The dense pelvic bones in combination with the sacrum form a complete structure - the pelvic ring. Its task is to unite the skeleton of the lower extremities with the spine. Nature assigns another important function to the pelvis: it serves as a container and support for internal organs.
This aspect takes on particular importance in women during pregnancy - the pelvis becomes a natural container for the pregnant uterus, which during this period almost completely displaces other organs (intestines, omentum). All large muscles of the lower extremities, muscles of the anterior and lateral walls are attached to the pelvic bones abdominal cavity. Large nerves (sciatic, obturator) and vessels (femoral veins and arteries) pass through the openings in the pelvic bones.
Functions of the pelvis:
- Supportive - the entire weight of the upper half of the body is transferred to the pelvis through the spine.
- Motor - the muscles of the legs and back, which are responsible for movement, are attached to the pelvis.
- Balancing - the interaction through the pelvis between the legs and spine allows a person to maintain balance.
- Protective - protects large vessels and nerve trunks from damage.
- Hematopoietic - in the flat bones of the pelvis there is a significant mass of red bone marrow that produces blood cells.
Where is the symphysis pubis located?
The human pelvic ring closes in front - that’s where it is located. Each person can feel it quite freely; difficulties may arise only in very plump people. If you place your hand 15-20 centimeters below the navel and press on the skin, you can feel the bones of the pubic symphysis underneath it.
The bladder is located directly behind the pubis in both men and women, so the location of the symphysis pubis can be determined by one more sign: when a person really wants to urinate, it is behind the pubis (behind the pubis) that the urge to urinate is felt.
Articulation pubis: norm and pathology
Normally, the pubic bones are connected to each other by a special type of interosseous joint - the symphysis. The peculiarity of this structure is that it is a cartilaginous plate between two bones. This plate has a small longitudinal cavity, which allows for slight displacement of the bones relative to each other.
Condition of the symphysis pubis during pregnancy
The ability of the pubic bones to shift plays an important role in the biomechanism of childbirth: when a child passes through the birth canal, the bones of the pubis move slightly apart. This allows, in most cases, to avoid serious injury to both the mother and the newborn baby. Normally, before childbirth, there is even some softening of the cartilage of the pubic symphysis, which further facilitates the birth process.
Causes of pubic bone problems
The area of the symphysis pubis in women is very susceptible to various pathological processes, which sometimes leads to problems during and after childbirth. All reasons can be grouped into several categories:
It is especially difficult for those women who have a combination of several causes at the same time.
Divergence and rupture of the symphysis pubis
The most common pathology of the musculoskeletal system in women giving birth is represented by discrepancy of the pubic bones. This is a very unpleasant phenomenon, the symptoms of which are:
Degrees of divergence of the pubic bones
The ligaments of the pubic symphysis are very plastic and have a good margin of safety. The severity of the condition in case of discrepancy can be assessed only by measuring the distance to which the pubic bones move away from each other. Based on this criterion, the following degrees of divergence of the symphysis pubis are distinguished:
- The first is that the width of the diastasis (the gap between the bones) is in the range from 0.5 to 1 cm. The symptoms are mild, most often no treatment is required - the bones will subsequently restore their original configuration.
- The second is that the pubic bones diverge by 1-2 cm, which is accompanied by severe pain and can complicate childbirth and the postpartum period.
- The third, or direct rupture of the womb, is a discrepancy exceeding 2 cm and can be determined by palpation.
With the second and third degrees of divergence of the symphysis pubis, a pregnant woman should be in a hospital in order to be able to receive qualified medical care at any time.
Inflammation of the symphysis pubis
Another unpleasant phenomenon that significantly complicates the life of a pregnant woman is symphysitis. This is an inflammation of the symphysis, which may be accompanied by a discrepancy, or may occur without it. Symptoms of symphysitis are the same: pain in the pubis, changes in gait.
Diagnostic methods
The diagnosis of symphysitis can be made only on the basis of a woman’s typical complaints. To confirm it and to identify discrepancies with the determination of the degree, it is necessary to conduct some instrumental studies.
The most accessible method diagnosis is ultrasound of the symphysis pubis. U non-pregnant women The most informative diagnostic method will be an x-ray of the symphysis pubis after childbirth.
An ultrasound of the symphysis pubis should be done to determine whether a woman needs hospitalization or whether she can be treated at home.
Possible complications
With a discrepancy of 1-2 degrees of the symphysis pubis, in most cases there are no consequences for the woman. At grade 3 there is a risk of severe complications:
- gap Bladder;
- damage to the urethra;
- clitoral trauma;
- fracture of the pubic bones;
- hemorrhage in the fracture area.
Some women may develop arthrosis of the symphysis pubis. It usually occurs in women with many children, in whom each pregnancy proceeded with symptoms of symphysitis.
All these phenomena occur as a result of pathological displacement of the pubic bones. To prevent complications from occurring, it is necessary to promptly identify the pathology and begin preventive and therapeutic measures.
Treatment methods
This pathology is treated conservatively, that is, no operations are performed. The exception is a complicated rupture of the symphysis pubis due to damage to neighboring organs.
The goal of treatment is to stabilize the frontal bones, allowing the symphysis to fuse. Treatment is always long-term - at least 1-2 months even in simple cases, and in severe cases it can last six months.
