Symphysite protocol. What is symphysitis and how to determine it for a pregnant woman. Previously experienced pelvic injuries

Symphysitis is excessive softening of the cartilage of the pubic bone, which makes the symphysis pubis mobile. Symphysiopathy is a pathological process in which the pelvic skeletal system becomes mobile, swollen and independently unable to return to its original position. The cause of the pathology lies in the pregnancy process itself, but not all pregnant women develop a similar phenomenon.

What triggers development

The female body is designed in such a way that it involves bearing and giving birth to a baby:

the muscular layer of the uterus is capable of stretching;
The musculoskeletal system, due to cartilage, is capable of divergence with subsequent restoration.

The ability of the pelvic bones to move apart while the baby is in the womb is especially important. The enlarging uterus puts pressure not only on the surrounding organs, but also on the woman’s skeletal system.

The pelvic bones, iliac bones and sit bones move apart to allow the baby to continue to grow.

Expectant mothers notice changes from approximately 30 weeks of gestation. In mirror image, they note a visual divergence of the sacral region and an increase in fat deposits in the coccyx area.

The stationary representative of the pelvic bones is the pubic symphysis or pubis. In anatomy, the pubic bone is called the symphysis.

Factors provoking the development of symphysitis:

congenital problems with the musculoskeletal system;
deficiency of calcium and minerals necessary for its absorption;
genetic predisposition;
history of natural childbirth, for which there were contraindications;
decreased function of cartilage tissue;
heavy weight of the pregnant baby;
polyhydramnios.

Most doctors are confident that the cause is diseases or developmental abnormalities of the musculoskeletal system.

Symptoms

Symphysiopathy does not appear earlier than the end of the second trimester, but most often with the arrival of the 30th week. Characteristic signs of the disease are:

Visual swelling of the pubis.
Pain in the groin and tailbone, worsening with movement.
Change in gait. She becomes a “waddle.”
Pain when lifting loads and turning the body.
Extended legs cannot be raised in a horizontal position.
When pressing on the pubis, clicking sounds accompanied by pain are noted.
Pain during sexual intercourse is possible.
Sleep disturbance and obvious discomfort when trying to change body position.

Pressing and moderate pain in the area of the symphysis pubis is a sign of normality. The fetus, amniotic fluid, and uterine mass put increased pressure on the connective tissue between the bones.

A similar phenomenon develops in 95% of expectant mothers.

Symphysiopathy can be distinguished by increasing pain and severe movement impairment.

What threatens

Symphysitis is one of the few pathologies that develops only during the gestational period. During pregnancy, the pathological process can lead to various complications.

Side effects continue after the baby is born.

The closer the expected date of birth, the more the joints are pulled. With symphysitis, the tissue becomes thinner, and there is a risk of cartilage rupture - symphysiolysis.

The condition does not pose a threat to the baby’s health, but can have a detrimental effect on the woman’s well-being.

During pregnancy, the danger of the disease lies in the loss of movement of the legs (from the hips to the feet), ruptures during natural childbirth and a difficult recovery stage.

In case of rupture of the pubic cartilage, surgical intervention is indicated.

Pregnant women with symphysiopathy are contraindicated in natural childbirth, and they undergo.

A divergence of the symphysis of more than 3 cm is considered a fracture.

Diagnostics

Pathology can be diagnosed using visual examination and instrumental high-tech devices, such as:

ultrasonic monitoring;
CT scan;
radiography of the pelvic bones.

During pregnancy, only an ultrasound examination is permissible, which allows one to identify the existing distance in the area of the symphysis pubis.

The results obtained only indicate the existing problem.

Other diagnostic methods are permissible only after the baby is born. To a greater extent, doctors rely on the patient’s complaints and ultrasound data; sometimes symphysitis is assumed as a result of measuring the volume of the hips.

Since there are no specific signs of pathology, it is important to differentiate symphysiopathy from other diseases:

nephropathy and infectious processes of the genital tract;
osteochondrosis;
lumbago;
sciatica;
myasthenia gravis;
osteomyelitis;
intervertebral hernia.

Treatment

There is no treatment during the gestational period, but the necessary maintenance therapy is provided.

It is possible to completely get rid of the manifestations of the pathological process after the birth of the child.

Before starting treatment, it is necessary to establish the extent of the disease.

