Symphysis pubis dysfunction - AbsoluteAstronomy.com

Symphysis Pubis Dysfunction (SPD) is most commonly associated with pregnancy

Pregnancy

Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...

and childbirth

Childbirth

Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...

. It is a condition that causes excessive movement of the pubic symphysis

Pubic symphysis

The pubic symphysis or symphysis pubis is the midline cartilaginous joint uniting the superior rami of the left and right pubic bones. It is located anterior to the urinary bladder and superior to the external genitalia; for females it is above the vulva and for males it is above the penis...

, either anterior or lateral, as well as associated pain, possibly because of a misalignment of the pelvis

Pelvis

In human anatomy, the pelvis is the lower part of the trunk, between the abdomen and the lower limbs .The pelvis includes several structures:...

. SPD is a dysfunction that is associated with pelvic girdle pain

Pelvic girdle pain

Pregnancy related Pelvic Girdle Pain causes pain, instability and limitation of mobility and functioning in any of the three pelvic joints...

and the names are often used interchangeably. It is thought to affect up to one in four pregnant women to varying degrees, with 7% of sufferers continuing to experience serious symptoms postpartum. Although the condition was recognised by Hippocrates

Hippocrates

Hippocrates of Cos or Hippokrates of Kos was an ancient Greek physician of the Age of Pericles , and is considered one of the most outstanding figures in the history of medicine...

, incidences of SPD appear to have increased in recent years; it is unclear whether this is because the average maternal age is increasing, or because the condition is being diagnosed more frequently.

Symptoms

The main symptom is usually pain or discomfort in the pelvic region. This will probably be centred on the joint at the front of the pelvis (the pubic symphysis). Some sufferers report being able to hear the lower back and hip joints, the sacroiliac

Sacroiliac joint

The sacroiliac joint or SI joint is the joint in the bony pelvis between the sacrum and the ilium of the pelvis, which are joined together by strong ligaments. In humans, the sacrum supports the spine and is supported in turn by an ilium on each side...

, clicking or popping in and out as they walk or change position. Sufferers frequently also experience pain in the lower back, hips, groin, lower abdomen, and legs. The severity of the pain can range from mild discomfort to extreme and prolonged suffering. There have been links between SPD and depression on account of the associated physical discomfort. Sufferers may walk with a characteristic waddling gait

Gait (human)

Human gait is the way locomotion is achieved using human limbs. Different gaits are characterized by differences in limb movement patterns, overall velocity, forces, kinetic and potential energy cycles, and changes in the contact with the surface .- Foot strike :One variable in different gaits is...

and have difficulty climbing stairs, problems with leg abduction

Abduction (kinesiology)

Abduction, in functional anatomy, is a movement which draws a limb away from the median plane of the body. It is thus opposed to adduction.-Upper limb:* of arm at shoulder ** Supraspinatus** Deltoid* of hand at wrist...

and adduction

Adduction

Adduction is a movement which brings a part of the anatomy closer to the middle sagittal plane of the body. It is opposed to abduction.-Upper limb:* of arm at shoulder ** Subscapularis** Teres major** Pectoralis major** Infraspinatus...

, pain when carrying out weight bearing activities, difficulties carrying out everyday activities, and difficulties standing.

Diagnosis

Early diagnosis is crucial in order to minimize the medium to long term severity of the condition, which can be disabling in its extreme form. Unfortunately not all healthcare practitioners are sufficiently aware of the condition. A diagnosis is usually made from the symptoms alone, although after pregnancy, MRI scans, x-ray

Radiology

Radiology is a medical specialty that employs the use of imaging to both diagnose and treat disease visualized within the human body. Radiologists use an array of imaging technologies to diagnose or treat diseases...

s and ultrasound

Medical ultrasonography

Diagnostic sonography is an ultrasound-based diagnostic imaging technique used for visualizing subcutaneous body structures including tendons, muscles, joints, vessels and internal organs for possible pathology or lesions...

scanning are sometimes used. Women initially report the condition to a midwife, obstetrician, general practitioner

General practitioner

A general practitioner is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities...

or physiotherapist. On seeing a health professional, women should expect to receive a thorough physical examination to rule out other lumbar

Lumbar

In tetrapod anatomy, lumbar is an adjective that means of or pertaining to the abdominal segment of the torso, between the diaphragm and the sacrum ...

spine problems, such as a prolapsed disc, urinary tract infection

Urinary tract infection

A urinary tract infection is a bacterial infection that affects any part of the urinary tract. Symptoms include frequent feeling and/or need to urinate, pain during urination, and cloudy urine. The main causal agent is Escherichia coli...

s and Braxton Hicks contractions.

