Symphysis Pubis Separation

Posted On: January 12, 2018 By Andrei Rebarber, MD

Peripartum pubic symphysis separation is uncommon, but not rare condition, that can affect a woman during pregnancy. This condition can be summed up as the excessive movement of a part of the pelvis called the pubic symphysis. This excessive movement can cause a great deal of discomfort throughout the pelvic girdle.

Inconsistent classifications and sporadic reporting have prevented an accurate estimate of occurrence; however, supposed risk factors include carrying a large fetus, quick-moving labor or rapid second stage of labor, intense uterine contractions, previous pelvic disease or trauma to the pelvic ring, multiples, and forceps delivery.

What are the Symptoms of Symphysis Pubis Separation?

Clinical examples of pubic symphysis separation include pain while urinating, tenderness, swelling, and edema with pain radiating to the legs, hips, or back. The pain is often potentiated by weight-bearing, especially with walking and climbing stairs. Turning in bed, lifting, or getting up from a chair may also cause pain. Some women report waking up during the night because of pain.

How is it Diagnosed?

Rarely, a tangible groove at the level of the symphysis may be detected by internal or external examination. In a nonpregnant woman, the normal symphysis gap is 4 to 5 mm; with pregnancy, the gap increases by at least 2 to 3 mm. The diagnosis of diastasis is based on the persistence of symptoms and a separation of more than 10 to 13 mm on imaging; however, radiographic imaging is not necessary, as the diagnosis can be made clinically on the basis of symptoms and response to therapy. Furthermore, the amount of symphyseal separation does not necessarily correlate with severity of symptoms or the degree of disability.

One study that performed X-rays of the pelvis and lower spine, magnetic resonance imaging, urine dipstick, and blood tests (erythrocyte sedimentation rate, C-reactive protein, complete blood count, creatinine, rheumatoid factor, antinuclear antibodies) in women with momentary or persistent pelvic joint pain and controls did not find any of these tests to be useful diagnostically.

How is it Treated?

Standard treatment of pubic symphysis separation is conservative: bedrest in the side position, pelvic support with a brace or girdle, walking with a walker or crutches, and a graded exercise protocol. Safe options for analgesia antepartum are more limited than after delivery. Nonsteroidal anti-inflammatory medications are helpful for controlling pain after delivery. If pain persists, your doctor may recommend a prescription medication to control pain.

Symphysis Pubis Separation Recovery

The pelvis usually returns to normal by 4 to 12 weeks postpartum. Pain resolves in the majority of patients within a month but can take much longer. In a group of nine women with atypical pubic pain after childbirth, a large interpubic gap (greater than 21 millimeters) measured sonographically was associated with a delayed recovery; two of the nine patients were still disabled 36 weeks postpartum. Severe abdominal separation (greater than 25 mm) may require surgery. Symptoms may recur in subsequent pregnancies and may be worse, but this does not prevent vaginal birth.

Carnegie Imaging for Women blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!

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