Symphysis Pubis Dysfunction (SPD/PGP)
The short answer
Symphysis pubis dysfunction (SPD), also called pelvic girdle pain (PGP), occurs when the joint at the front of the pelvis becomes too loose during pregnancy, causing pain, instability, and difficulty walking. It affects about 1 in 5 pregnant people to some degree. It is caused by the hormone relaxin and the weight of the growing baby.
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By Age
What to expect by age
SPD may begin in the second trimester as relaxin loosens the pubic symphysis joint. Symptoms include pain at the front of the pelvis that may radiate to the groin, inner thighs, or lower back. Pain often worsens with walking, climbing stairs, getting in and out of bed, or standing on one leg. A pelvic support belt and physical therapy can help significantly.
SPD often worsens in the third trimester. Keeping your knees together when turning in bed, sitting down to get dressed, avoiding wide-legged positions, and using a pillow between your legs at night can help. A physiotherapist specializing in pregnancy can teach you techniques to manage daily activities with less pain.
Let your birth team know about your SPD so they can help you find comfortable positions during labor. Avoid pushing your legs too far apart. Water birth may be helpful as buoyancy reduces joint stress. SPD does not prevent vaginal delivery in most cases.
SPD usually improves within weeks to months after delivery as relaxin levels decrease. Postpartum physiotherapy can help speed recovery. In rare cases, the pubic symphysis separates significantly (diastasis symphysis pubis), which requires specialized care. Most people recover fully.
What Should You Do?
When to take action
- Mild to moderate pubic bone pain that worsens with certain activities
- Pain when walking, climbing stairs, or getting out of bed
- Clicking or grinding sensation in the pelvic area
- Pain managed with position modifications and a support belt
- Pelvic pain is severe enough to significantly limit mobility
- You need crutches or a wheelchair due to pelvic pain
- Pain is not improving with recommended strategies
- Sudden severe pain in the pubic area with a popping sensation, which could indicate symphysis separation
- Inability to walk or bear weight on either leg
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Trust your instincts. If something feels wrong, reach out to your pediatrician.
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