With symphysitis there are three of them, they differ in the gap between the bones, expressed in centimeters:

in the first degree, the distance is not less than 5 mm and not more than 9 mm;
for the second it is typical from 1 to 2 cm;
for the third degree – more than 2 cm.

Therapy for symphysiopathy consists of taking vitamin D and calcium, but excessive consumption of the vitamin can cause early ossification of the fetal skull.

The complex prescribes “bandage therapy” and special exercises.

In case of unbearable pain, the obstetrician-gynecologist may recommend taking non-steroidal painkillers, but in moderation.

Pregnant women who have encountered a similar problem in previous pregnancies are allowed anti-inflammatory intramuscular injections.

The main treatment against the disease begins after childbirth. In case of rupture of the symphysis, surgical intervention takes place.

In the postpartum period, patients receive excess amounts of calcium and intravenous injections of NSAIDs. Sometimes a cast is applied and constant bed rest is indicated.

During the recovery period, physiotherapy in the form of magnetic therapy is used.

Bandage and pelvic belt

Designed to eliminate increased load on the pelvic bones. Elastic fabric and weights on both sides will speed up the fusion of cartilage tissue, but will help with grade 1 or 2 pathology.

For pregnant women with a tendency to symphysitis, wearing it is a must.

After the baby is born, the bandage is changed to a postpartum belt, which ensures the convergence of the separated bones.

Exercises for symphysitis

Physical exercises help maintain the skeletal system and eliminate increased stress on the musculoskeletal system.

Exercise 1

While kneeling, exhale and bend your back down, throw your head back, and lift your buttocks. As you inhale, pretend to be a cat: arch your back, lower your head and buttocks. Repeat no more than 10 times a day.

Exercise 2

In a horizontal position, move your feet towards your buttocks and bend your knees. As you inhale, spread your hips to the side, as you exhale, bring them together. Number of exercises 6.

Exercise 3

Lying on the floor, you should raise your hips up, while your legs are bent at the knees. 5-7 repetitions are enough.

Exercise 4

Starting position lying on your side. The lower leg is extended, the upper leg is bent. As you inhale, the legs change places; as you exhale, the ankle joint works.

A day is enough to do 4 exercises of 2 approaches.

How to prevent

Despite the suspected provoking factors, the disease can develop in any pregnant woman.

There are effective preventive measures that help get rid of discomfort with existing symphysis pathology and prevent its development in other patients:

do not lie on hard surfaces;
when sitting, use a chair with a back and armrests;
refuse to climb stairs;
follow up on the gained kilograms;
find a comfortable sleeping position.

If you have a predisposition to symphysiopathy, do not stand on your feet for long periods of time, avoid long walks, and place pillows under your feet.

Divergence of the symphysis pubis after childbirth

The pathology is associated with the natural birth process (and a CS should have been performed).

The condition does not threaten the mother’s life, but she will have to fight for her health. The phenomenon is not pleasant, since the recovery stage lasts from 6 to 12 months.

At this time, the patient may receive antibiotic therapy, which is a limitation for breastfeeding the baby.

Rehabilitation for symphysiolysis is carried out in a hospital setting with mandatory bed rest.

In severe cases, orthopedists decide to surgically restore cartilage tissue.

Useful video: pubic discrepancy after childbirth

With the onset of pregnancy, serious changes occur in a woman’s body. The hormonal and immune systems undergo the most dramatic changes. But sometimes expectant mothers encounter problems with the musculoskeletal system, which include the disease symphysitis.

What is symphysitis

A woman's pubic symphysis (or symphysis) is normally motionless. But during pregnancy, the body produces the hormone relaxin, which prepares the body for childbirth: it relaxes the pelvic bones to form the birth canal. In some cases, the symphysis becomes excessively mobile, inflamed, and the pubic bones are severely diverged. Then a diagnosis of symphysitis (or symphysiopathy) is made. Today, doctors cannot say with certainty why inflammation and stretching of the symphysis occurs. Most experts agree that the main cause is a lack of calcium. Some also note the role of hereditary factors and the pregnant woman’s history of musculoskeletal injuries before conception. An important role is played by the excess weight of the expectant mother or its rapid gain during the period of bearing the baby.

The relationship between the manifestations of symphysitis and age has not been established.

