5 Common Questions About Symphysis Pubis Dysfunction

Pregnancy can be hard on your body, both during and afterward. It can cause different aches and pains all over your body, including lower-back and pelvic pain. This type of musculoskeletal pain during and after pregnancy is commonly referred to as “pregnancy-related pelvic girdle pain” (PPGP). It affects up to 1 in 4 pregnant women, so you might think of pelvic pain as a “normal” condition of pregnancy. 

Symphysis pubis dysfunction (SPD) is a type of PPGP, but sometimes the terms are used interchangeably. It’s so named because it affects the pubic symphysis — where the left and right pubic bones come together in the pelvis. SPD causes pain in the pelvis and groin, and it may also occur with lower-back pain. 

Here’s the good news: SPD is not harmful to the baby, and it usually ends shortly after delivery. To further clear the air, we’ll cover five important questions you might have about SPD.

1. Why does SPD happen?

Experts don’t know exactly what causes SPD, but they think SPD is common in pregnancy for a few reasons. The growing baby puts pressure on the pelvic area, the center of gravity shifts, and hormonal changes in pregnancy can cause your ligaments to stretch out. This can lead to instability in the pelvis, especially at the pubic symphysis. 

2. Who is at risk for SPD?

You’re more likely to get SPD during pregnancy if you have any of the following risk factors:

• History of PPGP in a prior pregnancy

• Previous back and/or pelvic pain

• History of back and/or pelvic injury 

• A physically demanding job

3. How do you know if you have SPD, and what does it feel like?

The main symptom of SPD is pain anywhere in the pelvic area, including the pelvis, groin, and perineum. Sometimes the pain can even radiate into the low back, sacroiliac joints, back of the thighs, or buttocks. 

SPD pain can range from mild to strong enough that it limits your movement. You might hear clicking or popping with movement if you have SPD.

In addition to these symptoms, anything that moves the pubic symphysis can cause pain. So you might notice difficulty when:

• Sitting, walking, or standing for long periods of time

• Standing on one leg

• Engaging in sexual activity

• Going up and down stairs

• Changing positions

Concerning symptoms

In rare cases, pelvic pain in pregnancy may mean something more than SPD. Other symptoms to watch for include:

• Numbness, tingling, or weakness in your legs

• Bladder or bowel incontinence

• Vaginal bleeding 

• Pain with urination 

• Sudden increase in pain

• Severe pain that prohibits movement

If your SPD started after trauma, such as a fall, you should quickly reach out to your healthcare provider.

4. What works to treat SPD?

It’s important to discuss any pelvic pain with your provider. A lot of pregnant women think pelvic pain is just “normal,” so it’s often underreported and undertreated. But if you have SPD, your provider can help you come up with a plan to feel better during and after pregnancy. 

Treatment typically includes physical therapy, movement modifications, and other remedies to ease discomfort. 

Physical therapy is a great way to learn core-strengthening exercises that are safe during pregnancy and can help pelvic stability. A good therapist can also provide tips on how to move without worsening your pain, such as less painful ways to change positions in bed or get in and out of a car. They may advise you on equipment, such a support belt or walking frame in severe cases. 

Other ways to help SPD pain

Rest helps SPD. But, of course, rest is not always possible. So there are other things you can do, like:

• Wear low-heeled, supportive shoes.

• Sleep on your side with a body pillow in between your legs.

• Avoid standing on one leg or lifting heavy objects when possible.

• Try out massage therapy.

• Try acupuncture.

• Try hydrotherapy or water aerobics.

• Practice breathing techniques.

What to know about medications for SPD

There are a limited number of pain relievers that are safe to take in pregnancy. Acetaminophen (Tylenol) in pregnancy is one of the only options. 

NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen are typically not advised during pregnancy but can be taken after pregnancy. If you have questions, it’s best to ask your obstetric provider about medication safety during pregnancy.

It’s important to know that typically there’s not just one treatment method that can take care of SPD alone. Usually it takes a combination of several methods.

5. How long will SPD pain last?

Usually, SPD goes away shortly after birth. In some situations, the pain of childbirth might make SPD worse for a short period of time. But, the good news is that SPD most often goes away within a few months after childbirth. 

What to expect during childbirth

SPD typically doesn’t affect the safety of you or your baby during childbirth. If natural birth is your wish and a safe possibility, SPD won’t usually change that as long as there are no other risks involved. Your provider might help you position yourself in ways to alleviate SPD pain, such as getting on all fours, lying on your left side, and reducing certain movements in the hip.

How to treat SPD pain after birth

Postpartum treatment for lingering SPD can reduce your pain, improve long-term outcomes, and prevent recurrence of pain down the road. Finding the right balance between rest and activity can be hard, especially when you’re taking care of a new baby. 

Your care team can help you get a good plan. Treatment for SPD after pregnancy often includes many of the same methods as during pregnancy. Occasionally, surgery is used as a last resort.

Why trust our experts?

Written by:

Melody B. Jones, NP

Melody Jones, NP, has over a decade of experience as a nurse practitioner. She works in a multi-specialty practice in Atlanta, Georgia, and is a part of the American Academy of Nurse Practitioners.

Edited by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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