to accommodate various physiological processes, such as childbirth.

Causes

SPD is often caused by the hormonal changes that occur during pregnancy, particularly the release of the hormone relaxin. Relaxin increases the elasticity of the ligaments in the pelvis, allowing for greater movement of the pubic symphysis. Other contributing factors may include previous pelvic trauma, hypermobile joints, and multiple pregnancies.

Symptoms

The primary symptom of SPD is pain in the pelvic region, which can radiate to the lower back, hips, and thighs. The pain is often exacerbated by activities that involve weight-bearing on one leg, such as walking, climbing stairs, or turning over in bed. Some individuals may also experience a clicking or grinding sensation in the pelvic area.

Diagnosis

Diagnosis of SPD is typically based on a clinical examination and the patient's reported symptoms. Imaging studies, such as ultrasound or MRI, may be used to rule out other conditions and to assess the extent of the joint separation.

Treatment

Treatment for SPD focuses on managing symptoms and may include:

• Physical therapy: Exercises to strengthen the pelvic floor, abdominal, and hip muscles.
• Pain management: Use of pain relief medications, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs).
• Supportive devices: Wearing a pelvic support belt to stabilize the joint.
• Lifestyle modifications: Avoiding activities that exacerbate symptoms and practicing good posture.

In severe cases, surgical intervention may be considered, although this is rare.

Prognosis

The prognosis for SPD varies. Many individuals experience significant improvement postpartum as hormone levels return to normal and the ligaments regain their pre-pregnancy tension. However, some may continue to experience symptoms for several months or longer.

See also

• Pelvic girdle pain
• Pregnancy-related pelvic girdle pain
• Relaxin (hormone)
• Physical therapy