Disjunction of the symphysis pubis (symphysis pubis) is a separation of bone tissue that requires immediate treatment. This occurs due to softening of the pelvic bones due to intense blood supply and swelling of the cartilage. In most women, the discrepancy does not exceed 0.5 cm. When the pubic symphysis is ruptured, the bones can diverge by 7-8 cm, usually this occurs during surgical delivery or severe labor activity. In total, there are 3 degrees of discrepancy of the symphysis pubis:
- The first is that the pubic branches diverge by 5-9 mm; women often do not notice any changes in their well-being. Pathology can be diagnosed only by palpation or by X-ray results.
- The second is that the pubic branches diverge by 1-2 cm, women complain of pain in the lower abdomen during movement.
- Third - the pubic branches diverge by 2 cm or more, which indicates a rupture of bone tissue. Patients experience severe pain that interferes with a normal lifestyle. During palpation, severe swelling in this area is noted; several fingers or a hand can be placed between the bones. Treatment for third-degree pubic discrepancy takes about two months.
The divergence of the symphysis pubis can be spontaneous and violent. In the first case, such a pathology occurs as a result of spontaneous or too violent labor, or improper removal of the fetal head by the midwife. Forced separation occurs due to surgical interventions or separation of the placenta. Rupture of the womb is a more serious discrepancy that requires a long recovery period.
Causes
During pregnancy, a woman's pelvic bones begin to soften. Also, as the fetus develops, the fetal head begins to put pressure on the bone ring, which is why the bones begin to separate. Those with a narrow pelvis and women with a large fetus are at increased risk. The following can cause discrepancy or rupture of the symphysis pubis:
- The fruit weighs more than 4000 grams.
- Consequences of serious injuries.
- Quick or long labor.
- History of pelvic fracture.
- Numerous births.
- Incorrectly provided obstetric care.
- Inflammation of bone tissue.
Symptoms
Symptoms of symphysis pubis depend on the extent and duration of the lesion. In most cases, women complain about:
- pain in the pubic area, which intensifies even during minimal exertion.
- Change in gait - the patient seems to shift from one foot to the other.
- Inability to raise the leg perpendicularly when lying on the back.
- The pain subsides when she lies with her hips turned out.
Usually, when the divergence of the womb is up to 20 mm, a woman manages to move independently.
Problem long time may not manifest itself in any way, since the muscular frame reduces the discrepancy. The fact that pain cannot be relieved with analgesics may also indicate pathology.
Diagnostics
Diagnosis of discrepancy or rupture of the womb is not difficult. The specialist needs to collect a detailed history: find out when the pain began, what it is like, and in what position the discomfort increases. After this, an external examination is carried out: if there is a discrepancy between the edges of the symphysis pubis, several fingers, and sometimes a palm, can be placed. Vaginal examination confirms the divergence of the bones. To clarify the diagnosis, a pelvic x-ray is performed. It helps to accurately determine the size of the discrepancy and its degree, the condition of the articular surfaces and their shape. X-rays also show whether the sacroiliac joint is affected.
Impact on childbirth
Pupil discrepancy is not an absolute indication for cesarean section. This method of delivery is carried out with large size a fetus with a voluminous head, a narrow pelvis in a pregnant woman, or when the bones diverge by 1 centimeter or more. If discrepancy occurs during childbirth, the woman feels pain that intensifies as she moves her legs. If there is a serious discrepancy, you can hear the sound of tearing ligaments, after which the fetus begins to rapidly descend. A few weeks after giving birth, the pain becomes more intense. Also, after childbirth, this phenomenon is rare, however, with severe swelling of the pelvis, the pubic bones can still diverge by 5-6 millimeters.
Treatment
Treatment of postpartum discrepancy or rupture of the womb is a long and painful process that takes from 2 weeks to 6 months. For the bone tissue to converge, the woman must constantly observe strict bed rest on special boards, and tight bandaging is also necessary. If the injury is serious, the patient remains in the hospital and is placed in a medical hammock. Being in this position, bones and cartilage begin to grow together at an accelerated rate.
