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Pubic Symphysitis: A common cause of pain in pregnancy

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Pubic symphysitis is one of the most common causes of pain in pregnancy. It can manifest as pain on one side of the lower back, pain radiating into one or both groin areas, or pain around the pubic bone. Pubic symphysitis results when the ligaments and joints of the pelvis become relaxed due to the hormones of pregnancy and become inflamed by certain movement. Pubic symphysitis generally onsets after 20 weeks of pregnancy but it may occur earlier. The pain of pubic symphysitis is felt when walking (particularly up and down stairs), getting up after sitting, rolling over in bed, getting in and out of the car or standing for long periods. You can reduce the symptoms of pubic symphysitis by modifying movements that exacerbate the pain and wearing specially designed support belts if needed. Women having subsequent babies seem to suffer more from this condition and this is probably due to the fact they are carrying around a toddler, resting less and bending down to pick up toys all the time!

Things you can do to alleviate pubic symphysitis

  • Try to keep your knees together. When you get into bed, sit on the edge of the bed and press your knees tightly together, then lie down on your side and lift your legs into the bed with your knees still together. When getting out of bed do the reverse. What really exacerbates pubic symphysitis is when you lift one leg into bed and then the other. When in bed and needing to roll, always do so with your knees together. A pillow between your legs when turning in bed can help and assist in getting a better sleep.
  • Don’t try and pull yourself up when lying on your back. Roll to your side and use your hands to push yourself up.
  • When you get in or out of a chair make sure you feel the chair with the back of your legs then press your knees together and lower yourself into the chair. When you get up, keep your knees together and use your hands to push yourself up. In a car use the same approach but turn around to the front of the car, once seated, with your knees and ankles together. Make sure your seat is close to the pedals when you drive.
  • Avoid soft chairs like sofas, as you won’t get adequate support and they are hard to get out of!
  • Avoid squatting, or sitting cross-legged and sit symmetrically in the chair.
  • When putting on clothes, especially underwear and pants, sit down to avoid balancing on one leg.
  • Even when standing, try putting your weight on both legs rather than on one.
  • Avoid twisting your body, particularly when picking up toys!
  • Don’t lift anything heavy.
  • Some housework activities like vacuuming can exacerbate symptoms.
  • Lots of walking or stair climbing will worsen the symptoms. Large steps with climbing or walking will also make pubic symphysitis worse. Take the stairs one step at a time and try approaching it with sideways steps.
  • Sex in the supine position (woman on her back) can also worsen symptoms, so try alternative positions like side lying.
  • When in labour avoid lying on your back with your legs apart or squatting. Lying on your side or getting on your hands and knees are both good positions.

Sometimes simply changing the way you move about will reduce the symptoms of pubic symphysitis. If this does not occur then a specially fitted support belt can be obtained from the physiotherapists or midwives in your hospital. The belt goes around your pelvis and decreases the friction in your joints. Some people find ice packs on the pubic area soothing. Once you have had the baby the pain will lessen but it does not always disappear immediately. Be patient you will get your body back!

Dr Hannah Dahlen is the Associate Professor of Midwifery at the University of Western Sydney. She has been a midwife for more than 20 years. Hannah is also an executive member of the Australian College of Midwives, NSW Branch. She has researched women's birth experiences at home and in hospital and published extensively in this area. Hannah's website is www.hannahdahlen.com.au

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