Symptoms of symphysitis during pregnancy

Many women experience short-term pain in the pubic area during the third trimester. This is considered normal, as the pelvic bones prepare for the birth process: they expand, and the fetal head drops lower. The following symptoms should alert you:

frequent pain in the pubic area (pulling or sharp pain when trying to get out of bed or turn to one side);
a soft crunch accompanied by pain when pressing on the pubic bone;
pain when walking or other physical activity;
change in gait (it becomes “duck-like”, unhurried, neat, which helps to avoid shooting pain in the pubic part of the pelvis);
swelling in the pubic area;
pain during sexual intercourse;
inability to lift one or both legs from a lying position.

With symphysitis, the pubic bones soften and become too mobile

Can symphysitis appear in early pregnancy?

Inflammation and stretching of the symphysis can occur in any trimester and even after childbirth. Most often, this diagnosis is made starting at 25 weeks. If a woman had symphysitis in a previous pregnancy, the likelihood of symptoms recurring is high. More often in such cases, pain and separation of the pubic bones appear earlier.

Despite the enormous inconvenience and severe pain that symphysitis causes, the disease does not affect the development of the fetus and its health.

How to determine symphysitis during pregnancy: medical history, consultations with specialists, ultrasound

At the slightest sign of symphysitis, a woman should consult a gynecologist, and, on his recommendation, an orthopedic traumatologist. The most reliable diagnostic method is x-ray. However, it is contraindicated during pregnancy. Therefore, first of all, the doctor relies on the results of the examination and anamnesis. Afterwards, an ultrasound examination (ultrasound) is performed, during which the degree of divergence of the frontal bones is studied:

first - 5–9 mm;
second - 10–19 mm;
the third - 20 mm or more.

How to give birth with an established diagnosis

Symphysitis affects the process of delivery. Most often, a planned caesarean section is prescribed for the disease. Doctors sometimes hear a pregnant woman’s disagreement with the ban on natural childbirth, although the risk is great: when a child passes through the birth canal, the symphysis may rupture, and this can cause complications:

severe pain;
damage to the edges of the bones of the urinary canal and bladder;
hemorrhage in the joint area, which in the future threatens to develop into arthritis;
the need for strict bed rest for several weeks.

Natural childbirth is allowed only if the following factors are simultaneously present:

the divergence of the bones is no more than 10 mm;
the fruit is small (less than 4000 g);
A woman's pelvis is of normal size.

Treatment of the disease

Unfortunately, it is impossible to completely eliminate symphysitis. The goal of treatment is to relieve pain and prevent the sprain from increasing. The first degree is easier to treat than others. In some cases, it is enough to adhere to the following recommendations:

reduce physical activity and get more rest;
change body position more often (pain in the pubic area intensifies if you stand or sit for a long time);
if possible, sleep on an orthopedic mattress;
take vitamins and calcium as prescribed by your doctor;
do special exercises to strengthen the symphysis pubis;
eat right, avoiding excess body weight gain.

In the second and third degrees of the disease, the following is added to the intake of vitamins and a balanced diet:

strict bed rest;
wearing a special bandage;
taking anti-inflammatory and painkillers (most often this treatment takes place in a hospital).

During treatment in a hospital, the main emphasis is on physiotherapy - magnetic therapy and special massage.

Medications for the treatment of symphysitis

The main function of medications prescribed during this period is to relieve pain and replenish the lack of calcium and vitamin D in the body. Among them:

Nurofen in children's dosage;

Medicines prescribed for the treatment of symphysitis of the second and third degrees - photo gallery

The use of Aquadetrim (vitamin D) must be supervised by a doctor: its excess can harm the fetus
Nurofen for children can be used as a pain reliever, but only in the first and second trimesters of pregnancy Calcemin is prescribed to strengthen a woman’s bones Panadol is used to relieve symptomatic pain

Physical exercise

The need to perform exercises and their complex are determined by the doctor. Physical activity is aimed at strengthening the pelvic floor muscles, reducing pain and preventing further divergence of the pubic bones:

“Cat” - take the initial knee-elbow position (stand on your knees and elbows, straighten your back and shoulders in one line). Gently arch your back, lowering your head down and simultaneously straining your stomach. After five seconds, return to the starting position;
“Striving upward” - lie on your back, put your arms along your body, bend your legs at the knees. Focusing on your hands, slowly lift your pelvis up. Stay in this position for three seconds, then lower your pelvis;
Kegel exercises - training the vaginal muscles by squeezing them. In addition to its benefits for symphysitis, this technique helps prepare the body for childbirth.

It is dangerous to perform physical exercises with symphysitis without first consulting a doctor.