Treatment of discrepancy and rupture of the pubic symphysis
Therapeutic measures are as follows:
In pregnant women, treating discrepancies with medications is very difficult - they can have an adverse effect on the child, so therapy is limited to the above methods. Women who have given birth can take painkillers to relieve pain, but only after consultation with an obstetrician and orthopedist.
Exercises to relieve pain
You can reduce the pain of symphysitis with the help of some exercises from your arsenal. physical therapy. Remove completely pain syndrome They won’t be able to, but they will significantly alleviate the general condition.
Cat pose. The patient should get on her knees and elbows, after which she should arch her back as much as possible (like an angry cat). In this case, you should strain your abdominal and pelvic muscles as much as possible. The exercise is repeated 5-10 times, after which you can rest. 5-7 approaches are performed per day. This exercise is suitable for pregnant women early stages women who have already given birth; on later its implementation is difficult.
Kegel exercise - the task is to tense the pelvic floor muscles. It is necessary to simulate interruption of the urine stream during urination. The exercise is relatively simple and can be performed at any time.
Prevention of symphysitis
All women should be concerned about prevention, but this applies to a greater extent to the risk group, when there are all the reasons for the occurrence of symphysitis and rupture of the symphysis pubis.
No doctor can guarantee a pregnant woman that she will not have symphysitis. You can reduce the likelihood of this pathology by following simple recommendations:
- Adequate nutrition throughout the entire period of bearing a child. The diet should be enriched with proteins and calcium.
- Taking vitamin complexes and microelements according to indications.
- Regular ultrasound examinations to assess the expected weight of the child.
- Timely treatment of any concomitant diseases.
- Preventing excess weight gain.
If, despite all the preventive measures, pain still appears in the pubic area, then you should not delay it - you should immediately consult a doctor for advice. Early initiation of treatment significantly improves the prognosis and reduces the likelihood of complications.
A diagnosis is made: symphysitis. As a rule, a woman associates the resulting pathology with childbirth. Is this fair?
A little anatomy, what is symphysitis?
During childbirth, the fetus passes through the woman’s bony pelvis, which is formed from the sides by two pelvic bones (fused pubis, ischium and ilium), and from the back by the sacrum. Both pelvic bones are connected in front by the pubic joint - the symphysis, and in the back - by two sacroiliac joints.
The pubic symphysis is the pubic fusion of both pubic bones of the pelvis through a fibrocartilaginous disc, in the center of which there is an articular cavity in the form of a slit filled with articular fluid. Front and back, above and below, the symphysis is strengthened by ligaments that give strength to this joint. The pubic symphysis is a semi-joint, i.e. has an extremely limited range of movement. Normally, the width of the symphysis (the distance between the pubic bones) can be up to 1 cm.
In front of the pubic symphysis is the pubis with its fatty lining and the ligament that elevates the clitoris. Nerves and blood vessels pass below the symphysis. Behind the pubic symphysis are the urethra and bladder.
Symphysitis- this is the general name for changes and damage to the symphysis pubis, which hides up to 16 components: loosening, softening, edematous impregnation, stretching, expansion, divergence, rupture, inflammatory process, a special form of hypovitaminosis, symphysiopathy, symphysitis itself, etc. Most often, these changes arise and manifest themselves during pregnancy, childbirth and the postpartum period. This article will discuss the consequences that they can lead to.
Divergence of the symphysis pubis
It arises as a result of ongoing physiological changes as an adaptive process to facilitate childbirth; those. these are normal changes.
At physiological pregnancy the ovaries and placenta secrete a substance called relaxin, which has a specific relaxing effect. Under the combined action of relaxin and female sex hormones, articular cartilage and ligaments swell, loosen, and additional fluid-filled gaps appear in the joints, resulting in increased mobility in the pelvic joints and an increase in the distance between the bones that form each joint.
These changes are especially pronounced in the symphysis pubis, there is an increase in blood supply, swelling and loosening of the entire ligamentous apparatus. The width of the pubic articulation increases by 5-6 mm, small movements (up to 10 mm) of the articular ends of the pubic bones up and down are possible, like the keys of a piano. The width of the pubic joint reaches 1.5 cm; the divergence of the sacroiliac joint increases to a lesser extent.
In the postpartum period, all these changes are gradually eliminated - the cartilage in the joints becomes denser, the ligaments acquire their former elasticity and density, and the width of the joint space decreases.
Symphysiopathy. This is the name for excessive relaxation of the symphysis pubis as a manifestation of toxicosis in pregnant women with a predominant lesion of the osteoarticular system of the woman’s body. In some women, these changes in the structure of the joints go beyond the physiological processes, acquire a pathological character and lead to excessive divergence of the pelvic joints. Symphysiopathy is characterized by the appearance of complaints and symptoms in the presence of discrepancies in the symphysis pubis.
There are three degrees of divergence of the symphysis (above the physiological discrepancy of 5-6 mm):
I degree - discrepancy by 5-9 mm;
II degree - by 10-20 mm;
III degree - more than 20 mm.
A leading role in the development of symphysiopathy is played by disturbances in phosphorus-calcium metabolism and a lack of vitamin D. Calcium is the main structural component of skeletal bones and teeth. The metabolism of calcium and phosphorus is regulated mainly by the parathyroid hormone, calcitonin - the thyroid hormone - and vitamin D, depends on quality composition food, the ratio of calcium, phosphorus and magnesium in it. When the phosphorus-calcium balance is disturbed in the direction of decreasing calcium, these elements come to the fetus from the “reserves” of the mother’s body - bones and teeth.
