Pelvic pain in pregnancy may be a sign of symphysis pubis dysfunction (SPD). This is because during pregnancy, the joint in front of the pelvis (called symphysis pubis) becomes stretched and unstable, which cause pelvic pain. This pain can start early in pregnancy and gradually get worse by late pregnancy. If you also feel pain in your pelvic area, it is better to read this article.

 

What is SPD in Pregnancy?

Pubic symphysis dysfunction (SPD) or pelvic girdle pain (PGP) dysfunction appears when the ligaments which normally hold the pelvis, become loose and stretched due to the pressure of fetal weight gain in pregnancy. 

As labor approaches, this condition may worsen. This condition, in turn, can destabilize the anterior pelvic joint (symphysis pubis) and cause unpleasant symptoms such as pelvic pain.

 

Is SPD Common during Pregnancy?

In general, it can be said that SPD pregnancy occurs in about 1 in 300 cases. However, some experts believe that if we add the undiagnosed cases, up to 25% of all pregnant women experience this disorder.

 

What are the Signs and Symptoms of SPD?

Some of the common symptoms of SPD are: pain in the lower back, groin, and pubis when walking. Some women would also say that they feel their pelvis is dislocated and not properly aligned. The pain is usually concentrated in the pubic bone, but it can extend to upper thighs or knees in some women.

Pelvic pain can get worse when walking and engaging in strenuous activity, especially when lifting a leg. For example when climbing stairs , getting in a car, getting dressed or even at nights, when you are moving around in bed.

 

What causes Pubic Symphysis Dysfunction?

The leading cause of PSD is the Relaxin hormone. This hormone helps strengthen and stretch ligaments during pregnancy and facilitates fetal exit from the uterus in labor.

Relaxin sometimes relaxes the ligaments around the pelvis before delivery, causing pain in the pelvic joint. In addition to Relaxin, the levels of Estrogen, and Progesterone also increase during pregnancy, which causes the joints to loosen and move more. This can cause strain and instability of the anterior pelvic joint (symphysis pubis) and lead to pain.

 

What do you need to know about SPD in Pregnancy?

In very rare cases, pelvic opening symphysis dislocation may occur, which can cause severe pain in the pelvis, groin, and buttocks. In this condition, the two bones of the right and left pubis may separate and cause severe pain.

Pubic symphysis dysfunction may worsen after delivery and require medical intervention, but this is also very rare.

Fortunately, in most mothers, after birth, the ligaments and pelvic movements return to normal condition and the production of the Relaxin hormone stops.

 

Can SPD Pain be Dangerous during Pregnancy?

Pelvic pain is accompanied by certain symptoms such as fever and severe bleeding. In these cases, you should see your doctor immediately. Here are some common causes of pelvic pain during pregnancy:

Abortion

Abdominal pain in the first three months can be a sign of miscarriage. 15 to 20% of pregnancies end in abortion. Other symptoms of miscarriage include bleeding and rhythmic cramping or menstrual cramps.

Preterm delivery

Low back pain and persistent pelvic pressure can be a sign of premature birth. You should see your doctor immediately if you have four or more contractions per hour or if your contractions last for more than two hours. 

Ectopic pregnancy

An ectopic pregnancy means the egg is placed outside the uterus and often in the fallopian tube. It occurs in one in 50 pregnancies.

Between the sixth and tenth weeks of pregnancy, severe pain and bleeding can signify an ectopic pregnancy. The abnormal shape of the uterus and the use of artificial reproduction techniques also seem to increase this risk. Ectopic pregnancy requires immediate treatment.

Placental abruption 

The placenta is the source of oxygen and nutrition for the fetus. It is usually implanted in the uterus wall and does not separate from the fetus until birth.

In rare cases (one in every 200 births), the placenta separates from the uterine wall. This is a dangerous complication and occurs most often in the third trimester. The pain is caused by severe and persistent placental abruption that gradually worsens and is felt in the lower abdomen. The uterus hardens, and dark, red bleeding occurs.

In some cases, placental abruption causes labor, so the mother must have a C-section immediately. If the numbness is mild, the pregnancy will continue, and a vaginal delivery can be performed. Women with a history of surgery or high blood pressure, preeclampsia, and abdominal trauma are at a higher risk.

Uterine fibroids

Uterine fibroids are noncancerous growths of the uterus. This is common among women during the reproductive years, and pregnancy can cause them to grow. When a fibroid grows rapidly, it can cause pain. Fibroids should be removed by the operation if necessary.

Uterine rupture, preeclampsia, ovarian rotation, and appendicitis are other possible risk factors for pubic symphysis dysfunction in pregnancy.

 

Ways to relieve and treat SPD in Pregnancy

If you are suffering from pelvic pain during pregnancy, you can use the following strategies to relieve the pain:

• Avoid pain triggers as much as possible. The first step in relieving pelvic pain in pregnancy is to avoid factors that aggravate the pain. For example, sit down or avoid lifting and pushing heavy objects when getting dressed.
• Place a hot water bottle or cold compress (ice pack) on the pubic bone. Hot and cold water compresses can help relieve pelvic pain. If you use a hot water bottle, place it on the sore spot for less than 10 minutes, otherwise it can increase the fetus's body temperature.
• Use maternity bandages. Pregnancy belts (also called pelvic support belt) and bandages keep the pelvis in place and prevent pressure on the pelvis and back. 
• Do Kegel, pelvic tilts, and pelvic floor exercises. Regular exercise helps strengthen the muscles. So you can use these exercises to help relieve pelvic pain during pregnancy. Note that it is best to do these exercises after talking with your doctor.
• Use painkillers. If your pelvic pain is severe, ask your doctor to prescribe painkillers. Your doctor will determine the appropriate type and dose of medication depending on your condition.
• Get help from physiotherapy with a doctor. Physiotherapy also helps relieve pelvic pain. However, note that you should do this only with the permission of a gynecologist.

 

Conclusion

Fortunately, pelvic pain is a temporary pregnancy condition and goes away after delivery. Pelvic pain is more likely to occur in women who have had the condition in previous pregnancies. These women are advised to strengthen the pelvic floor and abdominal muscles. By doing so, they minimize the possibility of this complication in subsequent pregnancies.

Use the mentioned methods to relieve your pain and see a doctor when the pain is beyond your control. Your doctor can use the appropriate treatment methods depending on your pregnancy duration and your general condition.