After the integrity of the bone tissue has been restored a little, the treating specialists prescribe special physical exercise and also send the patients for massage. This helps reduce pain and speed up the healing process. As prescribed by your doctor, you may be prescribed vitamin complexes and medications that contribute rapid recovery body.
Rehabilitation and prevention
To speed up the healing process and prevent divergence of the symphysis pubis in the future, a woman must ensure the proper development of her body: eat well, perform special physical exercise to strengthen the muscular skeleton. With the help of special gymnastics, it is possible to strengthen the pelvic bones, which will prevent the bones from diverging in the future. It is also necessary to take a responsible approach to the management of childbirth, especially after surgical delivery.
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. Located in front of Bladder and from 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 in a woman’s body increases significantly, 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;
- the presence of pathologies of bones and joints, pelvic injuries in the expectant mother, 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” walk, 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 magnitude of the discrepancy is determined pubic bones. 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 about 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!
Symphysitis is a condition in which the pubic symphysis softens and the pubic bones separate. The disease often occurs during pregnancy. Progressive symphysitis interferes with the normal course of gestation, prevents spontaneous childbirth and can become an indication for caesarean section.
An excursion into anatomy
The female pelvis is a ring consisting of bones connected to each other: the pubic, pelvic, iliac, as well as the sacrum and coccyx. The pubic symphysis is the junction of the two pubic bones. In this area there is a large number of subcutaneous fatty tissue, nerve fibers pass through. Posterior to the symphysis is the bladder and urethra. This explains the appearance of disorders of the urinary system during the development of symphysitis.
Normally, the pubic symphysis is motionless. The bones are tightly connected to each other, the joints do not change their position. During pregnancy, due to the increased synthesis of the hormone relaxin, a gradual softening of the bones and ligaments of the pelvis occurs. The cartilage connecting the pubic bones stretches by 5-7 mm and becomes slightly mobile. This is a completely normal process provided by nature for the safe passage of the child through the mother’s birth canal.
After the birth of a child, the reverse process occurs. The amount of relaxin decreases, the pelvic bones become strong again. The cartilage becomes denser, the ligaments lose their extensibility. The size of the joint space decreases, and the symphysis returns to its usual size.
Causes of symphysitis
The exact reasons for the development of symphysitis during pregnancy are not known. In some women, the divergence of the symphysis pubis remains within normal limits, while in others this physiological process leads to the development of pathology. There are two theories that can explain this problem:
- Calcium deficiency (causes softening of the cartilage and separation of the bones of the pubic symphysis).
- Excess relaxin due to increased synthesis by the placenta and ovaries.
Symphysitis occurs already at early stages pregnancy and gradually progresses. Separately, symphysitis is distinguished, formed before the conception of a child as a result of injuries or inflammatory processes in the pelvic bones.
Risk factors:
- hereditary pathology of the musculoskeletal system, leading to insufficient synthesis of collagen, a protein responsible for the strength of ligaments and cartilage;
- injuries to the pelvic bones before pregnancy or during gestation;
- inflammatory processes in bones and joints;
- infectious diseases of the bladder and urethra;
- poor nutrition and hypovitaminosis (lack of calcium, magnesium, phosphorus, vitamin D);
- sedentary lifestyle;
- excess weight;
- metabolic disorders;
- multiple pregnancy;
- polyhydramnios;
- large fruit.
The likelihood of developing symphysitis increases with the second and subsequent pregnancies (especially with a short interval between them).
Symptoms
Symphysitis, or symphysiopathy, occurs in the first trimester, but in the early stages the signs of the disease are not pronounced. The first symptoms appear closer to the middle of pregnancy, when the woman’s weight increases and the load on the pelvic bones increases. With increasing gestational age, discomfort increases.
Signs of symphysitis:
- pain over the womb;
- visible divergence of the pubic symphysis;
- change in gait.
The pain with symphysitis is dull and aching. Unpleasant sensations are localized directly above the womb. The pain intensifies in such situations:
- when pressing on the symphysis;
- while walking;
- when climbing stairs;
- with a long immobile position (sitting or standing);
- when bending forward.