With a lack of vitamin D, bone mineralization is impaired due to impaired absorption of calcium and phosphorus from the intestine, as well as their mobilization from bone tissue. A decrease in calcium levels in the blood can also be observed with concomitant pathologies: diseases of the gastrointestinal tract, chronic enteritis, dysfunction of the parathyroid gland, renal failure, diabetes mellitus, as well as with a diet insufficient in calcium, vomiting during pregnancy and other conditions. Against such a painful background, pregnancy and breastfeeding can aggravate calcium deficiency.
As a rule, symphysiopathy manifests itself long before childbirth. Against the background of calcium starvation, tooth decay, brittle nails, general fatigue, paresthesia (the appearance of a tingling sensation and changes in skin sensitivity), twitching and contraction of individual muscles are characteristic, especially night cramps in the calf muscles. With minor discrepancies of the symphysis, the appearance of “flying” pain in the pelvic bones and lower back is regarded as radiculitis, osteochondrosis, or threat of miscarriage. In the second and third trimester of pregnancy, symphysiopathy is characterized by pain and discomfort in the pelvic bones when walking and standing.
The disease is not uncommon. Symphysiopathy may not make itself felt before childbirth and may be hidden. In the second half of pregnancy, the pubic bone ratio is constrained by the tension of the abdominal muscles due to the enlargement of the uterus. Immediately after childbirth, flabbiness of the abdominal muscles occurs and the discrepancy of the pubic bones can increase to 20 mm or more. For divergence of the symphysis pubis II and especially III degree during pregnancy and childbirth, diagnosis is not difficult: a change in the nature of pain in the symphysis occurs, which intensifies when turning in bed, when active movement legs, often a woman cannot walk. In bed, the patient takes a certain position - the “frog pose”: she lies on her back with her hips turned outward and her hips turned outward and her knees slightly bent.
When pressing on the pubic symphysis, both from the front and from the vagina, severe pain is determined. In addition, you can determine the discrepancy itself - the fingertip is placed in it. A significant discrepancy of the symphysis pubis (more than 2 cm) is also indicated by the appearance of a waddling, duck-like gait.
The diagnosis is clarified by x-ray and ultrasound diagnostics. During pregnancy, preference is given to ultrasound diagnostics, taking into account the harmful effects of X-rays on the fetus. Typically, an X-ray of the pelvis reveals discrepancy of the symphysis pubis of varying degrees, but there are no pathological changes in the bones.
When determining the concentration of calcium and magnesium in the blood and urine, their amount in the blood decreases by almost half, and their content in the urine is slightly increased. Only by determining the content of calcium and magnesium in the blood and urine of a pregnant woman in the absence of complaints can one predict the divergence of the symphysis pubis.
The course of symphysiopathy is usually favorable. In itself, this disease during pregnancy is not an indication for delivery by cesarean section, either unplanned or emergency. To determine obstetric tactics in choosing a method of delivery, the magnitude of the divergence of the symphysis pubis is important.
If there is a pronounced discrepancy of the symphysis during pregnancy and there is a risk of injury to the pelvic bone during childbirth, delivery is performed by surgery caesarean section. With a narrowing of the pelvis and a relatively large size of the fetus with a voluminous dense head, the critical distance of divergence should be considered 10 mm.
Rupture of the symphysis. This severe form of symphysis injury is rare. It is characterized by a violation of the integrity of the joint, is most often associated with childbirth and occurs when the divergence of the symphysis pubis of the third degree is more than 2 cm. Rupture of the symphysis pubis with damage to the ligaments is often combined with damage to one or both sacroiliac joints and usually occurs during childbirth with surgical delivery (obstetric forceps) or when a narrowed pelvis is combined with violent labor.
Mechanical trauma itself does not have a dominant significance: the tensile strength of the pubic symphysis is on average 200 kg. Of primary importance are changes associated with symphysiopathy, as well as previous inflammatory changes in the pubic bones and pubic symphysis, and even a minor mechanical effect is an impetus for the rupture of the weak adhesion of the ligamentous apparatus.
In most cases, during childbirth there is a slow spreading of the tissues of the symphysis pubis, so complaints of pain in the pubic area, aggravated by moving the legs, appear a few hours or on the 2nd -3rd day after birth. Only in rare cases does a woman in labor feel a sharp pain in the womb; sometimes the characteristic sound of tearing ligaments is heard, after which even the large head of the fetus quickly descends through the expanded bone ring.
Rupture of the pubic symphysis is sometimes accompanied by injury to the bladder and urethra, the formation of hematomas in the pubic area and labia, and the addition of an inflammatory process - symphysitis.
The postpartum woman cannot raise her legs (symptom of “stuck heel”) and turn on her side; in bed she takes a forced position (“frog pose”). On palpation both from the front and from the side of the vagina, severe pain is determined and, in addition, mobility of the pubic bones and retraction due to their wide distance from each other.
The nature of the damage is clarified by x-ray examination. A rupture of the symphysis pubis is indicated by:
- discrepancy of the pubic bones up to 7-8 cm,
- the presence of a vertical displacement of the horizontal branch of the bone by 4 mm or more.
