Carrying a child involves enormous difficulties that must be endured. female body. Most obvious changes require no explanation, but sometimes some changes in the body of the expectant mother cause concern. One of these exciting factors that needs special attention, - pubic symphysis. Where is it located what are the reasons possible appearance pain in its area and how to cope with it, every pregnant woman should know.
Pubic symphysis
The pubic symphysis, which also has a second name - the pubic symphysis, is two pubic bones of the hip joint, connected by fibrocartilaginous tissue along the midline. It is located in front of the bladder above the external genitalia and is attached to elastic ligaments.
During the prenatal period, a woman’s body is susceptible to dramatic changes, affecting her hormonal balance. The result of the influence of hormones such as progesterone and relaxin is the softening of all ligaments. The pubic symphysis, where the cartilage tissue is located, also becomes less static. This often leads to unnatural, painful mobility of the pubic symphysis.
During pregnancy, the purpose of the influence of these hormones is to increase the flexibility of the joints and bone structure, which contributes to an easier pregnancy. labor activity. Meanwhile, dysfunction of the pubic symphysis is quite rare in patients and requires immediate action.
Divergence of the symphysis pubis
The appearance of space between the pubic bones is called discrepancy. This diagnosis must be made on the basis of the complaints described by the pregnant woman. Symptoms often include:
- pain in the pubic area, which can result in unpleasant aching sensations below, “pulling” the leg and groin;
- sudden pain during loading movements (turning from side to side, climbing stairs, etc.);
— a kind of cracking of the joints is possible when the hip moves;
- painful pressure on
To obtain more accurate diagnostic data, you should undergo an ultrasound of the symphysis pubis and MRI.
The latter will help determine the degree and width of the discrepancy, which can reach one of three levels:
- 1 - width is 5-9 mm;
- 2 - width is 10-20 mm;
- 3 - width over 20 mm.
Causes of divergence of the pubic symphysis
The symphysis pubis is threatened during pregnancy due to impaired metabolism and lack of vitamin D. For example, hormones produced by the parathyroid gland are involved in the regulation of phosphorus-calcium metabolism in the body. If there is a lack of calcium supply, required for the full development and growth of the fetus, the body begins to draw the necessary substance from the mother’s reserves. The main source of calcium for the future baby will be the mother’s teeth and bones. Also gastrointestinal diseases and diabetes may cause calcium deficiency. In turn, vitamin D significantly affects the body's absorption of incoming calcium.
The divergence of the symphysis pubis begins to develop long before the birth of the child. However, the effects of hormones and fetal weight contribute to the manifestation of the above symptoms only in the second or third trimester. Often, the signs of pathology that appear are not given due attention and are attributed to osteochondrosis, radiculitis, or the threat of miscarriage.
Timely diagnosis is extremely important. It will help you take the necessary treatment measures in time to prevent Negative consequences through natural delivery or resort to caesarean section.
Treatment of discrepancy
Typically, pubic bone dehiscence does not require any intervention. After a successful birth, the flexibility, elasticity and integrity of the pubic symphysis can be restored naturally.
Wearing a bandage;
Performing gymnastic exercises;
Prescribing the necessary medications (magnesium, calcium, vitamins, especially group B).
The woman in labor should inform the obstetricians about the presence of this pathology before the start of labor.
The discrepancy turned into more severe degree, is fraught with rupture of the symphysis pubis. To avoid further expansion of the pubic bones, doctors also strongly recommend limiting this by preferring bed rest.
Rupture of the pubic symphysis
If the discrepancy of the pubic bones is observed mainly during pregnancy, then a rupture is possible during the birth process.
Among the types of breaks, violent and spontaneous are distinguished. The latter occur during spontaneous labor. The reason for the appearance of violent ruptures is often cited as the use of additional efforts when removing the fetus or manually separating the placenta. In addition, insertion of the hand into the uterine cavity in most cases is a decisive factor in the probable rupture of the symphysis pubis.