Exercises for pregnant women - video

Wearing a bandage

Wearing a bandage is one of the mandatory measures in the treatment of symphysitis. It is prescribed during pregnancy and after childbirth so that the pubic bones fall into place faster. When choosing a bandage you need to know certain rules:

this design is selected individually depending on the degree of the disease;
Before buying a bandage, you need to try it on to understand how comfortable it is;
Put it on only while lying down, tightening it tightly. In a standing position, a woman should feel the tight support of her pelvic bones;
The bandage is not worn all the time, but is used only when you need to walk a lot.

Home remedies for pubic bone dehiscence

Home treatments for symphysitis include certain foods that are rich in calcium:

cheese, preferably goat cheese (it can be added to fresh vegetable salads, put on sandwiches or eaten as a separate dish);
fish (steamed or baked);
cottage cheese (it is used to make casseroles, mousses, cakes, or eaten fresh);
almonds, if you are not allergic to this nut;
prunes.

Unripe almonds can be dangerous, as they can cause severe poisoning, and bitter nuts contain a substance that, when ingested, turns into potassium cyanide, a powerful poison.

Sesame with honey

Small sesame seeds are rich in calcium, so they can be used to make a simple, tasty and healthy dish for symphysitis. You need to mix 100 grams of sesame seeds with a small amount of uncandied honey (to taste). This mixture can be eaten throughout the day or left in the refrigerator overnight, after pouring into molds. The honey will harden and you will get sesame kozinaki.

Prevention of the appearance and development of the disease

It is impossible to prevent the occurrence of symphysitis. This is because the exact causes of pubic bone discrepancy are unknown. However, you can strengthen the pelvic floor muscles, reduce pain, and prevent rupture of the symphysis. To do this, doctors advise:

plan a pregnancy (before conceiving, undergo a full examination, get tested for hidden infections, check the functioning of the thyroid gland, tell the gynecologist about how previous pregnancies went and whether there were signs of symphysitis before);
at the planning stage and during gestation, ensure a sufficient supply of vitamins to the body (as recommended by a doctor), eat a balanced and nutritious diet;
undergo all recommended ultrasound examinations;
regularly visit an obstetrician-gynecologist, and if signs of disease appear, immediately inform him about it;
If the diagnosis is confirmed, follow all medical recommendations.

One of the most well-known skeletal pathologies during pregnancy can be considered symphysitis - damage to the pubic joint (or symphysis). You need to know that if symphysitis is detected during pregnancy with the first child, then it is almost always detected in subsequent pregnancies.

What is symphysitis - definition of the concept, terms

Symphysis In medical practice, it is customary to call the area where the articulation of the pubic bones occurs.

As the pregnant uterus grows, this area is stretched (due to relaxation of the ligaments), which subsequently leads to increased mobility of the joint.

There is no need to worry, because this is a physiological process that accompanies labor.

Only in certain situations can the joint become greatly softened, becoming abnormally mobile, which causes manifestations symphysitis.

Symphysitis has clinical features, in which the affected area swells, discomfort and pain appear in the perineal area. Such symptoms characterize mainly the second half of gestation, when walking and climbing stairs cause difficulty, and turning to one side from a lying position causes pain.

Causes of symphysitis in pregnant women and predisposing factors

This pathology can be detected when softening occurs in the area where the pubic bones of the pelvis connect. In a non-pregnant woman, the pubic bones that form the joint are connected to each other firmly and motionlessly.

Symphysitis, a strong degree of divergence of the pubic bones at the joint

During pregnancy, the state of the ligamentous apparatus is responsible relaxin hormone(it is released in increased concentrations). Due to its effect on the tissues, they soften, as a result of which the joint becomes mobile.

Nowadays, the causes have not yet been identified and the conditions due to which symphysitis appears in women during gestation have not yet been fully studied.

When pregnancy occurs, some women experience a slight stretching of the joint, but some patients experience symphysitis with the most striking clinical manifestations, which can then be observed for quite a long time in women who have given birth.

There are different factors and hypotheses regarding the development of symphysitis in pregnant women

Firstly, articulation may be adversely affected by decrease in calcium content in the female body, so bones may contain less calcium than they should.
Secondly, symphysitis may be associated with an increase in the amount of the hormone relaxin in the body. Therefore, the joint stretches excessively, swells, and characteristic symptoms appear.
In addition, special attention is paid to predisposing factors, these include the existence bone and joint pathology before pregnancy, the anatomical structure of the female body with its individual characteristics, genetic predisposition.