Without special treatment, the symphyseal ligaments do not fuse or are connected by scar tissue, forming a false joint, therefore, when walking, both halves of the pelvis subsequently perform rocking movements, a “duck walk” appears, and constant complaints of lumbosacral pain are regarded as radiculitis.
In severe cases of damage to the symphysis pubis (rupture, severe sprain), as well as in the absence of effect from conservative treatment, as a rule, surgical treatment using metal structures, applying lavsan and wire sutures. Working capacity is restored 3-4 months after surgery.
Symphysitis
This term means changes in the pubic symphysis caused by the inflammatory process. Symphysitis is characterized by the fact that in the presence or absence of a pronounced divergence of the pubic bones, the disease is accompanied by a characteristic inflammatory reaction: pain, impaired movement in the limbs, swelling and redness in the pubic area, and a feverish state. The x-ray shows the discrepancy of the symphysis pubis with the phenomena of osteoporosis (rarefaction) in the bone tissue.
Chronic inflammatory processes in the bladder (cystitis) and urethra (urethritis) may be accompanied by focal changes in the symphysis pubis. The disease develops in the presence of a chronic infection in the genitourinary tract (ureaplasma, mycoplasma, herpetic infection, staphylococcus carriage) in pregnant and postpartum women against the background of calcium and magnesium deficiency, with hypovitaminosis D. The use of antibacterial therapy in combination with calcium and magnesium preparations and UV irradiation gives excellent and a rapid therapeutic effect even in severe symphysitis with pronounced divergence of the symphysis pubis.
Prevention of symphysitis
For the prevention of symphysiopathy and other injuries of the symphysis pubis, the following are important:
- A diet rich in minerals and trace elements involved in the formation of the skeleton (calcium, phosphorus, magnesium, zinc, manganese), as well as rich in vitamin D: milk, lactic acid products, yoghurts, low-fat cheeses, eggs (yolk), meat and liver of mammals and birds , fatty fish meat, fish liver, caviar, seafood, as well as legumes, mushrooms, herbs, nuts.
- Sufficient physical activity during pregnancy, visiting schools for expectant mothers where it is used physiotherapy to strengthen the muscles of the back, abdomen, buttocks and stretch the pelvic floor ligaments.
- Long stay fresh air. Under influence ultraviolet rays Sunlight produces vitamin D in the skin.
- Taking multivitamins for pregnant women, dietary supplements with microelements and antioxidants.
- In case of poor calcium absorption associated with gastrointestinal tract disease, take digestive enzymes to combat dysbiosis.
Treatment of symphysiopathy
If the pubic symphysis diverges during pregnancy and childbirth, as a rule, surgery can be avoided.
In the case of the development of symphysiopathy with a slight divergence of the symphysis pubis during pregnancy or after childbirth, it is recommended to limit physical activity, wear a bandage, sleep on an orthopedic mattress, take calcium supplements in a well-absorbed form (CALCIUM CARBONATE, L ACT AT CALCIUM), CaDs NYCOMED, FISH OIL (better in capsules), MAGNE Be, B vitamins, UV irradiation. In the presence of a urogenital infection, antibacterial therapy is prescribed taking into account sensitivity to antibiotics. It is also recommended to use painkillers in the form of gels, ointments or suppositories and tablets.
With II and III degrees of divergence of the pubic bones in the postpartum period, the main thing is to bring the ends of the pubic bones closer together and hold the pelvic bones in a certain position. This is achieved by bed rest (you cannot get up or walk for 2 to 6 weeks after birth), as well as by using a bandage or tight bandage. On the first day after birth, cold is used, and subsequently physiotherapeutic procedures are used on the area of the symphysis pubis. Calcium supplements and painkillers are used; if inflammation occurs (symphysitis), antibacterial therapy and a diet with a high calcium content are prescribed.
After the expiration of the period, X-ray control is carried out, after which the woman begins to wear a bandage.
Currently, special corsets are used that help hold the pelvic bones in a certain position, which allows for extended bed rest. Usually, after 3-5 days of bed rest in a corset, a woman can already get up and care for her child. The corset is worn from 3 to 6 months.
In order to facilitate childbirth, eliminate the existing obstacle to the passage of the fetus, especially the head through the bone ring in the presence of a narrowing of the pelvis, from ancient times to the present, in some countries of Africa and Latin America, a pelvic dilatation operation is used - symphysiotomy (dissection of the symphysis).
Despite the fact that pregnancy and childbirth are natural processes, quite often they are accompanied by various complications that make themselves felt even after the birth of the child. Symphysitis is one of them.
What is symphysitis
The diagnosis of symphysitis is made in the presence of abnormal changes, damage and inflammatory processes in the connection of the pubic bones and their excessive divergence. In women, symphysitis most often occurs during pregnancy and may continue after childbirth.
The pubic joint or pubic symphysis (lat. symphysis pubica) is a vertical connection of the upper branches of the pubic bones located in the midline. It is located in front of the bladder and above the external genitalia (the entrance to the vagina in women and the penis in men).
https://ru.wikipedia.org/wiki/Pubic_articulation
Pelvic structure
During pregnancy, the level of the hormone relaxin increases significantly in a woman’s body, which affects the ligaments and cartilage that connect the pelvic joints. This makes the ligaments softer and looser, the joints become more mobile, and the width of the symphysis increases by several millimeters (usually by 5–6). This discrepancy is necessary to make it easier for the child to overcome the birth canal.
