The pubic symphysis is the bony joint between your pelvic bones at the front of your pelvis. Joined together by cartilage, during pregnancy this can become painful but is essential for your body to prepare for labour. However, after your pregnancy this pain should go away.  Reportedly 1 in 300 – 1 in 30,000 of vaginal deliveries result in a full separation of the pubic symphysis after giving birth, this can leave the new mum in debilitating pain. Widening of greater than 1cm has been found to result in extreme pain. This condition may be underreported according to Hines, K etal 2018. as people may only have mild symptoms.

Risk factors for pubic symphysis diastasis include:

  • Multiple births
  • First birth
  • Newborn >4000g
  • Epidural
  • Shoulder dystocia

Other causes for this condition may be

  • Biomechanical strain on the pelvic ligaments
  • Metabolic (calcium) and hormonal (relaxin and progesterone) changes leading to ligamentous laxity
  • Muscle weakness
  • Increased pregnancy-related weight gain
  • A very long or very short second stage of labour

Pubic Symphysis Diastasis can feel like

  • Pain in the front of the pelvis and sometimes at the back of their pelvis
  • Pain in the hips and down the legs
  • Difficulty with weight bearing, ie walking, standing, stairs
  • Urine retention
  • Hematoma to pelvic or perineal area

Your physio will also look for the following signs in your assessment :

  • Difficulty with lifting your legs up and down when laying down
  • Pain on palpation around the pelvic girdle
  • Gap in the pubic symphysis
  • May send you for an ultrasound or X-ray
  • They will also rule out the hips, back and legs to make sure they aren’t contributing to the pain.

What happens if I have a separation of my pubic symphysis?

  • Treatment can include a pelvic binder or belly band to help stabilise the pelvis
  • Physiotherapy to help strengthen the surrounding muscles and manage pain. Exercises can include abdominal stabilisation exercises, pelvic floor muscle strengthening and targeted hip muscle strengthening.
  • Surgical management is only advocated for if the separation is greater than 4cm due to the increased risk of perioperative complications.

People who are experiencing this pelvic pain should expect symptoms to dissipate after 3 – 6months with a physiotherapist involved in their care (Chawla, J eta 2017). Following a physiotherapist lead exercise program patients reported less pain and independent walking (Shim, J & Oh, D 2011).

If you or someone you know is experiencing pelvic pain after giving birth, please encourage them to see a women’s health physiotherapist to get an assessment as soon as possible. Bump Fitness Physiotherapists will service the Gold Coast and surrounding areas and are just a phone call away. Contact us today.

Until next time,