Divergence of the symphysis in pregnant women. Pain when walking and sitting in pregnant women - perhaps it is symphysitis! How to identify pathology

When carrying a child, a woman may experience discomfort and pain in the pubic area. Often these sensations are of high intensity and lead to limitation of activities. The reason for this is the moving bones of the symphysis of the pubis, which, under the influence of various provoking factors, diverge too far. This pathology can significantly worsen a woman’s well-being during pregnancy and complicate childbirth.

General information about symphysitis during pregnancy

In the area of ​​the chin, sacrum, pubis, sternum and intervertebral discs there is a symphysis - a cartilaginous or fibrous connection between the bones of the skeleton. During pregnancy, the symphysis pubis weakens. This process is normal because it helps a woman prepare for childbirth. With intense exercise, symphysiopathy may develop during pregnancy. The disease is characterized by the divergence of bones over a long distance and the formation of edema. Symphysitis causes discomfort to the expectant mother, accompanied by pain and limited mobility.

Signs of symphysitis during pregnancy

The first signs of the disease appear in the 4th month of pregnancy, the full clinical picture is revealed in the 3rd trimester. The following are common symptoms of symphysitis:

• Swelling in the pubic area. At first it appears slightly. Symptoms intensify as the inflammatory process develops.
• Pain in the pubic area. It has an aching, pulling character. The symptom intensifies when climbing stairs or walking for a long time. If the woman is at rest, the pain gradually subsides. At an advanced stage of symphysitis, the nature of the sensations changes, a feeling of pinching and lumbago appears. The discomfort persists throughout the day.
• Heaviness in the lower abdomen. It is formed under the influence of a rush of blood to the pelvis, swelling and the process of bone separation. This symptom of symphysitis intensifies when a woman takes an upright position and decreases at rest.
• Clicking, crunching, sharp pain. Occurs during physical activity or when touching the inflamed area. After a decrease in physical activity, edema may form.

Causes of symphysitis during pregnancy

Modern scientists cannot identify the exact factors influencing the formation of symphysitis. The probable causes of the development of the disease during pregnancy are the following:

• Lack of calcium. Having a great need for this element, the growing fetus draws it from the mother’s body. With its critical deficiency, a woman develops pathologies of joints and bones. For this reason, symphysitis develops in late pregnancy.
• Increased levels of relaxin. The production of this hormone occurs actively before childbirth. The substance is necessary for the female body to favorably endure the process of the birth of a baby. The production of this hormone in some cases is excessive. As a result, the consistency of the symphysis softens.
• Diseases of the musculoskeletal system. Disjunction of the symphysis pubis during pregnancy often occurs in women with such pathologies. Difficulties in movement and crooked posture of patients lead to the fact that the load given by the fetus is distributed unevenly, so symphysitis is formed.

Along with the main causes of symphysitis, there are risk factors, the presence of which significantly increases the likelihood of the disease during pregnancy. Among them:

• urogenital infections;
• low physical activity of women;
• child weight exceeding 4 kg;
• frequent childbirth;
• previous injuries to the pelvic bones;
• the presence of pathology during a previous pregnancy.

Degrees of divergence of the symphysis pubis

Upon examination, the doctor can determine not only the presence of the disease, but also the degree of its severity. Symphysitis in pregnant women has the following stages:

1. First degree - the distance between the pubic bones varies from 5 to 9 millimeters. This stage is characterized by nagging pain during long walking, localized in the pubic area, and mild swelling. After climbing stairs, the patient may experience discomfort in the lower abdomen. The disease at this stage is not dangerous for the woman; its symptoms disappear with a decrease in the intensity of the load and sufficient rest. A pregnant woman should be under the supervision of a doctor to prevent the progression of the pathology.
2. The second degree is characterized by an increase in the gaps inside the pubic symphysis to 15-20 millimeters. The disease is manifested by severe swelling, constant pain (the intensity depends on the woman’s activity during pregnancy), heaviness in the lower abdomen that occurs when the body assumes a vertical position. At this stage, the likelihood of rupture of the symphysis pubis increases, so natural childbirth is not recommended.
3. The third degree is severe. It is characterized by the divergence of bones by a distance exceeding 20 millimeters. At stage 3, pronounced symptoms appear: pain, lumbago, extensive swelling. When palpating (feeling) the inflamed area, specific clicks are detected. With grade 3 symphysitis, childbirth is carried out only by cesarean section. During pregnancy, the patient must be provided with rest and bed rest.

Treatment of symphysitis during pregnancy

It is impossible to completely cure the disease during pregnancy, but following some recommendations will help significantly alleviate the patient’s condition. At the first stage of symphysitis it is necessary:

• ensure bed rest, reduce physical activity as much as possible during pregnancy, the patient needs to spend more time at rest;
• take easily digestible calcium supplements and B vitamins;
• apply procedures with ultraviolet light;
• regularly perform exercises aimed at strengthening the symphysis pubis;
• during pregnancy, choose orthopedic mattresses for sleeping;
• avoid staying in one position for more than 60 minutes, long walking;
• Take painkillers that are safe during pregnancy if necessary.

