Coping with SPD in pregnancy

Symphysis Pubis Dysfunction (SPD), or Pelvic Girdle Pain (PGP), can make pregnancy feel like an endurance test. Emma Brockwell, Senior Physiotherapist with an interest in Women's Health at London Bridge Hospital, tells us how the condition is diagnosed and what you can do to make coping with SPD in pregnancy that little bit easier.

What are the symptoms and causes of SPD? 

SPD (symphysis pubis dysfunction) is now more commonly called Pelvic Girdle Pain (PGP) and is the pregnancy associated pain, instability and dysfunction of the symphysis pubis and or the sacroiliac joint.

The causes are most often unexplained, but are most likely to be a combination of factors including the pelvic girdle joints moving asymmetrically, a change in the activity of the spinal, abdominal, pelvic girdle, hip or pelvic floor muscles, causing the biomechanics around the pelvic girdle to alter. There is also a small percentage of women whose symptoms may not be biomechanical in nature but in fact hormonally induced.

Occasionally position of the baby may produce symptoms. 50-70% of pregnant women can suffer from pain in their lower back and pelvic region, 7% of these women can still report pain after giving birth.

Common signs and symptoms include pain in the following and can vary in severity among women:

  • Lower back
  • Symphysis pubis joint Pubic bone
  • Groin
  • Front and back of thigh
  • Back of lower leg
  • Hip area
  • Pelvic floor and perineum

Aggravating factors can include:

  • Difficulty walking
  • Pain when weight bearing on 1 leg i.e. climbing stairs, dressing, walking
  • Pain and difficulty in straddle movements i.e. getting out of car
  • Clicking or grinding in pelvic area
  • Decreased movement and pain taking leg out to side as well as difficulty lying in some positions
  • Pain during normal activities of daily living
  • Pain and difficulty during sexual intercourse
  • Difficulty walking with a decreased capacity for walking and standing for long periods

 

How is it diagnosed?

Once urinary tract infections, Braxton Hicks or even labour have been ruled out, your GP or midwife will refer you to a physiotherapist for clinical diagnosis.

The diagnosis will be made following a thorough assessment which will include a physical assessment of the spine, trunk, pelvic girdle and hip. The joints, muscles and nerves that supply these areas will be tested and along with the signs and symptoms a diagnosis will be established accordingly.

Coping with SPD in pregnancy

PGP is very treatable. Women should be referred to a women's health physiotherapist. Once assessed the physiotherapist may treat the woman's symptoms with an array of treatment techniques and adjuncts:

  • Manual therapy including mobilisations, manipulations, muscle energy techniques can help in addressing any dysfunction around the spine, hip or pelvis
  • Exercise to address strength of weakened muscles as well as control of certain muscles
  • Postural advice, ergonomics, lifting, looking after other babies and sexual positions
  • Pain control, in particular the use of tens and acupuncture
  • Equipment can be considered i.e. crutches and support belt

 

Can SPD affect labour?

The majority of women will be able to have a normal spontaneous vaginal delivery. Women should be encouraged to be upright and mobile during labour. If this is difficult then adopt positions like on all fours, supported kneeling, side lying with pillows, water births.

If restrictions of hip abduction (gap between knees) due to pain remains after physiotherapy, this distance should be assessed and measured by a Health Care Professional and recorded both antenatally and in early labour so that this distance is not exceeded thus avoiding potential damage to the pelvic girdle.

Elective caesareans may be the only option in women who are severely affected by PGP where a comfortable birthing position cannot be maintained.

In less severe cases there is no evidence that that elective CS vs normal vaginal delivery confers any benefit on recovery, prognosis or risk of recurrence. 

Recovery tips

  • If PGP occurred during labour or delivery, a referral to a women’s health physiotherapist should be made
  • If symptoms persist, resume physio as soon as you feel able to attend
  • Continue breastfeeding, this will not affect your symptoms
  • When menstruation returns, some women do report a recurrence of symptoms, if so request a referral to the physio and adequate pain reliefs
  • Accept any help offered for care of baby particularly lifting and bathing baby