A sudden change in body position also increases pain. Occasionally, when moving, characteristic clicks may be heard in the pubic area.
A woman's gait changes as symphysitis develops. Future mom shifts from foot to foot, waddles. The deflection in the lumbar spine increases. Movements slow down and walking hurts. In severe cases, a woman practically cannot move independently even for short distances.
The inability to raise straight legs while lying down is another typical symptom of symphysitis. This sign is one of the leading signs in the preliminary diagnosis of pathology.
Classification
Depending on the size of the divergence of the pubic braids, several stages of development of symphysitis are distinguished:
- 1st degree – from 5 to 9 mm;
- 2nd degree – 10-19 mm;
- Grade 3 – more than 20 mm.
The severity of the disease largely determines the prognosis and influences the choice of delivery method.
Diagnostics
To identify symphysitis it is indicated:
Examination by a gynecologist
During the examination, the doctor pays attention to the condition of the pelvic bones and especially the symphysis pubis. With symphysitis, the separation of the bones becomes quite pronounced. In stage III, when the cartilage stretches up to 2 cm, the resulting space freely fits the pad of the finger. At the same time, the characteristic “duck gait” appears.
Ultrasound
The final diagnosis is made after an ultrasound examination. Using ultrasound, the doctor can accurately measure the degree of discrepancy of the pubic bones and decide on further tactics.
X-ray examination
It is carried out only outside of pregnancy (for example, with symphysitis after childbirth). Radiography allows you to determine the distance between the pelvic bones, identify signs of previous injury and other associated pathologies.
In case of symphysitis, consultation with an orthopedist is required.
Complications
Rupture of the symphysis is the most dangerous complication of symphysiopathy. A similar condition is observed after childbirth if it is not managed correctly and the severity of the pathology is underestimated. Damage to the joint occurs with a violation of its integrity and divergence of the cartilage by more than 2 cm. This pathology is often accompanied by rupture of the ligaments in the sacroiliac joints.
Risk factors:
- stormy rapid labor;
- anatomically or clinically narrow pelvis;
- large fruit;
- multiple pregnancy during natural birth.
The combination of these factors with grade III symphysitis can lead to rupture of the symphysis and the appearance of the following symptoms:
- sharp or gradually increasing pain in the pubic area;
- gait disturbance;
- impossibility of full movements.
In most cases, ligament rupture during childbirth occurs gradually, and all symptoms of the disease become apparent 2-3 days after the birth of the child. It is extremely rare for a woman in labor to feel sharp pain and hear the characteristic sound of torn ligaments immediately at the moment of childbirth.
If the pubic symphysis is ruptured, the postpartum woman is unable to independently roll over onto her side. The woman cannot lift her feet from the bed (symptom of “stuck heel”), and takes a forced position in which the pain subsides (“frog pose”). When palpating the symphysis, a pronounced separation of the bones and severe pain in this area are felt.
To confirm the diagnosis, an X-ray examination of the pelvic bones is performed. A rupture of the symphysis is indicated by:
- bone divergence up to 8 cm or more;
- vertical displacement of the pubic bone by 4 mm or more.
Rupture of the pubic symphysis is often accompanied by damage to the bladder and urethra. Dysuric disturbances occur and the outflow of urine becomes difficult. The development of an inflammatory process against the background of injury is possible.
Treatment of symphysis rupture can be conservative or surgical. Without special therapy, the cartilage will not heal or will be replaced by non-functional connective tissue. In the future, refusal of treatment can lead to the development of chronic pelvic pain and a significant change in gait.
Principles of treatment
The choice of treatment method will depend on the severity of the process: the degree of divergence of the pubic bones and the presence of complications.
Conservative therapy
To treat symphysitis during pregnancy, the following drugs are prescribed:
- Nonsteroidal anti-inflammatory drugs to reduce pain (with caution in the 1st and 3rd trimesters) - locally or orally.
- Calcium and magnesium preparations to strengthen bone tissue.
