If you have not heard of symphysis pubis dysfunction (SPD), it is not surprising. SPD is not a condition that gets a lot of attention from American obstetricians. It is more likely to be recognized by doctors in other countries or by midwives. It also has another name, pelvic girdle pain (PGP). [1,2]
Whether you call it SPD or PGP, this condition causes pain in about one out of five pregnant women. American doctors are likely to regard pelvic pain of SPD as a normal part of pregnancy that does not need to be treated. However, studies show that SPD pain can be severe and disabling for some women, and that early diagnosis and treatment can help. In the United Kingdom, national guidelines have been developed for the care of women with SPD. [1,2,3]
What Causes SPD?
SPD affects the joints of your pelvis. These joints surround your pelvic area and they include the joints connecting your lower back to your pelvis (sacroiliac joints), and the joint where your pubic bones meet (symphysis pubis joint). 
Normally these joints are very stable and move very little. In early pregnancy, hormone changes can cause the joint tissues to soften and as pregnancy progresses, the joints can become stretched and unstable. These changes can cause pain that may affect quality of life during pregnancy and in rare cases may become disabling. 
The good news – before we go any farther – is that SPD usually goes away soon after delivery, does not affect your baby, and does not increases your risk of complications during delivery. You may be more likely to have SPD if you have back problems or if you have had SPD in a prior pregnancy. 
Signs and Symptoms of SPD
SPD is more common in later pregnancy and the main symptom is pain. You may also feel clicking or grinding of your pelvic joints. 
- Pain cab be felt in your hips, groin, lower back, pubic area, or shooting down the back of your thighs.
- Pain is made worse by certain movements, especially walking on uneven surfaces, standing on one leg, spreading your knees, or climbing stairs.
- You may notice pain when rolling over in bed, having sex, or getting out of a car.
Diagnosis, Treatment, and Self Care
Diagnosis of SPD is based on your symptoms and physical exam. In many cases, the diagnosis is made by a doctor of physical medicine (physiatrist) and treatment is given by a physical therapist. Studies show that with early diagnosis and physical therapy, most women improve and have much less pain. Physical therapy may include: [3,4]
- Learning about positions and movements that can make pain worse
- Exercises to strengthen muscles that support the pelvic joints
- Exercising in water
- Warm baths, ice packs, or heat packs
- Massage, acupuncture, or transcutaneous electrical nerve stimulation
Self-care is an important part of SPD treatment. It is important to stay active and get enough rest. Ask for help from friends and family to reduce activities that cause pain, like shopping or house cleaning. To relieve painful symptoms you can: [3,4]
- Wear flat and supportive shoes.
- Avid sitting or standing for any length of time. Avoid sitting with your legs crossed.
- Avoid putting all your weight on one leg. Sit down to get dressed and undressed.
- Avid spreading your knees when turning over in bed or getting out of a car.
- Avoid heavy lifting.
If you have SPD symptoms, talk to your pregnancy care provider. Do not accept the explanation that SPD pain is a normal part of pregnancy. If you have to, ask to see a physiatrist or a physical therapist. Early diagnosis, therapy, and self-care can help. [1,2]
- Facts, Views & Vision in Obgyn, Pelvic Girdle pain during or after Pregnancy: a review of recent evidence and a clinical care path proposal.
- Physical Therapy, Management of Symphysis Pubis Dysfunction During Pregnancy Using Exercise and Pelvic Support Belts.
- Royal College of Obstetricians & Gynecologists, Pelvic girdle pain and pregnancy.
- National Health Service, Pelvic pain in pregnancy.