SPD in Pregnancy: What Is Symphysis Pubis Dysfunction?

Pregnancy comes with a host of uncomfortable aches and pains. One of the most common complaints involves your symphysis pubis joint, which is located in front of the pubic bone. Due to a loosening of ligaments, hormonal shifts, and changes in alignment, this area may become painful during pregnancy. In some cases, pelvic pain can signal a condition known as symphysis pubis dysfunction (SPD)—also known as pelvic girdle pain (PGP).

In fact, up to 60% of pregnant people experience pain in their symphysis pubis, says Sheila Hill, M.D., an OB-GYN in the hospitalist division of Texas Children's Pavilion for Women. While SDP is not dangerous for you or your baby, it is uncomfortable. Luckily, SPD pain subsides after delivery. Here's everything you need to know about the causes, symptoms, and treatment options for SPD during pregnancy.

What Causes SPD in Pregnancy?

"We have connective tissue that attaches the two sides of the pubic bone. The connective tissue is called symphysis pubis," says Heba Shaheed, a physiotherapist specializing in women's and pelvic health who founded The Pelvic Expert in Sydney, Australia. In other words, the pubis symphysis is a cartilaginous joint located between the right and left sides of the pubic bone.

The hormone relaxin rises during pregnancy to increase your body's range of motion for childbirth. This hormonal change causes ligaments around the symphysis pubis to become stretchy, soft, and relaxed. In turn, the symphysis pubis can become unstable, leading to pain in some pregnant individuals. "People often feel like two sides of pubic bone are sliding up and down against each other," explains Shaheed. "It can be debilitating if you don't address the issue right away."

Note that in its most severe form, SPD can lead to an actual separation of the pubic bone. The pelvic and hip pain can be extremely painful in this situation. Dr. Hill says pubic bone separation is uncommon.

When Does SPD Start in Pregnancy?

"SPD can really come on at any time during pregnancy," says Allyson Shrikhande, M.D., a physical medicine and rehabilitation specialist at Pelvic Rehabilitation Medicine in New York City. She adds that 12-14 weeks is usually when you have a peak in relaxin, so you have a little more risk for developing SPD during that time. Many people report that SPD pain gets worse in the later stages of pregnancy as the baby grows and your pelvis stretches.

SPD Symptoms and Signs

Symphysis pubis dysfunction is characterized by pelvic pain, which can range from mild aching to debilitating discomfort that causes difficulty walking. The pain is usually localized in the pelvic region, although it can spread to the legs, hips, or back. SPD pain usually increases when climbing stairs, turning in bed, or standing on one leg, says Dr. Shrikhande.

SPD Risk Factors During Pregnancy

Anyone can develop SPD, but certain factors increase your risk. According to Dr. Hill, these include prior injury to the pelvis, having a large baby, a history of symphysis pubis dysfunction, and excessive weight gain.

"The normal weight gain during pregnancy (25 to 35 pounds) increases the force across joints up to twofold. It exaggerates the normal curvature of the spine, putting more pressure on the pelvic girdle," she explains. Excessive weight gain puts even more stress on the pelvis, potentially exaggerating SPD symptoms.

What's more, if your abdominal muscles are weak, they may separate in a condition called diastasis recti. This can "lead to further changes in neutral posture and even more strain on muscles and joints," says Dr. Hill. Shaheed adds that bad posture can also worsen SPD pain during pregnancy.

How to Treat SPD in Pregnancy

Staying fit before conceiving can lessen your chances of developing pregnancy-related symphysis pubis pain. "When the muscle systems (particularly the core and buttocks) are weak, they need to work harder to hold the joints in your pelvis stable while pregnant," says Shaheed."You need to use muscles to keep the two pubic bones from sliding against each other."

If you do develop SPD, Shaheed recommends hands-on physical therapy that targets the pelvic region. "After 12 weeks of doing core and glute exercises, the pain will likely go away. That's because you're strengthening the muscles," she explains. Make sure to talk to your doctor before starting any manual therapy program during pregnancy. Your provider may also refer you to a physical therapist for pelvic pain relief, and they'll teach you about pubis dysfunction management tactics.

Heat or cold application, pregnancy-safe medicines like acetaminophen, and supportive care may also provide SPD relief. "Supportive care includes rest in the lateral position or assistance with a walker or crutches," says Dr. Hill. "Additionally, those who fail conservative therapy may be helped with acupuncture." Pregnant people may also find immense relief by wearing a pelvic support belt.

SPD After Pregnancy: Management and Postpartum Rehabilitation

SPD pain will probably persist after delivery. "Your hormones don't return to normal levels right after you give birth. And the pain is usually worse if you don't address it in pregnancy, because you never strengthen your muscles," says Shaheed.

Some people develop SPD after delivery due to pelvic organ prolapse, stretched tissue in the pelvis, or abdominal separation. Dr. Hill explains that rapid or precipitous labor, multiple gestations, and forceps delivery also increases the risk of postpartum pelvic pain. Your birthing position may be a factor as well.

If you're experiencing SPD after birth, Dr. Shrikhande says to tell your doctor. They may refer you to a physical therapist specializing in the pelvic floor, since the key to recovery is strengthening the involved muscles. Dr. Shrikhande also advises against doing kegels without a doctor's consent. This common pelvic floor exercise might exaggerate the problem.

With proper treatment, Dr. Hill says the pelvis should return to normal by four to 12 weeks postpartum. She claims that 80% of people fully recover within six months. In rare cases, however, pelvic pain can last a year. A severe pelvic diastasis (separation of the pelvic muscles) may require surgical intervention.