Treatment of symphysis pubis tears
If a rupture occurs, the patient needs strict bandaging of the hip joint area. It is optimal to use a wide linen bandage for this purpose. Legs should be placed on the headboard and blocks should be attached to them at the level of the pelvis. The ends of the bandage must be tied on wooden strips, which are tied with cords. These cords pass through the blocks, and a load must be suspended from their ends, starting with a couple of kilograms and gradually increasing to 10 kg.
Thanks to early recognition of the rupture, restoration of the symphysis pubis occurs within 2-3 weeks. In case of delayed treatment, the bandage is applied for at least 1 month. Bandages made of fabric resembling a hammock are often used for this purpose. Its edges are attached to the longitudinal straps. The pelvic bones begin to converge due to the patient’s own weight. The recovery time when staying in a hammock is the same.
The musculoskeletal functions of the pelvis are completely restored when the treatment approach is carried out without delay. With a more delayed definition of the rupture, the inflammatory process of cartilage tissue contributes to difficult healing and protracted rehabilitation.
The postpartum condition of women is characterized by changes at the physical level. Some changes may cause complications. Sometimes after childbirth there are complaints of pain or discomfort in the pubic area, which intensify when changing position, getting out of bed, walking up the stairs, as well as swelling of the pubis and the appearance of a peculiar “duck” gait. Based on these and other symptoms, a disease called “symphysitis” is often diagnosed.
Pubic symphysis - what is it?
A woman’s bony pelvis is formed from the sides by two pelvic bones, and from the back by the sacrum. The pelvic bones are connected in front by the pubic joint - the symphysis, and in the back - by two sacroiliac joints. Fusion of both pubic bones pelvis through a fibrocartilaginous disc called the pubic symphysis. In the center of this fusion there is an articular cavity in the form of a gap filled with articular fluid.
The symphysis is strengthened by ligaments, which give strength to this joint. The symphysis pubis is a semi-joint and therefore has a very limited range of motion.
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 lifts the clitoris. Nerves and blood vessels pass below the symphysis. Behind the pubic symphysis are the urethra and bladder.
Symphysite (from Latin symphysit) means inflammation of the pubic symphysis. This is the general name for changes and damage to the symphysis pubis. Such changes most often occur and manifest themselves during pregnancy, childbirth and the postpartum period.
In medical sources for characteristics pathological changes on the part of the pelvic joints during pregnancy and after childbirth, terms such as symphysiopathy and sacroileopathy, symphysitis, arthropathy of pregnant women, discrepancy and rupture of the symphysis pubis are used.
For characteristics pathological conditions on the part of the pelvic joints during pregnancy and after childbirth, many authors recommend using the term dysfunction of the symphysis pubis.
What provokes the development of symphysitis?
During pregnancy, the ovaries and placenta release 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, additional gaps filled with fluid 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, where there is increased blood supply, swelling and loosening of the entire ligamentous apparatus. As a result of such changes, the width of the symphysis pubis increases by several millimeters. Moderate softening of the pelvic joints and stretching of the symphysis pubis promotes favorable passage of the fetus through the bony pelvis. Sometimes these changes cross physiological boundaries. In this case, excessive relaxation of the pelvic joints occurs, accompanied by pain and leading to their excessive stretching and even rupture during childbirth.
Pain that occurs after childbirth may be the result of a traumatic birth (use of obstetric forceps, excessive separation of the hips during childbirth, etc.). The discrepancy of the symphysis pubis can be very significant, the symphysis is more mobile, and the ligaments are too extensible, as a result of which symphysitis occurs.
Symptoms of symphysitis
Symphysitis is characterized by many symptoms and signs, the most common of which are:
- pain in the pubic area, “shooting” pain;
- pain when walking, changes in posture, pain when abducting the hip, pain with any movement;
- pain radiating down the abdomen, groin, perineum, back, thigh or leg;
- pain that occurs when bending forward, standing on one leg, rising from a chair, going up and down stairs, turning in bed;
- pain that disappears with rest;
- clicking, crackling or grinding noise heard upon palpation of the pubis;
- difficult act of defecation.
Pain may appear immediately after birth or 24 hours later.