For most women, an increase in the width of the symphysis does not cause unpleasant symptoms, although approximately a quarter of pregnant women experience periodic or constant pain of varying intensity in the pubic area.
Normally, after childbirth, when the production of relaxin decreases, the ligaments and cartilage restore their density, and the distance between the pubic bones becomes the same (on average, in non-pregnant women, the width of the pubic symphysis is 2-3 mm). However, in approximately 7% of cases this does not happen and women are forced to apply for medical care. In 1% of women, postpartum symphysitis leads to serious complications, including disability.
Causes of postpartum symphysitis
The mechanism of occurrence and development of symphysitis is not fully understood, but most researchers are inclined to believe that the cause is too high level relaxin production during pregnancy. In this case, the ligaments and joints begin to relax too quickly, and the body does not have time to compensate for these changes. As a result, the stability of the bones and joints of the pelvis is disrupted, they become too mobile, and pain occurs when moving. If the stretch is great enough, then after childbirth the symphysis cannot independently shrink to its previous size.
The inflammatory process in the connection of the pubic bones with symphysitis leads to pain of varying intensity
Other reasons that increase the risk of developing postpartum symphysitis, are:
- injuries and ruptures when a large fetus passes through the birth canal;
- availability expectant mother pathologies of bones and joints, pelvic injuries, hormonal disorders, excess weight etc.;
- lack of calcium and magnesium;
- first menstruation before the age of 11 years;
- the presence of symphysitis in a previous pregnancy;
- multiple pregnancy.
Symptoms of symphysitis
Usually the first symptom of postpartum symphysitis is periodic aching pain in the pubic area. It may appear almost immediately or within one to two days after birth. If a woman does not seek help and does not undergo appropriate treatment, her condition quickly worsens and new symptoms appear:
- Severe pain with any movement (especially when walking or climbing stairs) or trying to change position (when turning from side to side, when trying to get up from a chair or get out of a car). In this case, the pain begins to spread to the perineum and lower back, buttocks and legs.
- Pain with prolonged sitting.
- Increased pain at night.
- Swelling of the pubis.
- A shuffling or “duck” gait, which a woman unconsciously resorts to to relieve discomfort when moving.
- Characteristic clicking sounds when walking and when palpating the pubic area.
- Weakness in the legs.
Before diagnosing symphysitis, the doctor excludes other pathologies and diseases that may have similar symptoms (hernias, infections urinary tract, thrombosis, pinched nerves, etc.). Then, using X-rays or MRI (magnetic resonance imaging), the amount of discrepancy of the pubic bones is determined. There are three degrees of symphysitis:
- first degree - discrepancy from 6 to 9 mm inclusive;
- second degree - discrepancy from 10 to 20 mm inclusive;
- third degree - discrepancy over 20 mm.
The first degree of symphysitis, when pain is practically absent, can only be suspected based on the results of a blood test. The second and third degrees are quite easily determined by palpation.
Treatment of symphysitis
If the discrepancy is small, the doctor will most likely recommend that you wear a special bandage that supports the pelvis and hips and limits movement, reducing physical activity, a set of exercises to strengthen the muscles and ligaments of the pelvis, and courses of calcium and magnesium supplements.
If possible, visit a qualified osteopath who will help restore muscle tone and balance to the pelvic bones.
Avoid any movements that may cause pain and further injure the ligaments:
- keep your feet together when getting in or out of the car;
- sit on the bed to put on underwear or trousers;
- do not sit on hard surfaces and generally avoid sitting for long periods of time;
- use a pillow to support your lower back when sitting;
- if you have to sit, distribute your weight evenly: do not sit with your legs crossed, do not lean on one side, do not do exercises with crossed legs, etc.;
- the same applies to the standing position: do not put your weight on one leg, do not lean one shoulder on vertical surfaces, etc.;
- try not to climb the stairs, use the elevator;
- Even if you feel better, for the next six months, stop cycling, running, jumping, and wearing high-heeled shoes.
For more complex conditions, hospitalization is recommended. The duration and complexity of treatment depends on the severity of the condition. In the second degree of symphysitis, bed rest is indicated for 4–6 weeks. With the third degree of symphysitis, surgery is required to apply fastening staples and subsequent strict bed rest for a long time (up to two months).
Using bandages
These devices help realign the pelvic bones, thereby reducing the severity of symptoms. They are sewn from dense elastic fabrics and equipped with belts for tightening and reliable fasteners. Adapted for 24/7 wear. It is ideal if an experienced physiotherapist selects a bandage for you.
In the first degree of symphysitis, a high-quality maternity bandage can be used to fix the pelvis.
Photo gallery: types of pelvic bandages
Bandages and corsets are usually adapted for round-the-clock wearing. Bandages help relieve the lower back and pelvic ring. Bandages help reduce pain during symphysitis.
A maternity bandage can be used to fix the pelvis with a small degree of discrepancy
Video: pelvic and abdominal bandages, personal experience
Physical exercise
Before you start doing the exercises, consult with an experienced specialist: depending on the severity of your condition, you may need correction of the complex.