Today there is no clear answer as to why this disease appears and develops in women who are carrying a child.

Why symphysitis appears in pregnant women has not been fully studied, but doctors express different thoughts on this issue

A decrease in the amount of calcium in the female body during gestation.
Hypovitaminosis for many substances.
An excess of the hormone relaxin, which is detected quite often when carrying a child. Excessive levels of this hormone soften the ligaments. Up to a certain point, the symphysis gradually stretches as the fetus grows, and then a crack forms on it, which leads to rupture of the articulation of the womb during natural childbirth.
Hereditary predisposition.
Disorders of the musculoskeletal system during gestation.

Symptoms of symphysitis during pregnancy - how to notice and distinguish from other dangerous conditions?

After the fourth month of development, the fetal weight quickly increases, the uterus greatly increases, and clinical signs of pathology begin to appear.

Symphysitis manifests itself most often in the last month of pregnancy. It is characterized by the appearance of swelling at the junction of the pubic bones, a crunching sound when palpated, and severe pain is felt in the perineal area.

The pain syndrome is also localized in the pelvis, tailbone and hips. If the position of the body changes quickly - when a woman climbs the stairs, gets up from a chair, turns around - then the intensity of the pain sharply increases.

When a pregnant woman takes a lying position, then if there are manifestations of symphysitis, she cannot lift her straightened leg, plus a “duck gait” appears while walking, and if she climbs the stairs, she feels heaviness.

With the further development of pregnancy, the leading symptoms of symphysitis increase, the pain syndrome becomes more distinct - therefore, even at rest, pain begins to bother you.

Signs of symphysitis in pregnant women, when you need to see a doctor

To prevent the situation from getting worse, you need to carefully monitor your body, since when a woman is carrying a child, she must take care not only of her health, but also of the health of the baby, who has not yet been born.

Signs and symptoms of symphysitis during pregnancy:

In the place where the pubic bones connect, the inflammatory process increases, manifesting itself first as a small and then increasing swelling.
A pregnant woman develops a “duck walk.”
If you palpate the pubic area, a sharp piercing pain occurs in this place and clicks are heard when pressed.
When the position of the body changes, pain also occurs.
A woman in this position has a forced mincing gait so that the position of the hip area practically does not move.
A feeling of heaviness occurs in the abdomen, in its lower part.
There is a problem with raising a straight leg.
When climbing stairs, discomfort and pain in the hip occur.

During pregnancy, the signs of symphysitis become more pronounced, and the pain syndrome is more pronounced. A pregnant woman experiences pain when she moves, when she is at rest, when she sits and lies down.

Complaints usually appear towards the end of the last trimester, the listed symptoms clearly appear, in the second they appear quite rarely.

Complications of symphysitis during pregnancy - is the disease dangerous?

It is necessary to familiarize yourself with all the threats of symphysitis, what danger the pregnant woman and the fetus are exposed to:

Like any other pathology, symphysitis is an alarming sign for a pregnant woman because serious consequences may occur due to excessive increasing the mobility of the symphysis pubis.

The second half of pregnancy is accompanied by discomfort and pain that torment the woman. : that is, whether the woman will give birth on her own, or whether she will be indicated for a caesarean section.

In addition to the presence of symphysitis itself, it is necessary to take into account how the pregnancy is proceeding, whether there is toxicosis, gestosis, what the size of the fetus is, how many births there have been before, how they proceeded - in general, all the points that affect childbirth.

The effect of syphysitis on the condition of the fetus

The baby is not directly threatened by symphysitis.

But the pregnant woman emotional state worsens when it is constantly accompanied by pain and discomfort in the perineal area. When an expectant mother is constantly exposed to stress, this has a negative impact on the condition of the fetus.

Most often, this pathology is diagnosed at an appointment by an obstetrician-gynecologist in one of the last three months of pregnancy.

During gestation, a woman experiences a burning sensation in the pubic area, pain in the pelvis and projections of its organs, so the entire body should be examined more carefully.

The danger of symphysitis during childbirth and after pregnancy - all possible risks

This disease is not harmless, it is manifested by inflammation of the bone structures of the pubis, its anatomical changes: bones and ligaments are weakened and loosened, in the future it is possible divergence and then rupture of the symphysis.