- Vitamin therapy (taking multivitamins for pregnant women or vitamin D3 separately is indicated).
The effect of drug therapy is enhanced by physiotherapeutic effects on the affected area. Magnetic therapy has proven itself well.
- Wearing a bandage before childbirth. A specially selected bandage supports the bones of the pelvis and hip, preventing further separation of the bones and the development of complications.
- Limitation physical activity. It is not recommended to walk for a long time, climb stairs, carry heavy objects, bend over, or cross your legs.
- Do not sleep on an excessively hard surface. When lying down, you should place a special pillow or cushion under your feet. You can also place a pillow under the buttocks, thereby raising the pelvis and reducing the load on the symphysis pubis.
- It is not recommended to stay in one position (sitting or standing) for a long time.
- Therapeutic gymnastics: knee-elbow position, cat pose and other exercises recommended by the attending physician.
In most cases, treatment is carried out on an outpatient basis. In severe cases, hospitalization in a hospital is indicated. Therapy continues after the birth of the child.
Surgery
The operation is indicated for severe sprain or rupture of the symphysis pubis. Metal plates and implants are used to align the pelvic bones, and strong sutures are applied. Surgery carried out after the birth of the child.
Childbirth with symphysitis
Natural childbirth is possible if the following conditions are met:
- symphysitis I degree (divergence of the pelvic bones up to 10 mm);
- normal size of the mother's pelvis;
- one fruit;
- Fetal weight no more than 4 kg.
In other situations, a caesarean section is indicated. Symphysitis of degrees II and III during childbirth threatens to rupture the symphysis pubis and cause serious health problems.
After the birth of a child with symphysitis of II-III degree, the following is indicated:
- Bed rest for 2-6 weeks.
- Tight bandaging of the pelvic bones.
- Physiotherapy.
- Taking painkillers.
After a control x-ray examination, bed rest is canceled. It is recommended to wear a bandage and take calcium supplements and vitamins. Currently, special corsets are actively used to help hold the pelvic bones in place. Wearing a corset allows you to cancel bed rest already on the 5th day after birth. The corset should be worn for 3-6 months until the symphysis is completely restored.
Prevention
To prevent symphysitis and its complications, it is recommended:
- Balanced diet (eating foods rich in calcium, phosphorus, magnesium and vitamin D).
- Taking multivitamins during pregnancy.
- Yoga and gymnastics to strengthen the muscles of the back, abdomen, and gluteal region.
- Weight control.
- Timely treatment of any emerging diseases.
Paying attention to your health is the key to good health. When the first signs of symphysitis appear, you should consult a doctor.
Nature wisely created female body so that it can fully ensure the bearing and birth of a child. The female pelvis differs in structure from the male one: it is lower, wider, its bones are thinner, and the capacity of the cavity is larger. The pelvis consists of paired bones - the ischium, ilium and pubis. All bones are connected to each other using ligaments and fixed fusions. The exception is the pubic symphysis (pubic symphysis) - a relatively mobile connection of two pubic bones with the help of special cartilage and ligaments. Thanks to the hormone relaxin, during pregnancy the pubic symphysis and pelvic ligaments become loose and soft. This ensures good separation of the bones as the baby moves through the pelvic bone ring. Normally, the pubic bones can diverge up to 0.5 cm at the time of birth.
What is a rupture of the symphysis pubis?
Violation of the integrity of the pubic cartilage and retaining ligaments with a divergence of the pubic bones of more than 0.5 cm and severe pain is called a rupture of the symphysis pubis.
Fortunately, in modern obstetrics this is a relatively rare complication. More often during pregnancy, isolated pain syndrome is observed in the area of the pubic symphysis with bone separation of up to 0.5 cm. This phenomenon is called symphysitis or symphysiopathy.
- It is associated with excessive release of relaxin and lack of calcium in the diet of a pregnant woman.
- Causes of rupture of the symphysis pubis during childbirth
- discrepancy between the size of the woman’s pelvis and the size of the fetus, the so-called clinically narrow pelvis;
- rapid or rapid labor;
- narrow pelvis or history of pelvic trauma;
- numerous (more than 3) births;
improper provision of obstetric aids (application of forceps, vacuum extractor, Kristeller maneuver and others);
outside childbirth: car and sports injuries.
