When I was pregnant, I was constantly learning about new, weird, painful, and terribly annoying stuff that could or was happening to my body. Bleeding gums? Normal! Shortness of breath? Normal! Outlandish sex dreams involving celebrities I didn't even know I was attracted to? Somehow also normal! It's been five years since I was pregnant, and I'm still learning about the ailments that plague my gestating cohorts. The latest? Symphysis Pubis Dysfunction (SPD). As in, what are the signs of symphysis pubis dysfunction? Hell, what, exactly, even is it?
Romper spoke with Dr. Sonia Bahlani, M.D., an OB-GYN and pelvic pain specialist, to learn more about this common ailment with a not-so-commonly discussed name.
The main symptom in SPD is pain, which can range from mildly uncomfortable to sharp and debilitating. So what causes this pain? "There's a misalignment in the pelvis usually due to some sort of excessive movement of the pubic symphysis," Dr. Bahlani explains, which is a cartilaginous joint basically in the middle of the front of your pelvis. "It's moving a little bit more than it should that's what causes the pain and discomfort in the pelvic region."
This misalignment can be caused by any number of issues, among them the hormone relaxin, which sounds hilarious and made up but is actually a thing. Relaxin makes your ligaments less tense — relaxes them, if you will. This is great overall, because it means your body isn't going to split in half as your baby grows or makes its entrance into the world. Too much relaxin (or, too much too early), however, can loosen the ligaments around the pelvic bone, creating instability in the pelvis and, in turn, pain. Some people, Dr. Bahlani suggests, likely experience misalignment before pregnancy, but are able to compensate for it pretty seamlessly so they only notice it during pregnancy, when compensating becomes more difficult.
The good news is that, barring extreme cases, SPD shouldn't affect your ability to give birth vaginally (if that's your jam) and is usually resolved without major interventions. But how do you know you might have it? And what can you do about it?
While this SPD isn't exclusive to pregnant people, it's most commonly reported and observed in pregnant women. According to Dr. Bahlani, estimates range from 1 in 300 pregnancies to 1 in 50. That's a huge difference, and points to the idea that it's likely more common than most of us think. "It's probably underdiagnosed," she tells Romper. "Oftentimes, especially postpartum, it can be mistaken for something else, a lot of times it can be similar to ... other types of pelvic pain."
Pain In The Front Of Your Pubic Bone
It's pretty straightforward, right? The culprit, also known as the pubic symphysis, is in the front of the pubic bone so that's where it's going to hurt.
Pain In Your Lower Back
But remember, SPD can be mistaken for something else, because sometimes the pain can radiate from the pubic symphysis to the lower back. As you can imagine, this can create issues in diagnosing the issue. "You often have to get a lumbar MRI to make sure you're not missing something like a herniated disc," Dr. Bahlani says.
If you feel like something's off, something's probably off.
Pain In Your Perineum, Abdomen, And/Or Upper Thighs
Again, that whole general area is extremely connected. Think of it like a water leak — a leak in the living room ceiling could ultimately be due to a misaligned gutter way on the other side of the house, because the entire house is interconnected.
Pain Is More Pronounced Walking Or Using Stairs
This can be due to the aforementioned misalignment, but can also be a muscular issue. "You don't have the muscle being able to give you the strength in the area. ... Because they have symphysis pain, they're unable to garner that strength to balance it out," Dr. Bahlani says. So weight bearing activities, such as climbing stairs, getting out of the car, or one-legged yoga poses can be a sign that you might be dealing with SPD.
You Hear Popping Sounds
It has been reported that some patients will hear as well as feel the symptoms of SPD, specifically clicking or popping sounds. "I've never seen it in clinical practice," Bahlani admits, but hypothesizes the sounds are "likely because the muscles are so relaxed it causes a change in the alignment of the pelvis, so the side joints ... where the hips and the legs come together... are going in and out because it doesn't have the same muscle traction."
What Can You Do?
"It's something that's very much treated with conservative, holistic management," Dr. Bahlani says. "Things like baths, pelvic floor physical therapy, making sure they're not constipated. All the things that keep the pelvic floor healthy is what is going to help with this... you want to make sure you don't make that misalignment worse." While the pain usually resolves with time and more so with dedicated treatment, Dr. Bahlani does warn that it is a problem that may come and go, but that "the prognosis is pretty good ... most patients do pretty well."
Bahlani says people who feel like they are experiencing this sort of pain often face care providers and well-meaning friends and family who can make them second guess whether what they're experiencing is even real or not a big deal. But according to Dr. Bahlani, "If you feel like something's off, something's probably off."
The pain will often go away on its own, but not because it's nothing, and there are things a pelvic floor specialist or care provider can do to help you until it does.