Definition
DSP (Diastasis Symphysis Pubis) means an abnormally wide
gap between the two pubic bones at the symphysis pubis joint
situated at the front of the pelvis. It can only be diagnosed
conclusively by investigation such as x-ray, ultrasound or MRI scan.
The non-pregnant gap is 4-5mm but in every pregnancy there will be
an increase of at least 2-3mm due to the fact that ligaments which
‘tie’ the joint become slightly slacker under the influence of the
pregnancy hormones. Therefore, it is considered that a total width
of up to 9mm between the two bones is normal for a pregnant woman.
Following delivery, this natural extra gapping decreases within days
although the supporting ligaments will take three to five months to
fully return to their normal state to make the symphysis pubis a
strong joint again. An abnormal gap is considered to be 1cm or more,
sometimes with the two bones being slightly out of alignment, and
remains evident after the time that the joint should have regained
the normal non-pregnant width.
Incidence
Skeletal pelvic pain 1-9:300 pregnancies [MacLennnan 1997]
SPD (Symphysis Pubis Dysfunction) simply means
that the joint is apparently not working, as it should be. Together
with the two sacroiliac joints at the back of the pelvis, the
symphysis pubis plays an important part in holding the pelvis
absolutely steady during any activity, in any position, which
involves the legs. If the joint is not firmly ‘tied’ by all its
ligaments it cannot effectively perform its role and excessive
strain is placed on all the pelvic joints giving rise to the all too
familiar painful symptoms. It is important to remember that the
sacroiliac joints are equally affected by the hormones of pregnancy
and become slightly looser. It is very common to find that although
a woman might be complaining of groin and pubic pain, the main cause
of the symptoms is actually at one or both of the sacroiliac joints
and this puts extra stress on the symphysis.
In other words the term SPD is flagging up the
fact that the pelvic girdle is not functioning correctly and, unless
an abnormal gap is definitely shown at the symphysis pubis, the
condition will be termed SPD.
Symphysis Pubis
Dysfunction?
During pregnancy hormones soften and stretch the
ligaments of the body in order to allow the pelvis to open slightly
during labour so that the baby can move easily through. Symphysis
Pubis and/or lower back pain can occur as early as the 12th week of
pregnancy. During pregnancy, and after, the Symphysis can gap
slightly and walking, climbing stairs and turning over in bed can be
difficult or even impossible.
Not all women suffer from pelvic pain during
pregnancy, some only suffer postnatally. There are also those who
suffer both during and after pregnancy. Some women will experience
pelvic pain in their first pregnancy and not subsequently, while
other suffer from this distressing problem with each and every baby.
Radiographic Appearance
Symptoms
Pain is usually felt low down over the Symphysis
Pubis joint, which can be extremely painful to the touch. Pain may
also be felt in the hips, groin and lower abdomen and can radiate
down the inner thighs. Pain is increased by walking and all weight
bearing activities particularly lifting one leg eg. stairs, movement
in bed. Sometimes a "clicking" can be heard and felt.
Diagnosis
A simple pelvic x-ray (after delivery) and an
Ultrasound (in pregnancy) or MRI scan may help to provide a
diagnosis. Sometimes no abnormality can be found. The range of hip
movements will be limited by pain, there will be an inability to
stand on one leg. Exquisite pain on palpation of the symphysis
pubis.
Treatments
Painkillers or anti-inflammatory drugs to help relieve
pain. The drug prescribed will depend on whether you are pregnant or
breast-feeding. Your GP can refer you to a Specialist
Physiotherapist for help, advice and treatment. It may be possible
to arrange some home help if you're very disabled.
Physiotherapist
An Obstetric or Manipulative
Physiotherapist can offer various treatments. A support belt can be
supplied, to help hold the pelvis together, e.g. a Trochanteric belt
or double ply Tubigrip may be helpful. Your Physiotherapist may also
recommend Transcutaneous Electronic Nerve Stimulation (TENS) to
relieve the pain. There are some forms of Physiotherapy that can
only be used postnatally. Crutches may be necessary to you to remain
mobile.
Surgery
Although not common, an operation to fuse,
wire or plate, the Symphysis Pubis together can be carried out, but
only in extreme cases. there is little research on this method and
it is important to find a surgeon who is familiar with doing this
operation and managing it.
Other Treatments
Acupuncture, Chiropractic, Osteopathy, and
Aromatherapy may also help your condition to improve. Lots of
support from family and friends is vital, and having someone to talk
to, perhaps a qualified counsellor, may make a big difference.
It is most useful to be in touch with other women
who have also suffered from this problem.
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