The treatment strategy for stages 2 and 3 of symphysitis during pregnancy involves keeping the pelvic bones in the closest possible position. If severe pain occurs, the woman may be admitted to the hospital. In the hospital, it is necessary to undergo courses of medications that have analgesic and anti-inflammatory effects, and physical therapy. If therapy is carried out on an outpatient basis, pregnant women suffering from symphysitis are recommended:

• strictly observe bed rest;
• wear a special corset, bandage or use tight bandages;
• adhere to a diet that includes foods high in calcium;
• take painkillers and vitamin preparations prescribed by a specialist, permitted during pregnancy.

Physiotherapy

1. Lie on your back, bring your feet toward your buttocks, bending your knees. Extend your lower limbs at a slow pace, hold the position for 30 seconds, then bring them together again. Repeat the exercise 6 times.
2. Move your heels away from your buttocks by 30-40 cm. Raise and lower your pelvic area. Movements should be slow. At a minimum distance from the floor, try to hold your position for as long as possible. The pelvis must be raised by 2-3 cm. Repeat the exercise 6 times.
3. Do the “Cat” exercise. Get on all fours. Keep your spine straight and your back relaxed. Don't lower your head or raise your head. Arch your back while tensing your thigh and abdominal muscles. You need to raise your head. Perform 3 reps.

Undoubtedly, waiting for a new little person to appear is a miracle. Feeling how life is born and formed in you is very pleasant, unusual and even magical. But pregnancy is a very big burden on a woman’s body, and it has a number of “side effects”. Therefore, it is often accompanied by various unpleasant symptoms, pain, and complicates simple life actions. And if some of these sensations indicate increased stress, others may indicate various types of diseases.

One of these unpleasant conditions is inflammation in the place where the pubic bones connect, and it is called symphysitis. Let's figure out how to recognize it, how to treat it, and how dangerous this condition is.

Let's first look at what symphysitis is.. A woman's pelvis consists of the sacrum and pelvic bones, one on each side. They are connected at the back by two sacroiliac joints, and at the front by the pubis. This anterior joint is called the symphysis.

In a normal healthy state, the symphysis is a cartilaginous disc; in the middle there is a cavity that is filled with articular fluid. But this joint is fixed and limited in mobility. During pregnancy, a woman’s body produces the hormone relaxin, under the influence of which the pelvic joints become more mobile and soften closer to childbirth. Nature provided this function to make it more comfortable and easier for the child to pass through the birth canal during childbirth.

So, it happens that the joints become too soft and the symphysis pubis becomes inflamed and swollen. This pathology is called symphysitis, and pain in the pelvic area is called symphysiopathy. It can appear at any stage of pregnancy, but is often detected already in the third trimester.

There is symphysitis of the first, second and third stages of divergence:

1. Divergence of pubic bones by 5-9 mm. At this stage, most often, patients do not show any complaints and can give birth on their own.
2. Divergence of the pubic bones by 10-20 mm. Pain occurs in the pelvic area. There are indications for caesarean section.
3. The distance of the pubic bones is more than 20 mm. This degree is accompanied by severe pain when walking, turning over on one side and moving the legs. In this case, the pregnant woman is admitted to the hospital under strict observation, and delivery is strictly surgical.

Causes of symphysitis

It is still unknown exactly what influences the development of the disease.. But doctors put forward several main possible reasons why this pathology occurs:

• the hormone relaxin is produced in greater quantities than necessary;
• vitamin deficiency and calcium deficiency.

Also at risk are pregnant women who have:

• the presence of diseases in the musculoskeletal system;
• possible bone injuries;
• urogenital infections;
• a significant number of births;
• large fetal weight - over 4 kg;
• strong or —preeclampsia—;
• chronic problems associated with ion exchange;
• heredity.

Often this disease is identified by the symptoms of a pregnant woman and confirmed during an ultrasound examination (ultrasound), since X-rays and magnetic resonance imaging are contraindicated during pregnancy. Although, as practice shows, only 40% of women are diagnosed with symphysitis. It can also occur as a result of difficult childbirth, and bring anxiety to the woman after it.

Symptoms of symphysitis

First of all, it is by the characteristic signs that you can suspect this pathology. And you should definitely inform your doctor about this in order to take timely measures and not complicate the severity of the disease.

So, here are the symptoms to look out for:

• pain during physical activity or pressure in the pubic area, can radiate to the tailbone, throughout the pelvis or to the thigh;
• the pain intensifies with the development of symphysitis and can be disturbing even in a stationary state;
• Clicking or crunching noises are heard while driving;
• a so-called “duck” gait or lameness appears;
• soft tissues in the pubic area swell;
• there may be a low-grade fever.