- Signs and symptoms of symphysis pubis rupture
- Complaints from ruptures of the symphysis pubis are quite specific:
- pain in the pubic area, which intensifies when trying to stand up or roll over;
- “sticky heel symptom” is a diagnostic technique when the doctor asks you to raise your leg while lying on your back. A woman with a rupture of the symphysis pubis will not be able to complete this task;
With discrepancies of the pubic bones up to 2 cm, the patient is able to move independently. The muscular frame brings the pelvic bones together, masking the problem. For diagnosis, radiography of the pelvis is used, where the image clearly shows the gap between the branches of the pubic bones. To clarify the diagnosis of symphysiopathy in pregnant women, ultrasound that is safe for the fetus can be used.
Treatment of rupture of the symphysis pubis
Treatment of postpartum pelvic injuries is a very painful and lengthy process, previously taking up to one and a half months in severe cases. Fortunately, orthopedics has moved forward, and some innovations can reduce this process to 2 weeks. So, methods of treating ruptures of the pubic symphysis:
- Complete bed rest on hard boards, tight bandaging of the pelvis using weights from 2 to 10 kg;
- Finding a woman in a special hammock, which brings the pelvic bones together, allowing the cartilage and ligaments to recover;
- The modern orthopedic industry produces special designs for the treatment of pelvic injuries. Wearing a rigid pelvic girdle or symphyseal bandage allows a woman to get up and walk within 2-3 weeks;
- Physiotherapeutic procedures: electrophoresis with novocaine relieves pain; ultrasound and magnetic therapy on the pubic area improve microcirculation and promote a speedy recovery;
- Therapeutic exercise and massage in the early stages after disappearance pain syndrome help restore muscle tone;
- Taking calcium and vitamin D3 supplements and dosed ultraviolet irradiation promotes rapid restoration of the symphysis.
Planning pregnancy after rupture of the symphysis pubis
With such a serious complication after long-term treatment and rehabilitation, a logical question arises: “What about the next birth?”
There is no clear answer to this question, and different manuals provide different data. Some experts argue that in the absence of clinical symptoms of symphysitis in combination with normal sizes fetus and woman's desire natural childbirth possible. It is first necessary to undergo an ultrasound of the symphysis, determine the degree of its discrepancy, and also perform fetometry of the fetus to determine the estimated weight. However, most gynecologists are inclined to believe that the risk of re-rupture is too great to go for a natural birth. Doctors agree on one thing: the next pregnancy should be planned no earlier than three years after the end of rehabilitation.
Alexandra Pechkovskaya, obstetrician-gynecologist, especially for the site
Pain in the pubis, swelling, and difficulty walking may indicate symphysitis during pregnancy. This is inflammation at the junction of the pubic bones, which is called the symphysis. There is dense connective tissue here, in other words, cartilage, which, when inflamed, stretches and softens, causing increased bone mobility.
At any stage, pathology Treatment
painful sensations Cause of pain Pressure on the stomach is reflected by pain from the back
Discomfort gymnastics MassageSymphysitis during pregnancy can lead to dire consequences after childbirth.
Description and symptoms of the disease
Loosening of the connections between bones is a common and necessary phenomenon during pregnancy. It should not cause strong negative impressions - pain, limited mobility. This is a natural necessity to facilitate the birth process.
Signs of symphysitis during pregnancy that should be reported to your doctor are:
- painful sensations in the pubis when pressing or moving;
- swelling of the pubic tissue;
- clicking, crunching when moving;
- duck gait, lameness.
Pain may occur when walking, trying to lift the leg up from a lying position, turning the hip, turning over on the bed, squatting, or standing up. They become especially strong at night.
In general, symphysitis refers to a whole range of pathological changes symphysis, which can occur not only during pregnancy. This joint can soften, swell, stretch, diverge, rupture, or become inflamed after a pelvic injury or strenuous running.
