Pubic Diastasis in Pregnancy & Post-Partum – A Real Pain in the Crotch

Some aches and pains are just a common part of pregnancy. One of them is called symphysis pubis dysfunction (SPD). SPD is fairly common and is caused by a normal pregnancy change. In order for your pelvic bones to stretch and accommodate your growing baby, a pregnancy hormone called relaxin is released from your placenta. Hormones are chemical messengers. Relaxin’s message is to loosen the tight connective tissues – called ligaments – that connect your pelvic bones together. This loosening can cause slight movement and instability leading to pelvic pain, pain that gets worse with walking and weight bearing.

Pubic symphysis diastasis (PSD) is a more severe type of pelvic dysfunction that occurs during and after childbirth. Whereas SPD may affect about 25 percent of women, during pregnancy, PSD affect about one in 500 women during and after delivery.

What Is PSD?

PSD happens during a vaginal delivery. It affects the ligament that connects your pelvic bones in the front, the area called the pubic symphysis. Although some relaxation of this area is normal, PSD occurs when the bones stretch apart beyond what is needed childbirth, usually more than one centimeter. This can cause a strain or tear  of the ligament. In really severe cases, there may be a separation of four or more centimeters.

What Are the Symptoms?

The main symptoms are severe pubic or crotch pain. If you have an epidural, you may first notice the pain as the epidural wears off. The pain can be significantly uncomfortable. It is located in the lower front of the pelvic bone, your pubic area. Pressing on the pubic area just in front to the genital area may feel tender and swollen. Other symptoms are pain that:

  • Spreads to your hips
  • Shoots down your legs
  • Makes it hard to pass urine
  • Gets worse when you stand, walk, lift, get up from a sitting position, or try to climb stairs
  • Gets worse when you turn in bed and keeps you from sleeping

Who Is at Risk for PSD?

 PSD can happen to anyone, but the risk goes up if:

  • It’s your first pregnancy
  • You deliver more than one baby
  • You deliver a big baby
  • You have epidural anesthesia
  • Your baby’s shoulder gets stuck during delivery (shoulder dystocia)
  • You have a long second stage of labor or a quick but very stressful second stage
  • You have a forceps delivery

How Is PSD Diagnosed and Treated?

 PSD is usually easy to diagnose from the symptoms and a physical exam. In some cases, an imaging study (ultrasound, x-ray, or MRI) may be done to see how big the separation is. Treatment depends on how severe the separation is. For a mild separation, treatment may include:

  • OTC pain medication like Tylenol or Advil
  • Avoiding activities that make pain worse
  • Wearing a pelvic binder (a wide belt around the hips)
  • Physical therapy exercises
  • Temporary use of assistive devices like a walker or crutches

For more severe case, bed rest and a stronger pain medication may be needed for a while. In rare cases for a severe separation or tear, reconstructive surgery may be needed. Most cases of PSD are painful but not severe. The prognosis is very good with closure of the separation in about 3 months. Symptoms usually get better after about 4 weeks. PSD is rare, but if you have the symptoms, let your doctor know right away. Early treatment help you recover more quickly and with less discomfort.

Christopher Iliades
Dr. Chris Iliades is a medical doctor with 20 years of experience in clinical medicine and clinical research. Chris has been a full time medical writer and journalist since 2004. His byline appears in over 1,000 articles online including EverydayHealth, The Clinical Advisor, and Healthgrades. He has also written for print media including Cruising World Magazine, MD News, and The Johns Hopkins Children's Center Magazine. Chris lives with his wife and close to his three children and four grandchildren in the Boston area.

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