A woman is subjected to severe suffering when such a pathology occurs. The degree of development of the pathology, together with other parameters - for example, the weight of the child, the number of pregnancies that have occurred before, the course of the current pregnancy - can affect method of delivery.

Update: October 2018

Pregnancy is a special condition of a woman in which all organs and tissues undergo changes. The musculoskeletal system of the expectant mother is no exception. Very noticeable changes occur in the pelvic bones, which form a “channel” for the birth of a baby.

How does the female pelvis work?

The pelvis is a closed ring consisting of the pelvic bones, sacrum and coccyx. The pelvic bones, in turn, consist of the pubic, ischial and ilium bones. The female pelvis, in addition to supporting the internal organs, has a very important function: carrying the child during childbirth. In this regard, all ligaments and cartilages of the pelvis have a peculiarity: they “soften”. The pubic symphysis, where the cartilage is located, also becomes more mobile and soft under the influence of a special hormone - relaxin. This allows you to slightly adjust the size of the pelvis to the circumference of the baby's head.

What is symphysitis?

Literally, symphysitis during pregnancy is inflammation of the pubic symphysis. It doesn't happen very often. While waiting for a baby, it is more correct to use the term “symphysiopathy.”

It means excessive softening of the cartilage, an increase in the distance between the bones by more than 0.5 cm.
In a non-pregnant woman, the distance between the pubic bones is approximately 0.2 cm.
At the age of 18-20 years, it may be slightly increased (up to 0.6 cm), then gradually decreases.

If at the time of birth the pubic bones still diverge, sometimes with rupture of the symphysis, this is called symphysiolysis. Sometimes an inflammatory process begins at the point of their divergence. These are symphysites.

Symptoms of symphysitis during pregnancy

The process of excessive divergence of the symphysis pubis, and even more so inflammation of the symphysis, always reveals itself with the following symptoms:

Shooting or pulling pain in the pubic area
Increased pain with physical activity, especially when abducting the hip to the side
Pain spreading to the back, thigh or abdomen
Pain in the symphysis pubis upon palpation
Pain during intercourse
Change in gait (“duck”, “waddle”)
Relief or disappearance of pain at rest
Possible defecation problems

It must be remembered that mild pain in the pubis is the norm during pregnancy; this happens in 50% of women. Sprained ligaments and softening of the symphysis lead to some discomfort, especially in the last weeks before childbirth. In such cases, expectant mothers just need to be patient. Only the appearance of severe, unbearable pain, as well as loss of range of motion and sleep disturbance are considered symptoms of symphysitis during pregnancy.

Causes of symphysiopathy

Not all pregnant women experience pronounced changes in the pubic symphysis and pain. Certain factors predispose to this.

Heredity

It is believed that the risk of symphysis dehiscence is greater if close relatives had similar problems during pregnancy

Features of connective tissue

Congenital weakness of ligaments and connective tissue in general is a rather controversial issue in medicine. This condition is diagnosed much more often than it actually is. Children with this feature are more likely to experience dislocations and subluxations; there may be problems with heart valves, prolapse of the kidneys and other organs, and joint hypermobility. During pregnancy, women with connective tissue dysplasia may experience more discomfort in the ligament area.

Calcium deficiency and vitamin D deficiency

Often, although not in all cases, it leads to excessive softening of the symphysis. This factor may be indicated by brittle hair, splitting nails, and fractures in pregnant women.

Kidney diseases

It is believed that kidney diseases (for example, pyelonephritis) lead to increased excretion of protein and minerals from the body along with urine. This promotes more intense softening and divergence of the symphysis.

Previous pelvic injuries
Multiple births

Degrees of symphysiopathy

Depending on the distance to which the pubic bones have diverged, symphysiopathies come in three degrees:

1st degree – from 0.5 to 0.9 cm
2nd degree - from 1 to 2 cm
3rd degree - over 2 cm

This distance is determined using ultrasound. In addition, upon palpation, the doctor may detect softening of the cartilage and instability of the pelvic bones.

The effect of symphysitis on pregnancy and childbirth

Symphysiopathy itself does not affect pregnancy. It only worsens the well-being of the expectant mother. But excessive stretching of the symphysis pubis during pregnancy can thin it so much that cartilage ruptures during childbirth (symphysiolysis).

This is an unpleasant injury that results in disability for several months. The risk of rupture of the joint increases if the woman’s pelvis is narrow and the child is large (more than 4 kg). Therefore, doctors often recommend a cesarean section for symphysiopathy of degrees 2 and 3, as well as for severe pain and. This reduces maternal injuries significantly.

