Help for Pubic Symphysis Pain

Help for Pubic Symphysis Pain

International Journal of Childbirth Education. June 2009.

Heather Jeffcoat, DPT

Pubic symphysis pain, or anterior pelvic girdle pain, is one of a myriad of musculoskeletal pains that women may experience during pregnancy. This pain can be debilitating, requiring some women to use crutches or a rolling walker to alleviate the pain while allowing some mobility. Some studies report that up to 50% of pregnant women have some type of pelvic girdle pain prior to 20 weeks gestation. Additionally, this pain negatively affects perceived health and sexual life during pregnancy (Mogren, 2006).

pubic symphysis painPubic symphysis pain is defined as mild to severe pain over the pubic symphysis, and can extend down into the groin and medial thighs (unilateral or bilateral). It generally presents clinically as pain with standing (especially on one leg), prolonged sitting, or with transitional movements such as going from a sitting to a standing position, rolling over in bed, or going up or down stairs. In some women, there may be a clicking in the joint present.

Oftentimes, this pain is present along with other types of pain, most commonly with lower back or sacral pain. One study pointed to additional physical and psychosocial factors that may increase risk of pubic symphysis pain during pregnancy, such as increased weight and less job satisfaction (Albert et al, 2006). Risk factors that are associated with prolonged pelvic pain at six months' time include increased BMI and pelvic joint hypermobility (Mogren 2006).

A study published earlier this year looked at pelvic girdle pain (including anterior or pubic symphysis pain) and disability reported in pregnant women in the first trimester and again at gestation week 30 (Robinson et al, 2010). Clinical examinations were also performed. The results showed that self-reported pain locations in the pelvis, a positive posterior provocations test and the sum of pain provocation tests present in early pregnancy are statistically significant with disability reports at 30 weeks gestation, but the number of pain sites is not.

Another study looked at hormonal contraceptive use and the occurrence of all types of pregnancy-related pelvic girdle pain (Kumle et al, 2004). It found that the use of hormonal contraceptives was only significant with regards to pelvic girdle pain for the first pregnancy. The most significant determinant of pelvic girdle pain in subsequent pregnancies is the presence of pain in a previous pregnancy. Studies have looked at several factors to identify risk in developing various types of pelvic girdle pain, but there is no single factor that appears to play the biggest role. Once the pain occurs, there are some exercises your client can perform that may alleviate her symptoms.

Modifications in your client's daily activities are an essential first step to alleviate pain and pressure in the pubic symphysis. Instruct her to keep her legs together when she is rolling over in bed or getting out of the car, like she is wearing a tight mini-skirt. Also, it is generally more comfortable for her to get into bed "on all fours" and then lying on her side, rather than sitting in bed and lifting her legs up.

Additionally, there are some exercises your client can perform, which have been shown to reduce pubic symphysis pain (Depledge et al, 2005).

Exercises

  • Abdominal Stabilization: Instruct your client to gently pull her navel towards her baby.
  • Kegels: Instruct your client to contract her pelvic floor gently, like she is closing the openings.
  • Gluteus Squeezes: Instruct your client to gently squeeze the buttocks. This can be done while standing.
  • Lat Pulls: Instruct your client to grasp a door handle and gently pull it toward her.
  • Adductor Squeezes: Instruct your client to place a small, soft ball between her knees and squeeze gently.

The good news is that pubic symphysis pain usually resolves on its own after birth. However, if the pain worsens or these initial exercises do not work, there are additional exercises and treatments your client can learn or receive from an experienced Women's Health physical therapist. To locate one in your area, go to www.womenshealthapta.org or call (800) 999-APTA extension 3229.

Related Search Terms:

References

Bump, et al. Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol. 1991 Aug;165(2):322-7

Carriere, B., Feldt, C.M. 2002. The Pelvic Floor. New York: Thieme.

Di Benedetto, P., Coidessa, A., Floris, S. Rationale of pelvic floor muscles training in women with urinary incontinence. Minerva Ginecol. 2008 Dec;60(6):529-41.