Diagnostic methods
To diagnose symphysitis, special research methods are used (x-ray, computed tomography, magnetic resonance imaging, ultrasound), which make it possible to determine the degree of stretching of the symphysis, as well as to exclude rupture of the symphysis pubis and other pathological conditions.
Ultrasound examination is used to assess the condition of the symphysis. Computed tomography is used to examine the symphysis pubis after childbirth. The magnetic resonance imaging (MRI) method allows you to evaluate the condition of the symphysis, the condition of bone tissue, and soft tissues. In addition to stretching of the symphysis pubis, one should distinguish between ruptures of the symphysis pubis, which most often occur during childbirth.
For diagnosis, differential diagnosis is carried out with the following diseases:
- urinary tract infection;
- urethritis;
- inguinal, femoral hernia;
- lumbago (acute lower back pain);
- sciatica (pain associated with damage or irritation of the sciatic nerve);
- femoral vein thrombosis;
- nerve compression (eg, intervertebral disc injury);
- infection of the pelvic bones (osteomyelitis, syphilis).
It is also advisable to consult with neurologists, orthopedist-traumatologist, surgeon, radiologist, physiotherapist and other specialists. This is important because the difficulty of diagnosing of this disease lies in its symptoms, similar to the above-mentioned diseases.
There are three degrees of divergence of the pubic bones:
- first degree - divergence of the pubic bones by 5-9 mm;
- the second - by 10-20 mm;
- the third - by more than 20 mm.
Symptoms of the disease can range from mild discomfort to unbearable pain.
With first-degree pubic bone divergence, pregnant and postpartum women usually do not complain.
It is possible to find out about the discrepancy of the pubic bones after a thorough examination and palpation of the pubic symphysis. The final diagnosis can be made by ultrasound. In most cases, grade 1 symphysis pubis dehiscence does not require treatment.
Pain in the symphysis and sacrum, difficulty walking indicates second-degree divergence of the pubic bones.
With the third degree of divergence of the pubic bones, the signs are most pronounced. Postpartum women complain of severe pain in the pubis and sacrum (sacroiliac joints) and are unable to perform active movements in the lower extremities, turn on the side.
How long does symphysitis last after childbirth and how to treat it?
Paracetamol is used for analgesia; non-steroidal anti-inflammatory drugs and opiates are used to eliminate postpartum pain.
They also resort to transcutaneous electrical neurostimulation, use ice or external heat, and perform massage.
Bed rest is combined with exercise. Calcium preparations and B vitamins are used to treat symphysitis after childbirth. If pain cannot be relieved, then the help of qualified specialists is sought.
One of these may be an osteopathic doctor. Osteopath's recommendations for performing complexes therapeutic exercises can significantly improve a woman’s postpartum condition.
Especially for Lyudmila Levchenyuk
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
Pelvis 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 production of relaxin 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 syndrome practically absent, it 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 levels discomfort and make it easier 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 C-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!
In order for the baby to pass through the birth canal without hindrance, even during pregnancy there is a gradual softening and some divergence of the pelvic bones. But in some cases, such serious changes are observed that a woman needs long-term treatment, including surgical treatment.
According to various sources, discrepancy of the symphysis pubis after childbirth occurs with a frequency of 0.5 to 20 - 30%. Such a large discrepancy is due to the lack of an accurate systematization of pathology and a unified accepted name(symphysiopathy, dysfunction of the symphysis pubis, instability of the pelvic bones and others). What kind of disease is this, how to identify it and how to treat it?
Read in this article
What it is
The female pelvis consists of the pelvic bones (including the pubic, iliac and ischial bones), the sacrum and the coccyx. They are all connected to each other in a special way - by semi-joints with layers of cartilage tissue, i.e. movements are significantly limited in them, but minimal movements are still possible. During pregnancy, under the influence of a special hormone relaxin, some softening and divergence occurs, which is necessary for the safe birth of the baby.
A special role is played by the symphysis pubis, which is located in the pubic area at the junction of two bones. Subjected to maximum stress during pregnancy and childbirth, it, having a minimal area of contact between the bones and each other, can tear or even completely destroy its integrity.