How does a symphysis rupture manifest itself?

Symphysiolysis makes itself felt before, during, or immediately after childbirth. A postpartum woman cannot raise her legs, get out of bed on her own (only sideways), climb stairs, and sometimes even move her limbs to the required extent. Any physical activity causes pain.

Why is a symphysis rupture dangerous?

Symphysiopathy, although it causes a lot of inconvenience, does not threaten health or life. But a rupture of the symphysis pubis during childbirth is already an injury, a fracture of the pelvis.

If the bones are separated by 2 cm, then such a fracture is stable and rarely causes complications.
And if the distance between the edges of the ruptured symphysis is 5 cm or more, this is a direct danger to health.

The edges of the bones can damage the urethra, bladder, and clitoris. Hemorrhages may occur in the joint area, which will subsequently lead to arthritis. Therefore, such tears must be treated with surgery. Fortunately, such cases are very rare.

Case study: A young (26 years old) multiparous woman was admitted to the maternity ward with complaints of pushing. From the anamnesis it is known that the second birth, on time, began about 5 hours ago. My water broke an hour ago in the ambulance. An obstetric examination revealed: the opening of the cervix is almost complete, the head is pressed to the entrance to the pelvis, a sagittal suture in the right oblique size, a small fontanel on the left anteriorly. An hour later, a live, full-term boy was born without visible malformations. But only the next day, during a round, my colleague and I discovered that the postpartum woman had a duck’s gait and identified complaints of pain in the pubic area. After consultation with a surgeon, a diagnosis was made: divergence of the symphysis pubis. The child was discharged home on the 5th day under the supervision of his father and grandmothers, and the woman was transferred to the gynecology department, where she spent 1.5 months lying down with her legs bent and spread apart at the knees. It is difficult to say what led to such a condition; with timely diagnosis (ultrasound), a cesarean section is indicated for divergence of the symphysis pubis and such consequences could have been avoided. The postpartum woman was discharged with recovery after an X-ray examination (obstetrician-gynecologist Anna Sozinova).

Diagnostics

If there are complaints of pain and swelling in the pubic area, as well as difficulty in movement, all pregnant women are advised to undergo an examination.

Ultrasonography

Ultrasound of the symphysis pubis allows you to assess the distance between the bones of the pubis, as well as see indirect signs of inflammation. But often, with a small discrepancy, a woman experiences unbearable pain. Conversely, with a large distance between the bones, complaints are minimal. Thus, the ultrasound report will indicate only the amount of discrepancy of the pubic symphysis. And the final diagnosis will also take into account the severity of symptoms.

X-ray of the pelvic bones

This method is most often used after childbirth to diagnose symphysis rupture and monitor treatment. Pregnant women undergo X-ray pelvimetry (measurement of the pelvis) somewhat less frequently. It allows you to further assess the correspondence between the size of the fetal head and the circumference of the pelvis.

CT and MRI

More accurate methods are used after childbirth. This helps to monitor the effectiveness of treatment, as well as identify other pathologies in the pelvic area.

Differential diagnosis

Often, pain similar to the sensations of symphysitis is caused by completely different conditions. Therefore, it is extremely important to tell your gynecologist if you experience pain. The doctor will examine you and prescribe additional tests. Other causes of pubic pain:

Sciatica (sciatica)

This is pain in the area of the sciatic nerve. Unpleasant sensations can spread from the groin and tailbone along the leg to the shin. This symptom may be a sign of diseases such as arthritis, arthrosis, pelvic tumors and muscle damage.

Lumbago

This is acute back pain associated with spinal pathology (osteochondrosis, intervertebral hernia). Painful sensations can radiate to the leg, groin, abdomen, and often lead to urination and defecation disorders.

Infections of the genital and urinary tract

This is another cause of pain in the pubic area. Cystitis caused by E. coli or sexually transmitted infections often manifests itself as burning, stinging and tingling in the groin. Considering that during pregnancy the tendency to cystitis increases, if such pain appears, you need to be examined for infections.

Osteomyelitis and other bone diseases (tuberculous lesions)

They are quite rare. But they cannot be discounted. Women with a history of tuberculosis or who have suffered pelvic trauma require special attention.