Hay-Smith, E.J., Dumoulin, C. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2006 Jan 25;(1):CD005654.

Stephenson, R., O’Connor, L. 2000. Obstetric and Gynecologic Care in Physical Therapy. New Jersey: Slack, Inc.

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I was in multiple car accidents a decade ago, and I have been to many physical therapists through the years without success. They found the root of my lower back pain problems and after nearly a decade of barely being able to walk I finally can again without pain. They are also the best pelvic floor pts and the only ones who found the connection between my pelvic floor and lower back problems. If you need help with physical pain, they are your answer.

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I went to Heather after the birth of my third child. It was lucky, really, that I was referred to her, because my doctor had referred me to a surgeon for a possible hysterectomy or pelvic wall rebuild. Thankfully, I went to Heather before undergoing either surgery, she was able to fix the problem. She has studied extensively in women's health--even written a book about it--and was able to diagnose my problem, suggest a course of treatment (6 weeks), and then follow through with said treatment. By the end, as she said, I was as good as gold. Boy, was it worth it! Though uncomfortable to talk about, much less write about, it is worth getting the word out there. If you have painful intercourse, especially after birth or other trauma, the treatment may be as simple as Physical Therapy (with Heather, of course). I highly recommend her.

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My husband and I were having problems with painful intercourse. My therapist recommended that I go and get a pelvic floor evaluation from a physical therapist. Having never been treated by a physical therapist, I wondered how this really was going to help me. My husband who is a physician was very supportive and agreed that a PT evaluation would be a great idea. So i made the appointment and was blown away by what I learned. I had no idea that pelvic floor muscles could get tight and have trigger points just like any other muscle in the body. I'm a massage therapist and very familiar with tight muscles, and this new thought really amazed me. Heather's program to help relax and strengthen these muscles made such a difference. I can say that I am 100% pain free during intercourse now. Yippee! Going to the PT appointments and doing the at-home exercises was definitely a discipline, but it's 100% worth it! The rewards are amazing.

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Heather's unique physical therapy program literally changed my life! After years of struggling with vaginismus, a condition that made it impossible for me to have intercourse and very difficult to use tampons without pain, a gynecologist referred me to Heather. I was nervous for my first appointment, but Heather's professional and friendly demeanor put me at ease. She did a great job explaining each technique she was using to help my muscles relax. Heather uses a combination of internal and external stretches and exercises to relax the pelvic floor and build muscle strength. Her specially developed home program helped me quickly recover from an issue that seemed insurmountable before meeting Heather. She was optimistic about my progress and incredibly encouraging. Less than 6 months after my first session, I was able to have pain-free sex for the first time in my life! If you are suffering from vaginismus or any other pelvic floor issues, I highly recommend making an appointment with Heather and reading her book!

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A personal journey and testimonial from one of my patients:

I was diagnosed with vaginismus 4 years ago. I never heard of such medical condition until after I got married. At first my husband and I didn't know what to do, we didn't know what the issues were or how to overcome it. Being born and raised in Armenia and being Christian I wasn't that open about talking to sex with others and so it wasn't easy to seek help. But eventually I went to an Ob-Gyn and luckily she knew about the medical condition (not many doctors know). She referred me to a physical therapist and I couldn't believe it and thought it's something I can handle myself. I ordered a kit from vaginismus.com and started practicing with dilators. There was some small progress but wasn't much helpful.

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I wanted to let you know that my pelvic floor held strong and gave me no trouble whatsoever in my trail race this morning (12 miles)! In a way, I felt like I ran better than ever because my core feels so rock solid from all the exercises you have me doing. That was especially valuable on the technical downhill - I just flew down the trail because I had confidence in my balance and form. Thank you for helping me get back to doing what I love.

-- A.W., age 32
(completed Post-partum Renewal Program using the InTone biofeedback/stim unit)

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