Important! A characteristic sign of symphysitis is pain in the pubic area if you try to raise your legs while lying on your back.

Symphysitis usually appears in the second half of pregnancy, but symptoms may appear earlier. Women who are not giving birth for the first time and have already encountered this problem recognize the signs of symphysitis earlier. Symphysiopathy is especially pronounced at night. It hurts for a pregnant woman to turn over from one side to the other and get out of bed. During the day, pain interferes with walking, climbing stairs and simply enjoying your wonderful position.

Treatment and prevention of symphysitis

But don't get upset prematurely. Today, there are methods for treating and alleviating the condition of symphysiopathy during pregnancy.. Of course, first of all you need to contact your doctor and describe all the symptoms that bother you. After examination, the doctor should order an ultrasound examination (ultrasound) to confirm symphysitis and identify its stage.

• Most often, at stages 2-3, wearing a special bandage is prescribed. It reduces pressure on the inflamed area and, thereby, makes it easier to bear a child.

• Your doctor may also prescribe vitamin supplements containing calcium..

  But be CAREFUL: do not take calcium on your own, since excess amounts, especially in the last months of pregnancy, can negatively affect labor and the baby. The placenta tends to accumulate calcium, which makes it difficult for the baby to get oxygen. And compaction of the skull bones will significantly complicate the birth of a child.

• You can contact an osteopathic doctor who will select the right massages, physiotherapy and therapeutic exercises. He will also prescribe medications suitable for your case.
• In some, especially acute cases, a woman is hospitalized and used to relieve pain.

For a more gentle first stage, you need to:

• Walk less and therefore spend more time lying down;

• stick to a diet;
• take vitamins and calcium;
• to reduce pain, take painkillers that are allowed in your situation;
• purchase an orthopedic mattress;
• do not stay in one position for a long time;
• If possible, minimize walking on steps;
• do gymnastics to strengthen the pelvic muscles.

Fortunately, symphysitis in pregnant women often goes away on its own after childbirth., so treatment is aimed at alleviating the woman’s condition. In addition, since doctors have not yet reached a consensus on what exactly causes this pathology, it is difficult to say exactly how to prevent it. But there are still some tips for preventing symphysitis:

• Eat a healthy diet and include calcium-containing foods and B vitamins in your diet;
• Don’t overload yourself physically and get plenty of rest;
• Go for regular check-ups with your doctor so that the problem can be identified at an early stage of development;
• monitor your weight so that the load on the pelvis is not excessively high;
• when standing, distribute your weight evenly on both legs;
• when sitting, you should not cross your legs (during pregnancy, this position is also harmful to your baby, so avoid it for a while);
• do not sit in one position for more than an hour;
• do special exercises for pregnant women.

Exercises for symphysitis

There is a set of exercises for symphysitis. Doctors recommend doing it for medicinal purposes for this pathology. Such exercises strengthen the muscles of the pelvis, hips and lower back, and this gymnastics also reduces pain.

Do this easy set of exercises every day, and if you have pain, you can do it several times a day. But remember that during pregnancy you should not overload yourself or force yourself. Do all exercises slowly and smoothly, without sudden movements and with pleasure.

Video: exercises to prevent symphysitis during pregnancy

In this video you will find a few more exercises during pregnancy to treat and prevent symphysitis.

Diet supplements for symphysitis

In addition to gymnastics, you can use folk recipes to improve your condition. Introduce foods such as goat cheese, prunes, fish, almonds or, for example, sesame seeds into your diet. After all, sesame seeds are rich in amino acids and oils, and they contain significantly more calcium than dairy products.

Sesame mixture recipe:

• 100 g sesame seeds;
• honey to taste.

Mix the ingredients and take one tablespoon 3 times a day. This mixture can also be used as an additive to cereals, cottage cheese or fruits. It will be very tasty and will relieve pain from symphysitis.

Does symphysitis affect childbirth?

As practice shows, symphysitis does not in any way affect the health and well-being of the baby either in the womb or at birth. But the expectant mother can receive serious injuries during childbirth. After all, childbirth is a huge load on the pelvis, and when damage or inflammation in the pubic joint already exists, the likelihood of rupture of the pubic ligament is high.

This is why it is so important to identify symphysitis before birth. After all, the recovery period after this can end in months, and sometimes even years. In the most difficult cases, surgical intervention is required. Therefore, in order to avoid such consequences, in case of symphysitis of the second and third degrees, a caesarean section is prescribed.

Indications for surgical delivery for symphysitis are:

• divergence of the pubic bones by more than 10 mm;
• narrow pelvis;
• the fruit is more than 4 kg;
• very severe pain.

Causes of symphysitis after childbirth

It is worth noting that symphysitis can develop just after childbirth. Numerous factors may be the cause. For example, if the fetus is large enough and the pelvis is narrow, then as it passes during childbirth it can damage the birth canal.

