Symphysis Pubis Dysfunction (SPD)

Pregnancy-related pelvic girdle pain (PGP), also known as symphysis pubis dysfunction (SPD), is pain or discomfort in the pelvic area caused by stiff joints or by the uneven movement of joints in your pelvis during pregnancy. Read on learn about the symptoms and causes of PGP/SPD, as well as some of the ways to ease the pain – including exercises, pain relief options and support belts.

What Is PGP/SPD?

Pelvic girdle pain (or PGP for short) is one of the more common of the aches and pains of pregnancy. It affects around 20 percent of mums-to-be. It takes the form of mild to severe pain in the front and/or back of your pelvis, but you may also feel it in other places like your hips or thighs. Pelvic girdle pain in pregnancy can sometimes be very painful, but there are ways of easing the symptoms. In most cases, the PGP/SPD goes away after your little one is born, although in rare cases it can continue even after giving birth. Having pelvic pain during pregnancy does not harm your baby and doesn’t usually prevent you from having a vaginal birth if that’s your preference.

What Causes PGP/SPD

To understand what causes PGP/SPD, you need to know that your pelvis isn’t made up of a single bone but two. These are joined together to form a kind of ring around your lower trunk. The structure is known as the pelvic girdle. There are three joints holding the pelvic girdle together:

  • Two at the back: The sacroiliac joints are where your pelvic bones attach to the base of the spine

  • One at the front: The symphysis pubis joint is where your pelvic bones meet at the front of your body (this is where PGP got its former name of symphysis pubis dysfunction).

These joints are normally very stiff and only move a little. During pregnancy, they can loosen up, and may also move unevenly. This is what causes the pain and discomfort associated with PGP/SDP.

Pubic symphysis joint

What Causes the Joints to Loosen?

The reasons for the joint loosening (resulting in PGP/SPD during pregnancy) aren’t fully understood, but experts believe it’s down to a combination of some or all of the following factors:

  • Hormonal changes. When you’re pregnant, a hormone called relaxin is released in your body, to help relax the muscles and joints as your body prepares for giving birth. This also softens up your pelvic joints.

  • Weakening of pelvic floor muscles. The muscles in your abdomen also stretch to make room for your growing foetus during pregnancy. The pelvic floor muscles in the bottom of your pelvis can also get longer – and weaker – as a part of this process. As a result of this, your pelvis has less support which in turn puts an extra strain on the joints.

  • Your changing posture. As you gain weight during pregnancy and your centre of gravity shifts forward as your bump grows ever outwards, you instinctively adjust your posture to compensate. This also places an extra load on your joints and muscles – especially the lower back and pelvis.

  • Previous injuries. A fall or other kind of accident may have put extra strain on your pelvis, hips or back sometime in the past, making your more prone to PGP/SPD during pregnancy.

  • Strenuous activity. Long periods of standing, heavy lifting or other physical effort can tire out your muscles, so they are less capable of giving your looser joints the extra support they need.

  • History of PGP/SDP in pregnancy. There is evidence that having PGP/SPD in an earlier pregnancy makes it more likely that you’ll get it again. The good news is, if it’s managed properly – and in good time – the PGP/SPD doesn’t necessarily have to be as severe this time around. Talk to your midwife or doctor if you have a history of pelvic pain during pregnancy.

Symptoms of PGP/SPD in Pregnancy

Symptoms of pregnancy-related pelvic girdle pain can include:

  • Pain in the lower pelvis

  • Lower back pain

  • Pain in the hips, groin, thighs or knees

  • A clicking or grinding sensation in the pelvic area when you move

  • Pain when putting your weight on one leg or moving your legs separately from each other (for example: putting on trousers, getting into a car, climbing in and out of the bath)

  • Pain with regular daily movements like walking, rolling over in bed, going up or down stairs, bending forward or getting up from a seated position

  • Pain during sex.

Diagnosing PGP/SPD

If you’re experiencing the symptoms of PGP/SPD, let your midwife or doctor know so you can get referred to a physiotherapist who can diagnose your PGP/SPD.

The physiotherapist will examine your posture and the way your back and hips move in order to rule out any other causes of the pelvic pain.

