Symphysis pubis dysfunction (SPD) and Pelvic Girdle Pain (PGP) in pregnancy
What causes symphysis pubis dysfunction (SPD) - aka Pelvic Girdle Pain (PGP) - in pregnancy, and how can it be treated?
What is SPD or PGP?
SPD or symphysis pubis dysfunction, also known as pelvic girdle pain (PGP) or, now, according to the NHS, PPGP (pregnancy-related pelvic girdle pain) is a relatively common, but painful, condition that happens to some of us during pregnancy.
“Symphysis pubis dysfunction (SPD) is a long name for pain in the pubes!” explains GP, Dr Sarah Jarvis. “Obviously, your baby’s head will need to come out through your pelvis if you have a vaginal delivery, and it’s a pretty close fit”.
“Hormones in pregnancy are designed to help loosen your ligaments and make it easier for your baby’s head to get through”, she says. “In some women, this loosening process allows the joints to move when you do, causing pain that can be severe”, she says.
SPD can appear any time from the end of the first trimester, although the first symptoms usually appear around mid-pregnancy.
What are the symptoms of SPD?
“SPD usually occurs when you lift one leg or separate your legs, which can be incredibly painful”, explains Dr Jarvis.
“Sadly, this includes everyday things such as climbing stairs, turning over in bed and other movements that we take for granted”.
Other SPD symptoms include:
- Pain in the groin
- Pain in the thighs
- Pain in the hips
- Pain in the lower abdomen
- Pain that worsens when you walk
- Pain that worsens when you stand up
- You may hear your pelvic joints click as you move
The amount of pain that you get will vary and you can’t really compare it with anyone else, as we’re all so different.
You may just feel occasional mild discomfort, or you may feel severe pain for a lot of your pregnancy.
"I had this during my first pregnancy and all I can say is don't let it go unmentioned as I did," 30somethin on our forum says. "I got to the point where my niggles turned into excruciating pain and I was actually unable to walk without ending up in tears.
"I got an urgent referral to physio at around 34-36 weeks which helped as they gave me very gentle exercises to do and a pelvic/hip belt to hold me together a bit more. I couldn't get out of bed or turn over or anything.
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Why is it so painful?
Unfortunately, the combination of unstable joints, the growing weight of the baby and changes in posture all contribute to the pain of SPD.
The pains of SPD can be felt:
- in the lower back
- hips groin
- lower abdomen
- and down the inner thighs.
Willowbaby tells us: "I suffered with SPD during my first pregnancy I get pains in my pelvic bone and in my groin area. It hurts mainly when walking or getting up or moving from a different position."
Will I be able to give birth naturally?
Having SPD doesn’t necessarily limit your labour and birth options or mean that you automatically need to be induced or have a c-section.
However, it does require careful planning with your midwife, and although you might feel silly, you can try experimenting with different birthing positions before your baby is due, so that you can work out which ones will be more comfortable.
The key thing is that everyone caring for you during your labour and birth needs to know that you have SPD, both for your comfort during examinations and the pushing phase, and also for keeping within comfortable limits if you have any kind of spinal pain relief such as an epidural.
Also, once you’re in labour, make sure that your midwife knows how far you can comfortably open your legs.
Mum Carly found that a warm bath and rocking really helped her through labour. “I couldn’t walk around very well as the pain of my SPD combined with the contractions was too much, but I found a bath really soothing," she tells us.
"I then sat in a rocking chair and rocked through a lot of the contractions. I laboured for twelve hours without any pain relief just doing that”.
Can anything be done to help?
Yes but it’s all rather undignified. A physiotherapist can show you helpful exercises for rebuilding pelvic strength, as well as advice you on what you should and shouldn’t be doing.
You may be given a pelvic support belt or bandage to help support the area, but you might also need crutches to help relieve the pressure and pain.
"Best advice is to rest, and do no more than you need to," says IssyBell22. "Walk using your knees not your pelvis and keep knees together when turning in bed etc."
Other helpful tips to ease SPD include:
- Avoid lifting or pushing heavy loads (not always easy if you have a toddler in tow).
- Avoid twisting movements.
- Go up steps slowly, one step at a time.
- Keep both legs together when getting in and out of bed, off the sofa or in and out of the car.
- At night, it might help to support your joints with a rolled up towel or pillow between your legs.
- Stay active – as difficult as it sounds, try to keep moving while keeping within the limits of what’s comfortable.
- Know your limits – don’t push yourself too hard or ignore pain and carry on, as you will only worsen matters.
- Plenty of rest to allow your joints to heal. Easier said than done!
One of our mums, Marmitemumdrum, visited a physio who gave her the following advice:
"I had physio for it. She gave me lots of tips too:
"Don't push supermarket trollies/prams (if you can avoid it).
"Keep your knees together when getting out of bed.
"Put a plastic bag on your car seat so you can just swivel round and then get out keeping your knees together."
Will it go away?
The good news if that for most of us, SPD goes away a couple of weeks after giving birth. Everyone is different though, and for some it takes longer than others.
"I had SPD during pregnancy and once I'd given birth (2 wks ago) the pains just stopped as if by magic," says LYNNI. "Sometimes my hips ache a little bit, but I can turn over in bed and I can keep up with my hubby again when we're walking the dog."
Will I get it with my next pregnancy?
Most likely, yes. Some experts believe that the longer you leave between pregnancies the less severe it will be.
"It isn’t necessarily worse the second time round, but just remember to see your physiotherapist as soon as you feel your symptoms coming on. Even if it’s just a twinge!
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