It is worth considering that the physiological processes in the female body during pregnancy are caused by softening of the ligaments that hold the pubic bones at a distance from each other and swelling. As a result, the ligaments may partially lose their ability, and the bones simply separate. Due to swelling during pregnancy, the joints are also exposed to this factor, thereby increasing their mobility.

During preparation for childbirth, the pubic bones can diverge by a distance of up to 6 mm - this is normal. But after childbirth, the woman’s body must recover on its own and return to its original position. Unfortunately, this does not always happen, and help is needed to recover.

If a woman already has pathologies associated with diseases of bone structures or joints, injuries to the sacrum, as well as severe toxicosis, hormonal disorders or a lack of vitamins, then symphysitis may occur after childbirth.

Treatment of symphysitis after childbirth

In such cases, the woman is prescribed medications containing calcium, magnesium and B vitamins. This often promotes healing and eliminates surgical intervention.

Also, after childbirth, it is necessary to wear a bandage for symphysitis. Special corsets have been developed that hold the pelvic bones in the correct position. This makes it possible to take at least a little care of your newborn baby.

It is important to limit as much physical activity as possible, and for relaxation it is better to choose a high-quality orthopedic mattress.

If necessary, the doctor will prescribe antibacterial (if there is a urogenital infection) and painkillers or ointments. In addition, physical therapy, for example, ultraviolet irradiation, can speed up the healing and recovery process.

Consequences

If this pathology is present, a woman wants to know how long it takes for symphysitis to go away after childbirth. Symptoms may persist for quite some time. It all depends on the degree of damage, but the minimum recovery period will be at least a month, and for a more complex degree - from six months to several years.

A complication after symphysitis may be a change in the functioning of the musculoskeletal system - gait is impaired. If this disease is not treated, it can lead to further changes and the development of pathologies in the spine. The pain will increase and limit movement activity. Inflammatory processes in the pelvic area may occur, which contributes to the development of diseases of the genitourinary system. To treat such pathologies, you should consult a urologist.

In any case, you should not ignore the symptoms and delay treatment. First of all, consult your doctor and let him choose a comprehensive treatment for you.

Anyone who has already gone through this test, please advise what methods you used?, and what most effectively influenced the recovery process after symphysitis. Maybe someone knows additional methods of treating or preventing this pathology - share your experience in the comments. What methods do you know to relieve pain during pregnancy?

Pregnancy is a time when a woman's body changes significantly. Some changes are obvious and understandable (for example, breast and abdominal enlargement), and some are not so much. For example, starting from the second half of pregnancy, the expectant mother begins to experience unpleasant sensations in the pubic area; over time, they can intensify so much that it becomes difficult for the woman to walk or sit. Where did these pains come from and what to do with them?

The woman’s pelvis is a ring and consists of several bones that are attached to the sacral spine at the back and connected at the front with the help of a fibrocartilaginous disc and ligaments. This connection is called pubic junction(pubic symphysis), or symphysis, or pubis.

Usually the symphysis is in a stationary state, but during pregnancy it can diverge, because the pregnant woman’s pelvis becomes wider. The symphysis expands due to the fact that the ovaries and placenta synthesize a special substance - relaxin, which is able to relax ligaments. Under its influence, the ligaments swell and become loose, as a result of which the joints become more mobile and the distance between them increases.

This is especially pronounced in the pubic symphysis; it is the one that diverges the most. This is a natural, physiological state that facilitates the birth process, because it will be easier for the baby to pass through a wide pelvis. , when the level of hormones and relaxin returns to the pre-pregnancy state, all these changes disappear - the ligaments and joints become dense again.

How do you know if you have symphysitis?

Most often, symphysitis manifests itself in the 3rd trimester of pregnancy, when the effect of the hormone relaxin reaches its maximum and the child weighs more than 2 kg, which significantly increases the load on the pelvic ligaments.

Symphysitis is characterized by:

• significant swelling appears in the pubic area;
• if you press on the symphysis pubis, pain or a characteristic click will appear;
• independent pain in the groin, sometimes in the tailbone, thigh;
• in a lying position it is impossible to raise straightened legs;
• characteristic “duck” (waddling) gait;
• sharp pain occurs when climbing stairs;
• Over time, the pain can intensify and occurs not only when walking or moving, but also in a calm state - in a sitting or lying position.

The diagnosis of “symphysitis” is usually made on the basis of the described complaints. In addition, the doctor must prescribe an ultrasound in order to determine the width of the divergence of the symphysis pubis.

Depending on the degree of softening of the pubic symphysis and the size of the divergence of the pubic bones, three degrees of severity of symphysitis are distinguished:

• 1st degree - from 5 to 9 mm;
• 2nd degree - from 10 to 19 mm;
• 3rd degree - more than 20 mm.

If the signs of symphysitis are severe, then most likely it will be necessary - during natural childbirth there is a high risk of rupture of the symphysis. possible if the pubic symphysis has expanded no more than 10 mm, the child is not large, and the pelvis is of normal size.