During pregnancy, symphysitis appears at any stage, and can occur both at the very beginning and before childbirth, during childbirth and after it. For those who have experienced symphysitis previously, the onset of symptoms occurs earlier.
- Painful sensations.
- The lower back and hip joints may hurt.
- An ultrasound reveals discrepancy in the pubic bones.
During pregnancy, the doctor diagnoses symphysitis based on an analysis of these symptoms. The patient’s medical history is also studied - the presence of injuries, previous operations, diseases of the musculoskeletal system. For non-pregnant women, an X-ray examination is performed, which shows the degree of divergence of the bones and their possible shift up and down.
Appears at any time
There are three degrees of symphysitis:
- first - the pubic bones diverged by 5-9 mm;
- the second - by 10-19 mm;
- the third – from 20 mm.
The causes of symphysitis during pregnancy are difficult to determine, since doctors still do not have a consensus on the factors that cause it. But there are the most likely assumptions.
- Insufficient calcium intake during pregnancy. The norm is 1 g per day; if less is taken, calcium begins to be “washed out” from the “reserves” - teeth and bones.
- Excessive production of relaxin. This is a hormone secreted by the ovaries and placenta that helps relax joint ligaments to make it easier for the baby to pass through labor.
There is an increased risk of developing symphysitis, including in the early stages of pregnancy, with the following factors:
- heredity – diseases of the skeletal system;
- urogenital infections;
- a large number of births;
- previous injuries to the pelvic bones;
- child weighing more than 4 kg;
- limited mobility;
- presence of the disease during a previous pregnancy.
Methods of treating pathology
During pregnancy, symphysitis cannot be completely cured, but it goes away on its own after childbirth, when hormone production returns to normal levels. On the other hand, you can improve your diet, take vitamins, and undergo a course of medical procedures that can significantly improve your condition. If there are infections, they must be treated.
For the first degree of symphysitis, it is quite effective:
- reduce physical activity as much as possible - in other words, lie down more;
- do not walk or stay in one position for more than an hour (standing, sitting);
- sleep on an orthopedic mattress;
- drink calcium in the form of easily digestible preparations;
- take B vitamins;
- Ultraviolet treatments are useful;
- To reduce pain, take safe painkillers;
- perform exercises designed to strengthen the symphysis pubis.
You need to sleep on an orthopedic mattress
Treatment of grade 2-3 symphysitis during pregnancy mainly comes down to keeping the pelvic bones in the closest possible position. For this it is recommended:
- strict bed rest;
- a special bandage that looks like a skirt, or a tight bandage;
- diet high in calcium, taking appropriate medications.
Now there are corsets specifically designed to hold bones in the correct position. It allows you to not adhere to bed rest so strictly. This is especially important for a woman who has already given birth, who will be able to at least minimally care for the child.
Symphysitis can be treated during pregnancy by an osteopath. A specialist in diseases of the musculoskeletal system will select suitable medications. But what is especially good is that he will be able to prescribe adequate physical procedures, massage, and therapeutic exercises.
If the pain is severe, a pregnant woman may even be admitted to the hospital. Here she will undergo physiotherapeutic procedures, courses of anti-inflammatory and painkillers. In special cases of symphysitis, even epidural anesthesia (injection of an anesthetic into the spinal cord) is possible. Treatment with hormones is not usually used.
For symphysitis, to strengthen the symphysis pubis, it is prescribed medical complex exercises during pregnancy.
- Lying on your back, bend your knees, bringing your feet toward your buttocks. Slowly spread your knees apart, hold for half a minute, then bring them together. Repeat six times.
- Move your heels away from your buttocks by about 30-40 cm. Slowly raise your pelvis and also slowly lower it. Hold as long as possible at the minimum distance from the floor. There is no need to try to raise it high - at least a couple of centimeters is enough. Repeat six times.
- A popular exercise for symphysitis during pregnancy is the “cat pose” (in the photo, the woman’s pose looks like a stretching cat). Get on your knees with your hands on the floor. Relax your back, but your spine should be straight. Do not lower or raise your head. Arch your back, raising your head and tensing your abdominal and thigh muscles. Repeat three times.