The exercises are aimed at stabilizing the pelvis and strengthening the muscles and ligaments of the pelvic floor. The complex is performed 2-3 times daily at a slow pace, without jerks or sudden movements.
Kegel exercises
The easiest way to perform this exercise is to lie on your back and squeeze the muscles that form the anus and urethra (as if you want to stop urinating). Keep your muscles contracted for at least 5 seconds, while trying not to hold your breath or tense your hips and buttocks. Gradually increase the contraction time. Repeat 5 times.
Wall stand
Stand with your back to the wall, pressing the back of your head, shoulder blades and feet against it. Try to press your lower back to your back and stay in this position for 3-5 seconds. Repeat 5 times.
Try to press the entire back of your body against the wall
Thigh squeeze
Sit comfortably, thighs parallel to each other, thighs and shins forming a right angle. Place your fist between your knees, squeeze your knees and hold this position for 5-10 seconds. Repeat 5 times.
Make a fist with your knees for 5 seconds
If you are uncomfortable doing this exercise while sitting, you can do it lying on your back with your knees bent. Instead of a fist, you can use a small ball.
Video: technique for performing an exercise with a ball
Cat
Get on all fours so that your palms are located under your shoulder joints and your knees are under your pelvic joints. As you inhale, bend your back and lift your head up. Stay in this position for 5 seconds. As you exhale, arch your back, lower your head and neck, and tighten your abdominal muscles. Stay in this position for 5 seconds. Repeat 5 times.
When performing the “Cat” exercise, stay in each position for 5 seconds.
Half bridge
Lie on your back, bend your knees and place them a short distance apart. Hands along the body. As you exhale, lift your hips up and hold in this position for 3-4 seconds. The shoulder blades should remain on the ground. As you inhale, lower your pelvis to the floor. Repeat 10 times.
The “Half Bridge” exercise will help strengthen the pelvic muscles
Drug treatment
Drug therapy for symphysitis is rather auxiliary in nature. Calcium and magnesium supplements are intended to strengthen bones that are weakened after pregnancy. Analgesics and other painkillers reduce discomfort and provide relief. daily life. Unfortunately, many painkillers are incompatible with breastfeeding, so you should consult your doctor before taking them.
Consequences of symphysitis
If pain in the pubic area does not stop or intensifies after childbirth, you should definitely consult a doctor. Even if the pain is tolerable, without adequate treatment, serious complications are possible. These include lameness, chronic pain, and problems with subsequent pregnancies and births. In the most severe cases, for example, when the ligaments of the symphysis pubis are torn, the woman will not even be able to stand on her feet, let alone move independently.
In addition, be prepared for the fact that even with successful treatment in subsequent pregnancies, there is a high probability of re-development of symphysitis. Therefore, when undergoing an ultrasound, ask your doctor to also examine the symphysis. If the discrepancy of the symphysis pubis in a subsequent pregnancy is higher than normal, you will most likely be recommended a cesarean section.
I had symphysitis when I gave birth to my first daughter. It turned out to be a bit large for me - 4200 g. After 12 hours I stopped walking, I couldn’t turn over on my side, I just lay flat... well, I could only lift myself up onto one elbow in order to somehow change the baby’s clothes. They tied a sheet over my hips - it helped a lot and the pain became less. I couldn’t walk at all for 5 days. Doctors arrived, did an x-ray on the spot, and said it would be fine. On the sixth day I started trying to walk, but it worked just a little. It took me about a month to fully recover.
http://forumodua.com/showthread.php?t=467281&s=
Firstly, you need a corset, a pelvic ring, to immobilize the pelvic bones as much as possible. For the first month I wore it around the clock, then I started taking it off when I was lying down. Secondly, do not sit down or lie on your side for as long as possible, this is the biggest load. Well, don’t spread your legs to the sides. I was allowed to breastfeed on the third day, I remember asking in the breastfeeding community that what I was injected with was not contraindicated. I fed while lying on my back, it was uncomfortable, but somehow I managed. The main thing is to take care of yourself now! I fully recovered by the time the baby was four months old, I run and jump, and if I don’t heal, then I can suffer with my joints for the rest of my life.
Svetlana
https://www.babyblog.ru/community/post/vosstanovlenie/1692574
Apparently, symphysitis began to manifest itself during pregnancy; my lower abdomen and pubis hurt suspiciously, and my genitals were swollen. It was difficult to get out of bed and then walk. Like a cripple... I thought it would pass. Still, pregnancy big belly. And after giving birth it appeared on the third day. I couldn't move at all. My legs couldn't lift. The pain is hellish. The baby needs to be swaddled, he is crying, but I can’t get out of bed. For three days I was injected with diclofenac and painkillers. It helped while they were installing it. Then everything came back. After several days of torment, we went to an osteopath (I found him on a recommendation). After the first session, I started walking without pain and moving my legs at all! There is still a slight discomfort, but in a few days I will go back to the appointment to see how the body reacted. Girls! Don’t worry, look for a good osteopath in your city and run to him! No amount of injections will help. And the osteopath will definitely put you back on your feet!