Symphysitis: causes and treatment

Why symphysitis occurs has not yet been precisely established. There are two main theories to explain excessive divergence of the pubic bones:

• excessive production of relaxin, which leads to excessive relaxation of the symphysis pubis ligaments;
• disturbance of phosphorus-calcium metabolism and vitamin D deficiency.

In addition, the following factors contribute to the development of symphysitis:

• hereditary diseases of bones and joints, for example, a defect in collagen (protein of skin, ligaments, cartilage, bones), leading to excessive joint mobility;
• numerous births;
• past pelvic trauma;
• large fruit weighing more than 4000 g;
• sedentary lifestyle and excess weight;
• symphysitis during previous pregnancies.

If symphysitis is already present, then it is unlikely that it will be possible to completely get rid of it, but you can reduce its manifestations and the feeling of discomfort.

For symphysitis you need:

• lie down more often;
• When sitting or standing, distribute weight evenly on both legs;
• sit on a chair with an adjustable back and armrests;
• reduce the child’s pressure on the lumbar and pubic area; To do this, you can place additional pillows under the buttocks, place your feet on a raised platform;
• perform special exercises to reduce pain in the symphysis pubis;
• Ask your doctor if you can use special anti-inflammatory drugs to reduce pain in the symphysis;
• contact a trauma surgeon or osteopath who has experience in treating symphysitis in pregnant women.

With symphysitis you cannot:

• take asymmetrical positions: for example, sitting cross-legged or standing leaning on one leg;
• sitting, standing or walking for a long time;
• To climb up the stairs;
• When walking, take steps to the side.

Exercises to strengthen the muscles of the pelvis, lower back and hips

1. Lie on your back, knees bent, feet close to your buttocks. Slowly, as if overcoming resistance, but very symmetrically, spread your knees to the sides and connect again. Repeat 6 times.
2. Lie on your back, knees bent, feet slightly further from the buttocks. Slowly lift your pelvis up and very slowly lower it back down. Repeat 6 times.
3. Cat pose. Kneel down and lean on your hands, then relax your back muscles, keeping your head, neck and spine at the same level. Next, you need to arch your back up, at the same time lower your head down, tighten your abdominal and thigh muscles. Repeat 2-3 times.

Prevention of pain in the symphysis pubis

Like any pathology, symphysitis is easier to prevent than to treat. This is not difficult to do, the main thing is to follow simple rules:

1. Watch your diet! Your diet must include: milk and lactic acid products, low-fat cheeses, eggs, meat, poultry, fish, herbs, nuts.
2. Do fitness for expectant mothers.
3. Swim in the pool: water relieves stress on the spine and joints.
4. Take a walk in the fresh air: exposure to sunlight produces vitamin D in the skin.
5. Control your weight; extra pounds often contribute to symphysitis.
6. Take vitamins and microelements.
7. Wear it.

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Conference "Pregnancy and childbirth". Section: Childbirth (symphysitis and breech presentation). Now every day it’s getting worse, but, on the other hand, there’s a standard set of complaints: it hurts to walk, it hurts to turn from side to side, it’s painful to put on pants and boots only while sitting (and that’s all...

During my first pregnancy, I was diagnosed with symphysitis in the 9th month. The pain was very strong, I could barely walk. Of course, they intimidated me with a cesarean and ordered me to go to the maternity hospital at 38 weeks. My husband brought me, and our doctor was at some conference and we were asked to square...

Main symptoms:

• Pain in the pubic area
• Change in gait
• Inability to raise straight legs
• Swelling in the pubic area
• Spread of pain to other areas
• Difficulty climbing stairs
• Spasms when trying to change the position of the body
• Clicking in the pubic area when walking

Symphysitis is an inflammatory process of the symphysis pubis that occurs during pregnancy or in the postpartum period. In normal condition, the connection between the pubic bones and the pelvis is a fixed structure, but under the influence of certain factors it can soften. Very often such changes appear in the second and third trimester. This is due to the rapid growth of the baby and an increase in the amount of amniotic fluid. But symphysitis often occurs after childbirth. This occurs against the backdrop of intense movement of the baby along the birth canal, which causes injury to the joint.

Today, medicine does not fully understand the reasons for the formation of this disorder. Experts attribute this to calcium deficiency in the body and hormonal imbalance. The main signs of the disease are pronounced pain in the pubic area and lower abdomen, especially at night or when trying to spread your legs to the sides while in a horizontal position. In addition, changes in gait are observed.

Diagnosis of pathology is based on an analysis of the patient’s medical history, examination by a specialist, instrumental examinations, in particular ultrasound and radiography of the pelvic area and pubic joint. In most cases, this disease can be treated without surgery, namely by fortifying food with calcium or taking it in tablets, anti-inflammatory drugs, performing a set of special exercises and wearing a support bandage. But in the presence of aggravating factors, labor is carried out by caesarean section.

