The two halves of your pelvis are connected at the front by a stiff joint called the symphysis pubis. This joint is strengthened by a dense network of tough, flexible tissues, called ligaments. To help your baby pass through your pelvis as easily as possible, your body produces a hormone called relaxin. Relaxin softens your ligaments.
As a result, your pelvic joints move more during and just after pregnancy, causing inflammation and pain. This condition is known as symphysis pubis dysfunction (SPD).
A related condition is diastasis symphysis pubis (DSP), in which the gap in the pubic joint widens too far. The average gap between the bones in a non-pregnant woman is between 4mm and 5mm. During pregnancy it's normal for this gap to widen by 2mm or 3mm. If the gap is 10mm or more, DSP is diagnosed. It's rare, and can only be identified by X-ray.
What causes SPD?
SPD is thought to be caused by a combination of hormones that you produce during pregnancy and the way your body moves. If one side of your pelvis moves more than the other when you walk or move around, the area around the symphysis pubis becomes tender.
The size of the gap in your joint doesn't bear any relation to the amount of pain you may feel. Many women with a normal-sized gap feel a lot of pain.
You may be more likely to develop SPD if you started your periods before you were 11, or are overweight.
When does SPD happen?
SPD can occur at any time during your pregnancy or after giving birth. You may notice it for the first time around the middle of your pregnancy.
If you have SPD in one pregnancy, it is more likely that you'll have it next time you get pregnant. The symptoms may also come on earlier and progress faster, so it is important to seek help promptly. It can help if you allow the symptoms from one pregnancy to settle before trying to get pregnant again.
How is SPD diagnosed?
SPD is becoming more widely understood by doctors, physiotherapists and midwives. Your doctor or midwife should refer you to a specialist women's health physiotherapist who will have experience in treating it.
Your physiotherapist will test the stability, movement and pain in your pelvic joints and muscles. She'll also want to hear you describe your symptoms.
How is SPD treated?
SPD is often managed in the same way as pelvic girdle pain, and treatment will include:
• Exercises, especially focused on your tummy and pelvic floor muscles. These will improve the stability of your pelvis and back (Richardson et al 2002, Van Wingerden et al 2004, Vleeming et al 2005). You may need gentle, hands-on treatment of your hip, back or pelvis to correct stiffness or imbalance. Exercise in water can sometimes help.
• You should also be given advice on how to make daily activities less painful and on how to make the birth of your baby easier. Your midwife should help you to write a birth plan which takes into account your SPD symptoms.
• Acupuncture may help and is safe during pregnancy. Make sure your practitioner is trained and experienced in working with pregnant women (Bourne 2007, Elden et al 2007, Elden et al 2008, Kvorning et al 2004, Lund et al 2006, Ternov et al 2001).
• Osteopathy and chiropractic treatment may help, but again, see a registered practitioner who is experienced in treating pregnant women (Licciardone et al 2010).
• A pelvic support belt will give quick relief (Mens et al 2006, Ostgaard et al 1994, Vleeming 1992).
Are there any self-help tips I can follow?
There are things you can do yourself to ease your pain:
• Do pelvic floor and tummy exercises. Get down onto your hands and knees and level your back so that it is roughly flat. Breathe in and then as you breathe out, squeeze in your pelvic floor muscles and pull your belly button in and up. Hold this contraction for between five and 10 seconds, breathing through it. Relax your muscles slowly at the end of the exercise.
• Try not to move your legs apart when your back is slumped or you are lying down. Take care when getting in and out of the car, bed or bath. If you are lying down, pulling your knees up as far as you can stops your pelvis from moving and makes it easier to part your legs. If you are sitting, try arching your back and sticking your chest out before parting or moving your legs.
• Avoid pushing through any pain. If something hurts, if possible, don't do it. If the pain is allowed to flare up, it can take a long time to settle down again.
• Move little and often. You may not feel the effects of what you are doing until later in the day or after you have gone to bed.
• Rest regularly by sitting on a birth ball or by getting down on your hands and knees. This takes the weight of your baby off your pelvis and holds it in a stable position.
• Try not to do heavy lifting or pushing. Supermarket trolleys can often make your pain worse, so shop online or ask someone to shop for you.
• When climbing stairs, take one step at a time. Step up onto one step with your best leg and then bring your other leg to meet it. Repeat with each step.
• Avoid swimming breaststroke and take care with other strokes. You may feel swimming is helping your pain while you are in the water, but it could make you feel worse when you get out.
• When getting dressed, sit down to pull on your knickers or trousers.
Will I recover from SPD after I've had my baby ?
You're very likely to recover after your baby is born (Owens et al 2002). If you can, carry on with physiotherapy after the birth. Try to get help with looking after your baby during the early weeks.
You may find you get twinges every month just before your period is due. This is caused by hormones which have a similar effect to the pregnancy hormone relaxin.
Where can I get help and support?
You can get in touch with other women in your situation by contacting The Pelvic Partnership, a charity which was set up to offer support to women with SPD. If you live in Scotland, contact the Pelvic Instability Network Scotland.
The Association of Chartered Physiotherapists in Women's Health can provide a list of physiotherapists in your area.
What about the birth?
You should inform the midwifes present at your birth that you have suffered with pelvic pain during your pregnancy so that they will be able to support you accordingly. Generally, more active birth positions such as kneeling or all fours are more comfortable however you should do whatever feels best for you at the time. If you do have trouble parting your legs during the latter stages of pregnancy do ensure that your midwife knows this especially if you have an epidural as they will be able to keep you focused on not over widening your hips.
Fortunately for the vast majority of women pelvic pain lessens and gradually disappears in the months after their baby arrives. Treatments such as osteopathy and physiotherapy area also a great help in speeding up the recovery process.
Is it safe to take pain medications for spd whilst pregnant?
If you are finding it hard to cope with the pain that can be caused by spd, speak to your doctor as they will be able to prescribe pain killers that are safe to take in pregnancy. Hot water can help to ease the pain caused by spd as well.
Myths about pelvic girdle pain
Women are often told that their pelvic pain is due to:
• round ligament pain
• hormones
• sciatica
• trapped nerve
• normal aches and pains of pregnancy
• low back pain
• nerve irritation; and that it is not treatable and will get better on its own, or as soon as the baby is born.
Many women have discovered later that it was pelvic girdle pain and could have been treated as soon as symptoms occurred. If this sounds like you, you may well have pelvic girdle pain and need to take action.
Please note that here at *Mums World* we cannot be sure that there are any medical experts on the page, if you are experiencing any symptoms or issues related to our topic please speak you your doctor.
Many thanks to the following webisites which have used to gather this information www.babycentre.co.uk
www.askbaby.com
www.pelvicpartnership.org.uk
We hope you found tonight’s topic helpful. If it has helped you understand the causes and treatment of SPD, then we at *MumsWorld* have done what we set out to do.
Feed back on tonight’s topic is gratefully received. PP’s will resume shortly but in the mean time please feel free to check out our ‘Posts by others’. Enjoy the rest of your evening Nic, Becks, Dani.
There are no medical professionals on *Mums World*all information has beencollected from reputable websites and links will be posted at the end of the topic. If you are worried about anything please contact your GP.
No comments:
Post a Comment