During pregnancy, under the influence of hormonal changes, serous impregnation of the ligamentous apparatus and joints of the pelvis, in particular the pubic symphysis, or symphysis, occurs. In some expectant mothers, the softening of the pelvic adhesions can be significant.
pubic symphysis during pregnancy
Significant relaxation of the joints of the pelvis, especially the symphysis, can be attributed to specific manifestations of toxicosis of pregnancy. As a result, swelling and non-physiological mobility of the pubic fusion occurs during pregnancy, or symphysitis, which, in turn, during childbirth can lead to divergence of the pubic fusion (symphysiolysis). The pubis, pubic symphysis, or symphysis, along with the ilium and ischium, is an integral part of the pelvis. There are such sections of the pelvis as the upper (large pelvis) and lower (small pelvis - the bony part of the birth canal).
The female pelvis has a number of significant differences from the male pelvis, for example:
- The female pelvis is wider, lower and larger in volume than the male one;
- The bones of the female pelvis are less massive, lighter and thinner;
- The sacrum of the female pelvis is wider and not as concave as in men.
During pregnancy, the pubic fusion, as part of the pelvis, experiences pressure from the enlarging uterus; in addition, under the influence of hormonal processes in the woman’s body, the symphysis softens.
The concept of symphysis: this is part of the female pelvis
The pubic symphysis, as an integral part of the female pelvis, plays a vital role during pregnancy. In addition, the pubic symphysis plays an important role in the process of normal physiological childbirth.
Pregnancy, as well as childbirth, especially in those who have given birth repeatedly, may have the following pathological changes:
- Abdominal muscle diastasis (separation);
- Varicose veins of the extremities;
- Weight gain;
- Significant (more than 4 centimeters) divergence of the symphysis during childbirth, etc.
Softening and divergence of the symphysis is a normal physiological process that ensures pregnancy and comfortable childbirth. It should be noted that all these pathological changes in the body of a pregnant woman must be considered as specific manifestations of toxicosis, requiring appropriate corrective therapy.
The term symphysitis: what is it?
At approximately 8-9 months of pregnancy, a dull pain may appear in the pubic area, in the groin or between the legs. This is due to the softening of the pubic and other joints of the pelvis.
According to modern medical interpretation, the term “symphysitis” is outdated and inaccurate, since during pregnancy the pubic fusion and its ligamentous apparatus do not become inflamed, as one might assume from the name of the disease - symphysitis, similarly - rhinitis, otitis, etc.
It’s just that the pubic symphysis experiences pressure from the uterus, so the pubic symphysis becomes tense, which is accompanied by pain. The divergence of the symphysis itself during childbirth is extremely rare. As for the phenomenon of symphysiopathy, or symphysitis, this is a phenomenon of swelling and excessive mobility of the pubic fusion of the pelvis due to hormonal changes in the body of a pregnant woman. As a rule, symphysitis can precede symphysiolysis (actually, the divergence of the symphysis during childbirth).
Therefore, in order to avoid divergence of the symphysis pubis during childbirth, a pregnant woman needs such measures as:
- Bed rest;
- Additional ultrasound;
- If the size of the divergence of the pubic fusion is more than four cm, then such symphysiolysis is dangerous because it is an indication for a cesarean section and also entails subsequent surgical treatment.
It is worth noting that symphysitis and symphysiolysis are obstetric and orthopedic problems that must be corrected with the involvement of appropriate specialists - obstetricians-gynecologists and orthopedists.
Divergence of the symphysis pubis during pregnancy: causes and what it can lead to
Divergence of the pubic fusion of more than 0.5 cm (symphysiolysis) is sometimes recorded in pregnant women.
This happens if there are:
- Spontaneous natural childbirth large fruit;
- With a narrow female pelvis;
- In case of rupture of the ligaments of the pubic or sacroiliac joint.
According to ICD 10, this disease is coded as “S 33.4 traumatic injury to the symphysis pubis.” It must be said that symphysiolysis during pregnancy up to 10 mm is considered normal. In addition, in principle, symphysis discrepancy, as such, is not an indication for a cesarean section, since, on average, during pregnancy, the pubic bones diverge by 7.7 mm - this is the norm, while the range of discrepancy ranges from 3 to 20 mm, but a discrepancy of 9 mm occurs in 25% of women. During childbirth, women with symphysis dehiscence are given local epidural anesthesia, and sometimes acceleration - stimulation of labor.
It is very important during the birth process to allow the woman to choose the position that reduces pain, since there are a number of positions during pushing that reduce the load on the pubis.
It must be said that, as a rule, the main causes of rupture of the pelvic ligamentous apparatus are pathological birth and operative delivery, for example, during: application of obstetric forceps, extraction by the pelvic end, fetal destruction operations, etc.
The appearance of symphysitis during pregnancy: symptoms and signs
It is possible to diagnose and determine the presence of symphysitis if certain symptoms are recorded.
Namely:
- Pain in the pubic area, in particular when moving the legs. In this case, the pain intensifies significantly if you spread your legs, bent at the knee and hip joints.
- Upon palpation, swelling of the pubic tissue and a depression between the separated parts of the symphysis bones are determined. The patient feels pain on palpation.
- With significant divergence and rupture of the pubic and other joints of the pelvis, bleeding is observed, possibly sometimes damage to the bladder, urethra, and clitoris.
Diagnosis of symphysitis consists of conducting clinical studies, studying data on the course of labor, and in some cases, radiography may be performed.