Etiology

At present, the prerequisites for the formation of this disorder have not been fully elucidated, but two main hypotheses are known that explain the pathological discrepancy of the pubic bones and the appearance of inflammation:

• calcium deficiency. Representatives of the fairer sex who are carrying a child need to consume this component in the amount of one hundred grams per day;
• too much of the hormone relaxin, which is produced by the ovaries and placenta. It is responsible for the process of relaxing the ligaments of the pubic bones.

Other predisposing factors for the occurrence of symphysitis are:

• genetic disorders of the normal functioning of the musculoskeletal system. Such diseases can cause joint mobility, excessive bone fragility and stretching of the skin;
• repeated pelvic injuries preceding pregnancy;
• several births in the patient’s life history;
• sedentary lifestyle;
• the presence of a similar disorder during previous pregnancies;
• high fetal weight - more than four kilograms.

Varieties

There is a classification of symphysitis according to the divergence of the pubic bones. Thus, there are several degrees of severity of the disease:

• initial – the discrepancy is no more than one centimeter;
• average - up to two centimeters;
• severe – more than two cm.

In addition, the disease occurs:

• associated with bearing a child - formed during pregnancy, starting from the first trimester or in the postpartum period;
• not related to pregnancy - in rare cases, such a disorder develops as a consequence of a pelvic injury or during professional sports, in particular it occurs in runners.

Symptoms

Symphysitis can appear at any time during pregnancy, but is often diagnosed in the second and third trimester, when the fetus begins to actively grow. Symptoms of the disease are:

• swelling of the affected area;
• the appearance of pain and a specific click when walking or pressing on the pubic area, as well as if you remain upright for a long time;
• spread of pain to the pelvis, groin, tailbone and hips;
• sharp spasms when trying to change the position of the body;
• inability to raise straight lower limbs high while lying on your back;
• change in gait - movement in small steps is observed;
• difficult process of climbing stairs.

As symphysitis progresses during pregnancy, the signs become more pronounced - pain appears not only when walking. A set of special exercises and wearing a bandage will help reduce pain. Since the disease is accompanied by intense pain, sexual relations with symphysitis should be excluded.

Complications

In cases of attempts to independently diagnose and treat symphysitis, as well as in case of untimely seeking help from doctors, a serious complication may develop. The only consequence of the disease is a complete rupture of the pubic symphysis. This may result in the inability to stand on your feet, lift them, or move around independently. In such cases, wearing a bandage will not help correct the problem. Women are prescribed a caesarean section.

Diagnostics

The process of establishing a diagnosis is carried out by identifying complaints, the intensity and first time of onset of symptoms, as well as possible predisposing factors that could cause the formation of such a disease.

Instrumental examination for symphysitis consists of:

• Ultrasound of the area where the pathological process is localized is necessary to determine the stage of the disease;
• radiography - this procedure cannot be performed on women carrying a child, so it is carried out outside the period of gestation. An x-ray is an examination prescribed to study the distance between the bones of the pubic joint and confirm their displacement. It is also an indispensable way to control the recovery process and the effectiveness of treatment.

In some cases, additional consultations with specialists such as a physical therapist and orthopedic surgeon may be necessary. After all the studies have been carried out, an individual treatment strategy for the disease is determined - cesarean section, drug treatment with wearing a bandage and performing exercises.

Treatment

Depending on the course of symphysitis, as well as on the basis of examinations, individual treatment tactics for this disorder are determined. The basis of therapy is to reduce the pain syndrome. Drug treatment includes:

• taking a vitamin complex and calcium;
• prescribing non-steroidal anti-inflammatory drugs - they must be taken to relieve inflammation and eliminate pain;
• constantly wearing a bandage;
• a set of special gymnastic exercises designed for pregnant women;
• physiotherapy, consisting of exposure to a low-frequency magnetic field on the affected area.

Drug and physiotherapeutic treatment of symphysitis is used at the initial stage of the disease. In such cases, a female representative can independently, naturally, give birth to a baby.

In severe cases of the disease, as well as in the presence of the following indications, a caesarean section is prescribed. These factors include:

• divergence of the pubic joint by more than one centimeter;
• unbearable pain in the pubic area during natural labor;
• anatomical structure - a narrow pelvis is an indicator for performing a cesarean section not only for this disorder;
• large fruit - more than four kilograms.

A set of gymnastic exercises and a bandage is the basis of the treatment process, which is also used to eliminate symphysitis after childbirth. The bandage looks like a bandage made of dense material. Its purpose is to hold the pelvic bones in a normal and comfortable position for a woman. It must be put on only in a supine position, fastening it as tightly as possible. You don’t need to wear it for a long time, but only in cases where you plan to go for a long walk or need to stand for a long time. At night, it must be removed in order to avoid compression of internal organs.