If you’re diagnosed with PGP/SPD, your physiotherapist will advise you on how to manage the pelvic pain and recommend or prescribe treatments.

Management and Treatment of PGP/SPD

Alongside any treatment your physiotherapist may recommend, some home remedies and strategies you can try include:

  • Avoiding activities that make the pain worse, but remaining active within your pain limits

  • Getting as much rest as you can

  • Delegating household chores – especially any that require lifting – to your partner, family or friends

  • Wearing flat shoes that offer good support

  • Getting dressed in a sitting position (so you don’t need to stand on one leg when putting on trousers or tights, for example)

  • Keeping your knees together and swivelling on your bottom when getting in and out of a car or turning over in bed

  • Sleeping with a pillow between your legs and under your bump, for extra support

  • Taking stairs one at a time, keeping the weight on your less painful leg or even going up or down the stairs on your bottom.

Depending on the severity of your pelvic pain, your physiotherapist may also recommend or prescribe treatment for your PGP/SPD, such as:

  • Wearing a pelvic support belt or using crutches

  • Exercises to ease pain and build up supporting muscles, including pelvic floor exercises (also known as Kegels)

  • Manual therapy, given by the physiotherapist, an osteopath or chiropractor, who can gently manipulate the joints back into position, so they move normally again

  • Hydrotherapy (exercises in water)

  • Taking pain relief medicines that are safe to use during pregnancy

  • Using a TENS (transcutaneous electrical nerve stimulation) unit.

PGP/SPD and Birth – Finding Your Pain-Free Range of Movement

If you have PGP/SPD that causes pain when opening your legs, it’s a good idea to measure your pain-free range of movement, especially if you’re planning to give birth vaginally.

Apart from helping you to avoid movements that make your PGP/SPD symptoms worse, staying within this pain-free range is the best way to protect your joints during labour.

To find your pain-free range of movement, lie back or sit on the edge of a chair and open your legs as much as you can without experiencing any pain.

While you’re in this position, have someone measure the distance between your knees with a tape measure.

It’s particularly important to know this if you have an epidural anaesthetic during birth, because you won’t be able to feel anything from the waist down.

Make sure your midwife and birth partner and/or doula know your pain-free range of movement.

If you’re writing a birth plan, it’s a good idea to add a note that you have PGP/SPD and include your pain-free range.

Ask your midwife about birthing positions – for example, lying on your side – that can make it easier to keep your legs closer together

In some cases, opening your legs beyond the pain-free range may be the only way to have a safe delivery. If this happens, take things easy after the birth until you can see your physiotherapist for a check-up.

FREQUENTLY ASKED QUESTIONS

  • To relieve pelvic pain (PGP/SPD) during pregnancy, your physiotherapist might recommend things like

    • special exercises
    • rest
    • avoiding strenuous activity and moving more carefully
    • applying ice packs or heat
    • wearing flat supportive shoes
    • manual therapy
    • pain relief medicine
    • using a TENS machine.
  • Pelvic girdle pain (PGP/SPD) is caused by the joints in your pelvis moving more than usual, or moving unevenly, during pregnancy. The reasons for this can include hormonal changes, weak or fatigued muscles and/or changes in your posture associated with your changing body shape.

  • If you take the right precautions, pelvic pain (PGP/SPD) during pregnancy rarely causes problems with labour. Ask your midwife about how to protect your joints during labour and about staying within your pain-free movement range.

The Big Picture

Although PGP/SDP can be painful, know that you don’t need to suffer in silence.

Now is a good time to lean (sometimes literally!) on your partner, family and friends for help and support. Your midwife and doctor can also help you access treatment and your physiotherapist can give you the best strategies and treatments to keep your symptoms under control.

Hang in there – although pelvic pain can be tough before you know it you’ll be cradling your newborn baby in your arms and all this will have been worth it.

How we wrote this article
The information in this article is based on the expert advice found in trusted medical and government sources, such as the National Health Service (NHS). You can find a full list of sources used for this article below. The content on this page should not replace professional medical advice. Always consult medical professionals for full diagnosis and treatment.