Treatment and management

There is no evidence in the medical literature to support any particular treatment. The mainstay of currently accepted treatments are the use of elbow crutches, pelvic support devices and prescribed pain relief. The vast majority of problems will resolve spontaneously after delivery. Osteopathic, Chiropractic, Physiotherapy, and occupational therapy

Occupational therapy

Occupational therapy is a discipline that aims to promote health by enabling people to perform meaningful and purposeful activities. Occupational therapists work with individuals who suffer from a mentally, physically, developmentally, and/or emotionally disabling condition by utilizing treatments...

input may also be beneficial.

In some cases, patients may also receive advice on pelvic floor

Pelvic floor

The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the levatores ani and coccygei, with which may be included the...

and core stability exercises. Women should also discuss their birth plan with their midwife or obstetrician, receive daily living advice from an occupational therapist

Occupational therapist

An occupational therapist is trained in the practice of occupational therapy. The role of an occupational therapist is to work with a client to help them achieve a fulfilled and satisfied state in life through the use of "purposeful activity or interventions designed to achieve functional...

and receive a referral to a pain clinic if this is deemed necessary. In very extreme cases surgery is considered after pregnancy to stabilise the pelvis, but success rates are very poor.

Birth planning

It is usually recommended that women with SPD give birth in an upright position, with knees slightly apart, and it is often suggested that a woman tie a ribbon to both legs to ensure that the gap never exceeds her maximum comfort zone. Practices such as placing the feet on the midwife's hips during delivery, stirrups

Lithotomy position

The lithotomy position is a medical term referring to a common position for surgical procedures and medical examinations involving the pelvis and lower abdomen, as well as a common position for childbirth in Western nations...

, and interventions such as forceps

Forceps in childbirth

Forceps are a surgical instrument that resembles a pair of tongs and can be used in surgery for grabbing, maneuvering, or removing various things within or from the body...

should be avoided in the delivery room if at all possible, as they can strain ligaments further and cause long term problems. If stirrups must be used, for example during suturing, great care must be taken to move the legs in symmetry

Symmetry

Symmetry generally conveys two primary meanings. The first is an imprecise sense of harmonious or aesthetically pleasing proportionality and balance; such that it reflects beauty or perfection...

, manoeuvering them gently into position.

Everyday living

Typical advice usually given to women includes avoiding strenuous exercise, prolonged standing, vacuum cleaning, stretching exercises and squatting. Women are also frequently advised to:

Brace the pelvic floor muscles before performing any activity which might cause pain
Rest the pelvis
Sit down for tasks where possible (e.g. preparing food, ironing, dressing)
Avoid lifting and carrying.
Avoid stepping over things.
Avoid straddle movements especially when weight bearing.
Bend the knees and keep the legs 'glued together' when turning in bed and getting in and out of bed.
Place a pillow between the legs when in bed or resting.
Avoid twisting movements of the body.

If the pain is very severe, using elbow crutch

Crutch

Crutches are mobility aids used to counter a mobility impairment or an injury that limits walking ability.- Types :There are several different types of crutches:...

es will help take the weight off the pelvis and assist with mobility. Alternatively, for more extreme cases a wheelchair

Wheelchair

A wheelchair is a chair with wheels, designed to be a replacement for walking. The device comes in variations where it is propelled by motors or by the seated occupant turning the rear wheels by hand. Often there are handles behind the seat for someone else to do the pushing...

may be considered advisable.

Pharmacological interventions

It is not usually considered advisable to take anti-inflammatory

Anti-inflammatory

Anti-inflammatory refers to the property of a substance or treatment that reduces inflammation. Anti-inflammatory drugs make up about half of analgesics, remedying pain by reducing inflammation as opposed to opioids, which affect the central nervous system....

medication in pregnancy, which makes SPD a particularly difficult condition to manage. Women are therefore typically often prescribed 30 mg or 60 mg of codeine phosphate to be taken in conjunction with 1000 mg paracetemol, four times a day. However codeine phosphate is an opiate

Opiate

In medicine, the term opiate describes any of the narcotic opioid alkaloids found as natural products in the opium poppy plant.-Overview:Opiates are so named because they are constituents or derivatives of constituents found in opium, which is processed from the latex sap of the opium poppy,...

, and as such carries a risk of depressed respiration in the newborn baby if it is taken near the time of the birth. Therefore it is usually considered advisable to cease taking codeine phosphate 2–4 weeks before the estimated due date, as advised by a medical professional. If this is not possible, then a planned hospital birth is recommended. Other medications in common use include oral morphine.