- The following terms are used to describe this entire process:
- Symphysiopathy is a condition in which only softening of the cartilage in the semi-joint occurs, as a result of which the distance between the pubic bones increases to 0.5 cm. While up to 0.2 cm is allowed in non-pregnant women.
- Symphysiolysis is a complete divergence of the pubic bones, more than 0.5 cm. Most often it occurs at the time of natural childbirth, since it is during this period that the pressure on the area is maximum.
Symphysitis is inflammation of a semi-joint. It can be against the background of a gap, or simply with a slight discrepancy.
Reasons for appearance
Many pregnant women report discomfort and even pain in the pubic area (symphysis pubis), but in most cases we have to talk about symphysitis or symphysiopathy. Doctors encounter true large gaps and all the ensuing consequences quite rarely.
- Genetic and family predisposition. It has been noted that the likelihood of symphysiopathy or lysis is higher in certain nationalities (residents of England, Norway), as well as in the presence of pathology in close relatives (mothers, grandmothers, etc.). In the latter case, the increase in detected cases is associated with the peculiarity of the girl’s connective tissue. Often there is unusual mobility and elasticity in other joints, long and thin bones.
- The presence of pelvic pain or discrepancy in previous pregnancies, including trauma and surgery in this area.
- Early puberty.
- Long-term use of oral contraceptives.
- Second and subsequent births, since each subsequent child in most cases has a slightly larger weight at birth, and, accordingly, the load is greater.
- Post-term pregnancy.
- Large fetus or in a woman.
- During childbirth, use of vacuum extraction of the fetus, obstetric forceps or Werbow's bandage (usually a diaper that is placed over the stomach to help the woman push), the Krestseller maneuver.
- Undoubtedly, a lack of calcium or a disturbance in its metabolism in women plays an important role. As a result, bones and joints become less resistant to external influences.
- With kidney pathology, there may be an increase in the excretion of proteins and minerals from the body, and in conditions of increased need, they are borrowed from bones, joints, teeth, etc. These structures are destroyed, and the likelihood of divergence of the symphysis pubis increases.
It is believed that when a combination of conditions (features of connective tissue, metabolism, etc.) occurs, excessive relaxation of collagen fibers occurs under the influence of relaxin and some other substances.
Degrees of divergence
Depending on how much the pubic bones diverge from each other, several degrees of pathology are distinguished. The classification is as follows:
- 1st degree - from 0.5 to 0.9 cm;
- 2nd degree - from 1 cm to 2 cm;
- Grade 3 - more than 2 cm.
It is ideal to determine this distance using X-ray, CT or MRI, but during pregnancy only ultrasound determination is performed for the least safety reasons. developing baby.
Watch the video about the divergence of the symphysis pubis:
Symptoms of pathology
The severity of symptoms does not always vary depending on the degree of discrepancy of the pubic bones. It is assumed that the clinical picture depends largely on concomitant inflammation in this area. So, if it is there, the woman feels severe pain, and if not, then even with a significant discrepancy, nothing bothers her until a certain moment.
The main symptoms include the following:
- Most often, pregnant women complain of pain in the pubic area and symphysis pubis. They can be pulling or shooting. Most often they radiate to the groin, perineum, back, leg. The pain intensifies when turning the body, standing or leaning on only one limb, when going up and down stairs, etc. At the same time, after rest there is some improvement in well-being.
- Sometimes a woman notices that “something clicks” in this area.
- Pain during sexual intercourse may occur, urination and defecation may be impaired.
- Upon examination, pain and swelling of the area above the pubis is revealed. In this case, sometimes the gap between the bones is even palpable.
- Any tests in which it is necessary to involve the pelvis and limbs will be painful or even impossible (Lasège's symptom, Trendelenburg and others).
- Often a woman's gait becomes like a duck's - she waddles from one leg to the other.
What are the dangers during pregnancy and after?