To exclude or confirm the above diagnoses, it is enough to perform an ultrasound, x-ray, as well as smears and cultures for infections. Read more about.

Treatment of symphysitis

Symphysiopathy (softening of the symphysis pubis) is a phenomenon characteristic only of pregnancy. Therefore, 4-6 months after birth, all symptoms usually disappear. Sometimes pain in the pubic area can persist for up to 1 year. Medical attention is not required in such situations. If symphysiolysis (rupture of the pubic symphysis) has occurred, then treatment will depend on its degree.

Treatment of symphysiopathy during pregnancy

You can alleviate the symptoms of symphysis dehiscence by following simple recommendations:

Limiting the duration of walking, sitting in one place and climbing stairs
Even distribution of body weight in a stationary position (standing, sitting)
Eating foods rich in calcium. In some cases, your doctor may prescribe calcium supplements. Taking supplements should be under the supervision of a specialist, since an excess of this microelement can harm the fetus, especially in the 3rd trimester. In the last weeks before giving birth, calcium supplementation is not recommended.
Body weight control. Excess weight increases the load on joints and ligaments, causing pain.
Wearing a prenatal bandage from 25-28 weeks of pregnancy. Special abdominal support reduces pressure on the symphysis and reduces pain.

Treatment of symphysitis during pregnancy is controlled by an obstetrician-gynecologist and an orthopedist-traumatologist. Consultation with a physiotherapist and neurologist is often necessary.

Exercises to relieve pain:

Cat pose - standing on your knees and elbows, you need to straighten your back and shoulders. Then arch your back while lowering your head down, tensing your abdominal muscles. Repeat these steps several times.

Raising the pelvis - while lying on your back, you need to bend your knees. Then slowly raise your pelvis, fix it at the top point and lower it. Repeat the exercise several times.

Kegel exercises- exercises that simulate the retention and release of a stream of urine strengthen the pelvic floor muscles. This can somewhat reduce pelvic instability and relieve stress on the pubic bones.

All physical exercises can be performed if they do not cause increased pain and if there are no medical contraindications.

Treatment of symphysiolysis after childbirth

Anesthesia

Typically, substances from the group of nonsteroidal anti-inflammatory drugs (NSAIDs) are used to relieve pain. These are well-known and other painkillers. They should be used only in case of severe pain, since uncontrolled and long-term use of NSAIDs leads to the formation of stomach ulcers and liver dysfunction. In addition, it is necessary to consult a doctor when breastfeeding a child. Not all painkillers are safe for your baby.

Gentle mode

When the bones are not too far apart, sometimes it is enough to reduce physical activity using canes and other special means.

Bandages

Wearing a bandage that grips the trochanters of the femur can reduce pain and reduce the risk of further separation. This accelerates the fusion of the symphysis.

Physiotherapy

Some types of physiotherapy (for example,) are used to accelerate the healing of the symphysis. This method helps only in combination with bed rest and fixation of the pelvic bones.

Bed rest

In cases of severe dehiscence and rupture of the symphysis, strict bed rest is indicated. To speed up fusion, use a special hammock with cross-hung weights. This device brings the pubic bones together.

Treatment with controlled pelvic girdle

To enhance the effect of the hammock, a special pelvic belt is used. It has several straps to which weights are attached. With their help, the tension of one or another part of the belt is regulated, which contributes to the rapid healing of the gap.

Surgical treatment of old ruptures

If for some reason treatment of symphysitis was not carried out, and an old rupture reminds of itself with pain and limitation of movements, then they resort to surgery. During surgery, rods and plastic materials are used to restore the integrity of the pelvis.

Prevention of symphysitis

It is impossible to prevent the occurrence of symphysiopathy, since there are no precisely established causes of this condition. But by following these recommendations, you can reduce the risk of symphysis rupture and avoid long-term treatment.

Careful pregnancy planning (examination for infections, thyroid pathology)
Adequate nutrition during the planning period and throughout pregnancy and lactation
Taking additional medications if necessary (calcium, iron,)
Ultrasound of the fetus in the 3rd trimester to determine the expected weight of the child
Controlling glucose levels in diabetes mellitus (since this disease is accompanied by the birth of large children weighing more than 4.5 kg)
It is necessary to inform the doctor about all injuries, fractures and problems during previous births.
Contact a specialist if you experience pain in the pubic area, swelling and limited movement
Consultation with a specialist on the method of delivery (in some situations, caesarean section can avoid severe pelvic injuries).