Severe symphysitis: symptoms and how to treat in different cases
After an accurate diagnosis of “symphysitis” has been established and symptoms characteristic of this condition are observed, the pregnant woman should be hospitalized in the antenatal department of pathology of pregnant women at any stage when symphysitis was diagnosed.
As a rule, symphysitis is treated as follows::
- Rest and bed rest;
- Lack of any physical activity;
- Taking painkillers for severe pain (as prescribed by a doctor);
- Frequent change of static positions (in sleep, etc.);
- Positive psychological attitude.
Some women after childbirth with symphysitis have a gait disturbance for some time - a “duck” gait, which subsequently disappears.
It must be said that symphysitis cannot be treated by taking any medications, for example, vitamins and calcium-based drugs, in addition, modern medicine does not recommend wearing a bandage (reviews of such “treatment” are negative).
But in the case of divergence of the symphysis pubis, or symphysiolysis, the treatment is as follows. Rest, bed rest for 3-5 weeks, tight cross bandaging of the pelvic bones are indicated. This helps relieve the symptoms of discrepancy. In rare cases, suppuration of the hematoma in the area of the divergence of the symphysis pubis and persistent gait disturbance are recorded. In this case, the hematoma is treated surgically and a course of antibacterial drugs is prescribed.
In case of symphysiolysis during childbirth, strict bed rest is recommended for 4 weeks, in a special hammock with weights hung crosswise. In rare cases, if the symphysis has not recovered after 4 weeks of the above-described regimen, then plastic surgery of the symphysis pubis is indicated, which is performed by fixing the symphysis with metal plates or nylon. In this case, it is preferable to use nylon, since it grows into the scar and provides a semi-rigid connection similar to natural fusion. Such Plastic surgery It is not classified as complex and is performed in an orthopedic clinic.
In case of damage to the pelvis not during childbirth, for example, in men, with ruptures of the pubic fusion with divergence of both parts of the pelvis in different sides perform a small adhesive plaster or skeletal traction along the length of both limbs (load 3...5 kg). In this case, traction must be carried out so that the pelvic ring is compressed at both ends, as a result of which the diverged halves of the pelvic ring are brought closer together. Traction continues for two to two and a half months, and after 2.5...3 months the patient is allowed to walk.
How to treat symphysitis during pregnancy (video)
Thus, symphysitis during pregnancy is a normal physiological condition, which, in general, is not an obstacle to childbirth naturally and is treated by observing bed rest and choosing a comfortable position during childbirth.
Quite often, pregnant women and women in the postpartum period complain of pain and discomfort in the area of the symphysis pubis. The sensation may intensify when walking or even just changing position. Changes, damage and inflammation of the symphysis pubis, accompanied by pain, are an alarming signal and a reason to consult a doctor.
A little anatomy
The hip bones are connected to each other by the symphysis pubis using a fibrocartilaginous disc. This connection is surrounded on all sides by ligaments, which give it strength. But at its core, the symphysis pubis is a half-joint with disabilities movements.
Before pregnancy, the distance between the bones of the symphysis pubis is 4-5 mm, and during pregnancy it can reach 1 cm. A wider distance indicates dysfunction (diastasis).
Divergence of the symphysis pubis
In order for the fetus to pass freely through the hip joint, the placenta produces relaxin, which, together with female sex hormones, has a relaxing effect on the pelvic bones. Divergence of the symphysis pubis during pregnancy is normal phenomenon, unless it crosses physical boundaries.
A discrepancy of up to 1 cm is considered normal. Divergence of the symphysis pubis during pregnancy is diagnosed by ultrasound, based on the results of which the doctor determines best option delivery. It is worth noting that the discrepancy in itself is not . The decision is made taking into account other factors, such as the narrow pelvis of the woman in labor or the large head of the fetus.
Treatment of the symphysis pubis after childbirth depends on the degree of discrepancy. If there is a slight deviation from the norm, the woman is prescribed a special bandage, which is used for six months after childbirth. If the discrepancy was significant (10-20 mm), the woman in labor should remain in bed for at least 2-3 weeks, use wide bandages, avoid physical exertion, and subsequently wear a bandage.
Rupture of the symphysis pubis during childbirth
Rupture of the symphysis pubis is much less common than dehiscence, but in turn is more dangerous. Breakups can be spontaneous and violent. In the first case, the injury occurs during spontaneous childbirth, in the second - as a result of an obstetric operation to remove the fetus or placenta. As a rule, rupture of the symphysis pubis occurs after separation, so an experienced obstetrician will be able to diagnose and prevent injury.
The consequences of a rupture of the symphysis pubis in the absence of proper treatment can be disappointing. The fact is that the pelvic bones will not be able to heal properly on their own, so, first of all, the function of the musculoskeletal system will suffer.
Rehabilitation of a rupture of the symphysis pubis takes from two weeks to several months. As a rule, a woman is prescribed bed rest in a hammock or in combination with a special tightening structure and dressing
pelvis with wide bandages.
Inflammation of the symphysis pubis
Inflammatory processes in the symphysis pubis are called symphysitis. The process takes place without pronounced divergence of the bones, but is accompanied by painful sensations, swelling and redness.
One of the causes of symphysitis may be calcium-magnesium deficiency, so a woman is usually prescribed an appropriate diet and vitamin complexes. It is worth noting that if left untreated, inflammation can develop into chronic arthrosis of the symphysis pubis.