In 99% of cases, a clear clinical picture of the disease appears after childbirth. During pregnancy, a woman is only bothered by varying degrees of pain, which goes away after rest. If you do not pay attention to them and do not take appropriate measures, you may encounter not only divergence of the symphysis pubis after childbirth, the consequences may be injuries or even rupture of the bladder, urethra, clitoris, etc.
Most often we have to deal with single symphysiolysis. At the same time, on the second or third day after giving birth, the woman discovers that she cannot get out of bed and care for the baby.
Treatment of the pathology requires long-term (sometimes several months) immobilization in a certain position, which makes the normal life activities of the young mother impossible. Often, major surgery is required to fix the pubic bones.
Diagnostics
The diagnosis is established based on the clinical picture, the patient’s complaints and after examination by specialists. The following additional studies are carried out:
- , during which you can determine the presence or absence of discrepancy, the approximate extent, and also check the integrity of all other pelvic organs (bladder, etc.).
- X-ray of the pelvic bones is a low-cost and fairly informative way to establish a diagnosis.
- MRI allows you to accurately identify all bone defects.
- A CT scan will mostly show changes in soft tissues, as well as the cartilage itself in the symphysis pubis.
After performing at least two studies, you can finally establish a diagnosis and decide on the tactics for managing the woman.
What can be confused with during pregnancy and after childbirth
Since dysfunction of the symphysis pubis (DPS is one of the most commonly used terms to describe symphysiopathy, symphysitis and symphysiolysis) has a clinical picture quite similar to other diseases, this pathology can often be confused with no less dangerous ailments. Thus, it is always necessary to differentiate DLS from the following conditions:
- Manifestations, in particular, lumbialgia, lumbishalgia, etc. At the same time, sometimes unbearable pain also occurs in the area of the pelvic bones, sacrum, lower back with irradiation to the leg and other places.
- Muscle spasm. In this case, any unpleasant sensations disappear after a course of calcium supplements, which relieve muscle tension.
- Inguinal or femoral hernia, which causes pain and swelling in the pubic area and nearby.
- Urinary tract infections, as well as urolithiasis. In this case, urine tests with signs of inflammation will be indicative.
- Compression of the sciatic nerve.
- Infectious processes of bones, such as osteomyelitis, tuberculosis, etc.
- Thrombosis of the femoral vein at different parts of its length.
Treatment
Treatment of pathology of the symphysis pubis differs in management tactics during pregnancy and after childbirth. But in any case, it is necessary to choose the most rational method of delivery in a given situation. So, if symphysiolysis is within 1 cm, the woman is not bothered by severe pain and a small fetus is expected, then it is quite possible natural childbirth. If the risks increase, you should be inclined to perform a cesarean section.
- It is effective to wear a fixation bandage that should cover both trochanters of the femur. It should be noted that it differs from regular belts that are recommended to be worn during pregnancy.
- For the purpose of pain relief, physical methods (cold), physiotherapy (acunpuncture, etc.) are used. Painkillers are also allowed. Sometimes, for severe and intractable pain, epidural analgesia is performed.
- You should rest in a horizontal position as much as possible.
- It is recommended to take vitamins and calcium supplements.
Treatment of discrepancy of the symphysis pubis after childbirth is based on complaints and the general clinical picture.
In addition to what was done during pregnancy, it may be suggested surgical treatment. Its essence lies in fixing the pubic bones with special staples, bolts, etc.
Most often it is used in cases of large discrepancies as an alternative to bed rest in a special hammock with legs suspended “like a frog’s.”
Otherwise, the therapy is not fundamentally different, the only thing is that after the birth of a child, the range of drugs and procedures used is wider, especially if the woman does not breastfeed.
Prevention
It is not always possible to predict the development of any type of symphysis pubis dysfunction. Often women at risk do not experience any difficulties both during pregnancy and after childbirth. But it is recommended to adhere to the following rules:
- It is necessary to plan your pregnancy and undergo regular examinations to identify other diseases, as well as conditions that provoke DLS.
- During pregnancy, you should include foods rich in calcium, iron and other microelements. This is necessary not for the developing baby, but to make up for the woman’s losses.
- An ultrasound of the fetus should be performed in order to identify in advance supposedly large children. This is especially true for women.