Prevention

There are no specific preventive measures against symphysitis, since the reasons for its formation have not been clarified. By following simple recommendations you can reduce the risk of developing the disease:

• Healthy food. Eliminate fatty, spicy and salty foods, as well as sweet flour products from the diet. It is necessary to enrich food with vitamins, nutritional minerals and calcium;
• register with an obstetrician-gynecologist on time and undergo regular examinations;
• Wear the bandage not for long, only for long walks. It must be removed at night;
• performing therapeutic exercises;
• spend several hours a day walking in the fresh air;
• choosing a rational method of labor – assess the indications and contraindications for natural childbirth and cesarean section.

The prognosis of symphysitis directly depends on the degree of divergence of the symphysis pubis and the intensity of the expression of symptoms. Despite the fact that such a disorder does not have a negative impact on the life of a woman and child, it is necessary to begin effective treatment as soon as possible. After childbirth, pain subsides, hormonal balance is restored, and swelling goes away.

Is everything in the article correct from a medical point of view?

Answer only if you have proven medical knowledge

Almost every second pregnant woman faces such an unpleasant diagnosis as symphysitis. This disease is not considered dangerous for the child, but it significantly complicates the course of pregnancy. And if in the second trimester the pathology manifests itself only as mild pain, then closer to childbirth they become stronger. In particularly difficult situations, women even experience difficulty walking. What are the causes of symphysitis in expectant mothers, what can it mean and how to deal with it - we will answer these questions in the article.

What is symphysitis

The human pelvis is a kind of closed ring, which consists of the sacrum, coccyx and several paired bones: pelvic, ischial and pubic. In the center of the lower abdomen, the pubic bones are connected by the pubic joint - the symphysis, which is a layer of connective tissue.

During the period of bearing a child, the symphysis, under the influence of the hormone relaxin, becomes more mobile and soft to facilitate the passage of the baby through the mother’s pelvic bones. However, greater mobility of the pubic joint sometimes leads to inflammation, excessive looseness and stretching of the tissue. In this case, doctors talk about the occurrence of symphysitis.

Symphysis - articulation between the pubic bones

How dangerous is it for the expectant mother?

To understand the consequences of this disease, you need to share its danger for the expectant mother and child. What is the threat of symphysitis to a pregnant woman?

1. In the second half of pregnancy, discomfort and pain only increase. In some situations, a woman simply cannot stand on her feet due to severe pain.
2. The degree of inflammation of the symphysis affects the choice of method of delivery. Obstetricians resort to caesarean section if there is a high risk of rupture of the symphysis pubis during childbirth.
3. If the joints do tear during natural childbirth, the woman will be bedridden for several weeks or even months. Obviously, pain and forced immobility do not contribute to happy motherhood.

But for a child, the disease does not pose a particular threat, but this is from a physiological point of view. After all, discomfort and constant pain cannot but affect the psycho-emotional state of the mother. And a woman’s stress and negative emotions negatively affect the condition of the fetus.

How to determine whether a woman is at risk of symphysitis

In the medical community, there is no consensus on the causes of symphysitis during pregnancy. Experts identify two main theories that can explain excessive divergence of the pubic bones and inflammation of the symphysis:

• deficiency of calcium, the main component of bone tissue, in the female body. The optimal daily dose of this element for an expectant mother is about 1200 mg;
• excessive production of relaxin by the ovaries and placenta and, as a result, too much softening of the pubic symphysis.

Factors contributing to the occurrence of symphysiopathy in pregnant women include:

• hereditary diseases of the musculoskeletal system, leading to increased joint mobility and elasticity of ligaments;
• numerous births;
• large fruit (weight exceeds 4 kg);
• injury in the pelvic area;
• "passive lifestyle;
• rapid weight gain by mother.

It is difficult to say how much each factor influences the occurrence of symphysitis. However, when two or more similar “provocateurs” are combined, the pregnant woman is at risk, which requires constant monitoring by the treating doctor.

Early signs and subsequent development of symptoms

Signs of symphysitis begin to actively appear closer to childbirth, but there are often cases when the first symptoms of the disease bother a woman already in the second trimester. Initially, pain appears in the pubic area during prolonged walking, physical activity, or climbing stairs.

Many expectant mothers attribute such discomfort to natural changes during pregnancy. If you don’t consult a doctor in a timely manner, the symptoms only increase:

• the pubis swells;
• discomfort in the area of ​​the pubic joint intensifies (“pulls in the stomach”), and the pain is worse at night;
• pain affects the hip joints and lower back;
• “clicking” sounds are clearly audible while walking;
• the so-called duck gait occurs - the expectant mother walks in short steps, waddles;
• It is impossible to raise straight legs from a supine position.

Specific signs that indicate the presence of symphysiopathy in the expectant mother include symptoms of Opokin and Volkovich. The first symptom is detected while listening to the pubic area with a phonendoscope. When pressing on the symphysis or spreading the legs, a crunching sound is heard. To detect Volkovich's symptom, a woman must take a horizontal position: with severe symphysitis, the hips are spread apart and the knees remain bent. It resembles frog legs.

