Pubic Bone Pain in Pregnancy

Pubic bone pain in pregnancy is fairly common. A condition known as symphysis pubis diastasis (SPD) often causes this pain. In later pregnancy, the hormone relaxin causes the pelvis, particularly at the pubic bone, to loosen. In general, this is a good thing: It makes birth easier for mom and baby. However, sometimes the separation is exaggerated. This can be quite painful and can persist in the early postpartum period.

pubis diastasis
Verywell / Nusha Ashjaee 

Symptoms

When there is too much laxity in a joint, there can be instability and pain. The most common symptom of SPD is the pubic bone pain. Most of the pain is centered upfront in the pubic bone area, above the mons pubis (below pubic hair). For some women, certain movements can be painful: getting out of bed, getting into the bathtub or car, putting on pants, sitting for long stretches, or performing repetitive tasks.

You may also note some swelling in the area of your pubic bone and experience waddling in the way you walk or notice that your legs don't quite come together. You may notice that you can feel or hear a clicking noise when walking or moving your legs. Your doctor or midwife can help you best understand your symptoms.

The waddle often associated with pregnant women is also often a result of the relaxing and loosening of the pelvic ligaments.

Risk Factors

You may be more likely to experience pubic bone pain if you are carrying multiples, if this is not your first baby, or if you have a very large baby. Having SPD in a prior pregnancy is also a risk factor.

Diagnosis

Because X-rays are not recommended during pregnancy, your practitioner may order an ultrasound. The ultrasound can look at the space between the bones of the pelvis. It is more common, however, to make a diagnosis based on your symptoms alone. If you have already had your baby and you are still having pain, an X-ray is the best diagnostic test available.

Treatment

Although SPD is usually relieved once you have your baby, there are some treatments available for when you're still pregnant.

  • Low back and pelvis support: Stabilize your pelvis as much as you can via a pregnancy/maternity binder, which can help to relieve back pain as well. You may also try using a rebozo Mexican shawl. Studies suggest that a flexible belt or binder works better than a rigid one. This can also help you prevent further injury from having a less stable pelvis.
  • Physical therapy and/or acupuncture: Ask your doctor or midwife about these treatments. They may help in the long term. While they may be time-intensive, many say it's worth it. Ask your therapist or acupuncturist for advice on what you can do at home to decrease your visits.
  • Avoidance: Avoid situations that cause pain. For example, sit down to put pants on, or sit on the side of the tub and swing over both legs together.
  • Limited standing: It is also best to avoid standing for long periods of time. If you must stand, wear sensible shoes and try to move around, even if this means you simply shift from foot to foot every so often. You can also use a small stool or box to prop one foot up as you stand.
  • Exercise: Certain forms of exercise can help. Ask your doctor, midwife, or physical therapist for moves you can do. The buoyancy involved in swimming, for example, can provide pain relief.
  • Medication: Occasionally, pain medication is appropriate. However, this should be done under the supervision of your doctor as some analgesics are contraindicated in pregnancy and lactation, and some medicines should not be taken later in pregnancy.

The good news is that shortly after delivery you should be feeling much better, as the production of relaxin stops. If you do not feel notably better after a few weeks, ask your practitioner for additional screening. You may need to add additional therapies, like physical therapy, to help build muscle strength in the pubic bone area.

A Word From Verywell

Pubic bone pain during pregnancy can make some of the most basics tasks of life a bit more difficult. Talking to your doctor or midwife can help you figure out what you can do to minimize pain. Most of the time this involves lifestyle adjustments and waiting until the baby is born, but there may also be other forms of help available.

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Article Sources
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  1. Flack NA, Hay-Smith EJ, Stringer MD, Gray AR, Woodley SJ. Adherence, tolerance and effectiveness of two different pelvic support belts as a treatment for pregnancy-related symphyseal pain - a pilot randomized trial. BMC Pregnancy Childbirth. 2015;15:36. doi:10.1186/s12884-015-0468-5

  2. Pennick V, Liddle SD. Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Syst Rev. 2013;8:CD001139. doi:10.1002/14651858.CD001139.pub3

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