I don’t know how I can give birth like this
“Every movement is making me hurt, I don’t know how I can give birth like this….”
It can seem like there is no end to this road, and not the smoothest of journeys, but there can be change possible Symphysis pubis dysfunction occurs where the joint becomes so relaxed that it is essentially unstable and may, in very severe cases actually rupture. Increase in the gap of more than 10 mm is termed ‘diastase’ of the symphysis pubis. It most commonly can start from late during your first trimester to any time after approximately 22 weeks. Studies have failed to show any correlation between the size of gap and pain severity of symphysis pubis dysfunction. The symphysis pubis is a fibro-cartilaginous joint with a central disc, which holds the two innominate bones (ischium, pubis and ileum – the bones that form the pelvis) stable during movement. It resists tensile, shearing and compressive forces, and is capable of a small amount of movement, with slightly more mobility in the average pregnant woman. Typically we see the following symptoms of the condition.
Pain localized to pubic symphysis shooting, stabbing, burning, grinding, clicking, Pain radiating to lower abdomen, groin, pelvic floor. Difficulty walking, up and down stairs, getting up from a chair, weight bearing or flexing and abducting the hips, turning over in bed
“But I have pain going down my thighs – how does that make sense?”
The build-up of inflammation at the pubic joint, and groin, can cause some radiating pain through the tissues which can affect the inner or outer thighs. A build-up of toxins can make tissues feel tender and the attachments of the inner thigh muscles can become sore and hypertonic .Multiple births and history of difficult deliveries can be causative factors, as well as increased maternal age, hypermobility and weak connective tissues. This can also account for having symphysis pubis disorder at each pregnancy. Couple this with physically strenuous work during pregnancy, poor posture, lack of regular exercise and weight gain – your body needs a bit of a break to get back to itself.
“Surely the hormones are supposed to make me feel more supple?”
Circulating hormones eg. relaxin, oestrogen & progesterone induce, structural changes to the interpubic disc – increases and decreases to fibrocartilage density and collagen. The pubic ligaments become thicker, looser & more vascular with increased water content. Relaxing isn’t a bad thing, but the long term exposure over the duration of the pregnancy can influence the structure of the ligaments and make them unbalanced and possibly unstable.
“But I came in with back pain and now you are checking the pubic joint?”
There are certain factors which can contribute towards symphysis pubis dysfunction; alterations in pelvic stability & function - pelvic & sacro-iliac joint asymmetry which can cause pain, increased curvature of the lower back due to your growing baby bump, weakened muscles, rectus diastasis, poor hip function etc. Sometimes back pain is a symptom of symphysis pubis disorder, so it’s not uncommon after taking a full case history, that assessment of the whole pelvis including the pubic joint is necessary, and usually it reveals the cause of pain or dysfunction.“What will you do to help me?”As Osteopaths, we need to build a picture of your whole body in relation to one part. A symphysis issue for example that stems from very tight inner thigh muscles that occur as your body adapts to pregnancy, will need a very different approach than a true joint separation and again will be different to a ligament strain of the symphysis itself from a twisting and lifting injury.
“But I need to collect my kids from gan, and do the shopping and…..”No you don’t. You will need a rest after treatment, as sometimes the pain can feel worse for a couple of days before it gets better, but don’t worry – you’re body is just trying to reset itself, you have to give it a little time and listen to what is going on. Please take the advice; too many times we see patients persevering, which is fine, mobility is important, but time to heal is just as crucial Other things obviously need to be ruled out such as bladder infections, early labour contractions, stomach issues, or preterm labour
“Will I be okay? Will I be okay giving birth?”
As Osteopaths, we can offer a lot more than anyone else, as we have the time and expertise to make an analysis of the patient’s individual pelvis, and overall posture and then treat accordingly. We specialize in women’s health and understand the changes anatomically and physiologically that your body is going through. We use a specific set of treatment techniques for the pelvis; but sometimes a patient will need an additional technique in the session, or exercises to do at home to help rehabilitate their pelvis for the state of pregnancy. Most symphysis pubis disorder is treatable, with patients reporting a great reduction in pain, and an increase in mobility and then going on to have their births as planned. Sometimes a patient reports a reduction in pain, but some limit in movement that is aggravating the joint but manage to give birth comfortably. There isn’t one outcome from treatment for this condition but most often patients report an improvement that allows them to continue enjoying their pregnancies.
“When can I come in?”
I can treat you any time after 14 weeks of pregnancy has passed. Many women don’t realize the pain they are experiencing is quite likely to be this so if you aren’t sure, give me a call, tell me what is happening and I will see how I might be able to help you get back to being you
This material is owned and copyrighted by Zoe Merkazy, and under no circumstances can be used by other persons without express permission from the author. Date of content written 1/06/2019 ©