- If even the slightest discomfort appears in the pelvic area or pubic symphysis, you should inform your doctor about this.
Disjunction of the symphysis pubis is a serious, sometimes disabling pathology. More often we have to deal with less dangerous forms of DLS - symphysiopathies, isolated symphysitis.
The most typical complaints are pain in the area of the corresponding joint of the pelvis, which most often appears on the 2-3rd day after birth. The pain sharply worsens when moving the legs. The postpartum woman seems to be bedridden, her hips are slightly turned outward and at the same time rotated with her knees slightly bent (the “frog” position) - a symptom of N.M. Volkovich. Raising the legs sharply aggravates the pain. The gait of a postpartum woman, when she is allowed to stand up, is waddling, the so-called duck-like.
The most common injury is the symphysis pubis. In some cases, the woman in labor herself feels a rupture of the symphysis pubis, a cracking sound is heard during the rupture, and the presenting part, which was previously motionless, quickly descends. But these signs are not constant and are rare.
Clinical picture depends on the degree of divergence of the pubic bones. There are three degrees of their divergence, established radiographically (J. Bumm, K. S. Zalevsky, M. A. Dubinina). The first degree is the divergence of the pubic branches by 5-9 mm, the second degree by 10-20 mm, the third degree by more than 20 mm.
In case of divergence of the pubic bones of the first degree Postpartum women usually do not complain. Only a thorough examination and palpation of the symphysis pubis can suggest the possibility of discrepancy, and x-ray examination finally establishes the diagnosis (Fig. 131). In most cases, first-degree symphysis pubis discrepancies are visible, and since they are usually diagnosed and do not require treatment, their practical significance is small.
Rice. 131. Stretching of the symphysis (x-ray).
In case of divergence of the pubic bones of the second degree Postpartum women complain of pain in the symphysis and difficulty walking.Most pronounced signs of the third degree of divergence of the pubic bones. Postpartum women complain of severe pain in the symphysis area, cannot make active movements in the lower extremities, or turn on their side. They are forced to remain in bed and lie in a position with the hips turned outward: upon palpation of the pubis, swelling and pain in this area, mobility or wide distance of the pubic branches from one another are determined. X-ray examination finally confirms the diagnosis (Fig. 132).
Rice. 132. Rupture of the symphysis (x-ray).
The pain continues for several weeks, walking is impossible for 3-10 weeks, depending on the severity of the injury. With inflammation of the symphysis, sacroiliac and sacrococcygeal joints, the first signs appear on the 2-3rd day after birth and are expressed in low-grade fever, pain that increases with movement, swelling, redness and soreness in the area of the corresponding joint. X-rays of the pubic and sacroiliac joints show no changes.
Treatment for sprains and divergence of the pelvic joints
Treatment consists of bed rest, prophylactic antibiotics, transfusions of small doses of blood, vitamins and calcium chloride. Tight circular bandaging of the pelvis is used, although some obstetricians are skeptical about this measure. In case of divergence of the symphysis, consultation with a traumatologist is necessary to decide on the use of a “hammock” and special placement for better reduction of the separated bones.
Typically, the discrepancy of the symphysis pubis is eliminated within 3-10 weeks. With severe damage to the sacroiliac joint, recovery can take a protracted form. Some postpartum women, especially those who get up early, may be left with a persistent gait disorder (duck walk).
In the presence of a hematoma and its infection, it is necessary to use antibiotics, sulfonamides, and in case of suppuration, an autopsy is necessary.
Prevention of damage to the pelvic joints
Prevention of damage to the joints of the pelvis should consist of measures that ensure the proper development of the female body (physical education, rational, nutritious nutrition, etc.). The use of medical gymnastics during pregnancy helps to strengthen the articulation of the pelvis.
Careful management of labor is necessary, especially during surgical delivery. The latter must be carried out in compliance with all conditions and technically correct, without the use of rough, traumatic manipulations.
Emergency care in obstetrics and gynecology, L.S. Persianinov, N.N. Rasstrigin, 1983