Gymnastics should be done at least three times a day, especially if pain increases.
The use of folk recipes
Some help improve the condition of symphysitis folk recipes. Provided that before using them, the pregnant woman consults a doctor.
A sesame-honey mixture is effective. Sesame seeds are very rich in calcium; they are much higher in calcium content than dairy products. For the treatment of symphysitis during pregnancy, the daily norm is:
- 100 g sesame seeds;
- honey to taste.
Application.
- Mix sesame seeds with honey.
- Eat throughout the day.
- Use until the pain goes away.
Sesame-honey mixture
- goat cheese;
- almonds;
- fish;
- prunes
How to apply it.
- Products can be consumed in different combinations and dishes can be prepared from them.
- The health of a person, and especially of a pregnant woman, is largely determined by diet. Therefore, use healthy foods It is possible even after the pain subsides.
The following will help reduce pain with symphysitis:
- Corvalol.
How to use.
- Lubricate the pubis, rubbing lightly.
- You can repeat it several times a day.
Complications and prevention
There is no danger for the unborn child from symphysitis during pregnancy - ultrasound photos always show its normal development, if there are no other complications.
The greatest risk is the possibility of damage to the ligament of the pubic bones during childbirth. After this, the recovery process can last for months and years, sometimes even surgery is necessary - if the symphysis gap is large enough. On the other hand, symphysitis often goes away on its own after childbirth.
To avoid serious consequences, the second and third degrees of symphysitis may become an indication for surgical delivery - in other words, a caesarean section. Indications for this:
- the pubic bones have diverged by more than 10-15 mm;
- the pain is too strong;
- the child weighs more than 4 kg;
- the pelvis is anatomically narrow.
Each specific case is always discussed individually both with the doctor leading the pregnancy and with the one who will deliver the baby. If a woman is in doubt, you can consult several gynecologists and an osteopath.
If diagnostics have shown a fairly serious degree of symphysitis during pregnancy, and doctors strongly recommend cesarean section, you should not stubbornly refuse. A severely stretched joint, and even complicated by an inflammatory process, can very easily rupture. Treatment after this is very complex and long-term. The woman constantly feels pain, cannot get out of bed, cannot raise her legs, and it is very difficult for her to walk.
Decrease pain using Corvalol
When treating a symphysis rupture, strict bed rest is recommended. This option fits very poorly with the need to care for a newborn. If the gap is too large, then an operation is generally performed with the application of staples, then a plaster cast is applied.
But it's not that scary. In fact, a problem detected in time gives a fairly high chance of maintaining health. Judging by numerous reviews, women with symphysitis during pregnancy manage to prevent too much divergence of the bones and give birth safely. Moreover, having established nutrition, doing special exercises, many of them got rid of this problem altogether.
To prevent the appearance of symptoms of symphysitis during pregnancy and not require treatment, prevention is needed. Unfortunately, this is a rather complex question - after all, the exact causes of the disease have not been established.
- Pregnancy must be planned - that is, preparation for it is necessary, which includes a full examination and treatment of identified diseases.
- When it occurs, you need to register early, but no later than 12 weeks.
- Come regularly routine inspection, which is prescribed by the doctor.
- Eat right - exclude fatty foods, fried foods, sweets, baked goods, eat enough meat, dairy, legumes and foods rich in calcium.
- Take appropriate vitamin and mineral complexes.
- Wear a bandage to prevent symphysitis.
- Spend time on gymnastics during pregnancy.
- Avoid increased physical activity, walking, sitting and standing for more than an hour.
- Avoid psychological stress and take sedatives if necessary.
Attention!
The information published on the website is for informational purposes only and is intended for informational purposes only. Site visitors should not use them as medical advice! The site editors do not recommend self-medication. Determining the diagnosis and choosing a treatment method remains the exclusive prerogative of your attending physician! Remember that only complete diagnosis and therapy under the supervision of a doctor will help you completely get rid of the disease!