Video: a pregnant woman about the symptoms of symphysitis

Ultrasound and other diagnostic methods

If discomfort occurs when walking and moving, or swelling in the pubic area, a woman should contact a gynecologist who is managing the pregnancy. It is he who will make a diagnosis using the following methods:

1. Survey and inspection, including analysis of complaints. The doctor asks the expectant mother when the pain began, where it is located, how much the gait has changed, and establishes the symptoms of Opokin and Volkovich.
2. The patient’s medical history, which examines the presence of injuries to the pelvic joints, diseases of the musculoskeletal system, and nutritional patterns.
3. Obstetric history. The doctor learns about past gynecological diseases, the course of previous pregnancies and births.
4. An ultrasound examination performed to assess the distance between the pubic bones.

X-rays, magnetic resonance imaging and computed tomography are considered the most informative methods, but they are not recommended during pregnancy. They are prescribed after delivery to measure the degree of stretching of the symphysis pubis and evaluate the effectiveness of the treatment.

Ultrasound is the safest instrumental diagnostic method during pregnancy

How to give birth with this diagnosis

An ultrasound, in addition to determining the size of the discrepancy of the pubic bones, helps the gynecologist clarify the degree of softening of the pubic symphysis and draw a conclusion about the preferred method of delivery.

Table: severity of symphysitis and prognosis for childbirth

In addition to the degree of divergence of the pubic bones, the choice of obstetric care option also depends on related factors, including the size of the fetus and the position of the child in the uterus. If the expectant mother feels pain in the pubic area, but the stretching of the symphysis does not exceed 1 cm, and the baby is not large, then the obstetrician gives preference to a natural birth.

Caesarean section for symphysitis is mandatory if:

• the distance between the pubic bones is more than 2 cm;
• the child is large (his weight is more than 4 kg);
• the woman in labor has an anatomically narrow pelvis;
• The expectant mother had a history of trauma to the pelvic bones, a hereditary disease of the musculoskeletal system.

Treatment during pregnancy

Medicines

Unfortunately, it will not be possible to completely get rid of the unpleasant symptoms of the disease during pregnancy. Symphysitis usually goes away on its own (or with medical help) after childbirth, when the hormone relaxin stops acting on the musculoskeletal system. The main goal of treating an illness during pregnancy is to alleviate the condition of the expectant mother and choose the right birth strategy.

A gynecologist prescribes and administers treatment. He directs an ultrasound scan, prescribes medications, recommends that the woman wear a bandage to strengthen her muscles and perform simple physical exercises.

Table: medications prescribed for the prevention and treatment of symphysitis at different stages of pregnancy

Funds group	Name of drugs	Destination purpose
Calcium preparations	Calcium citrate; Calcium lactate; Calcium carbonate.	Replenishment of calcium deficiency in the body; relieving inflammatory processes in various tissues and organs.
Vitamin complexes with calcium	Calcemin;	Replenishment of calcium deficiency; replenishing the lack of vitamin D, necessary for better absorption of calcium itself.
Nonsteroidal anti-inflammatory drugs		Reduction of pain syndrome; reduction of inflammatory processes.

Photo gallery: medications for the treatment of symphysitis

Paracetamol is a safe anti-inflammatory and analgesic drug Panadol is a paracetamol-based pain reliever Calcium D3 Nycomed - a vitamin complex to replenish calcium and vitamin D deficiency in the body Ibuprofen is used after assessing the possible risks and benefits for the mother and fetus. Calcium gluconate is a drug that helps replenish calcium deficiency

Self-treatment with these medications is excluded, since each of them has its own contraindications and features of use depending on the stage of pregnancy and breastfeeding.

In addition, calcium supplements in the third trimester must be taken with extreme caution. Excessive concentration of this element causes early ripening of the placenta, which is fraught with delayed embryonic development and premature birth. It is also possible that the bones of the fetal skull will become stronger, making passage through the birth canal more difficult. During this period of pregnancy, calcium intake is carried out under the supervision of a gynecologist, who checks the development and maturation of the child and evaluates blood flow in the placental arteries.

Home measures

Exercise and wearing a brace

Therapy for symphysiopathy during pregnancy involves limiting physical activity. But at the same time, doctors recommend performing specially designed exercises that strengthen the pelvic, lumbar and femoral muscles. They are simple and easy to make at home.

In addition, a necessary condition for effective treatment of the disease iswearing a special bandage, more serious than a regular bandage for pregnant women. This wide belt is made of elastic fabric, sometimes with rigid inserts and additional straps. This design not only supports the abdomen, but also “fixes” the woman’s pelvis and hips, preventing the divergence of the pubic bones and stretching of the pubic joint. You need to wear a bandage both during pregnancy and after childbirth. It is purchased in orthopedic stores and selected according to size.

Important! Depending on the degree of symphysitis, the doctor will recommend a specific bandage of a certain shape.

Diet and lifestyle

Therapy for symphysitis also involves maintaining a proper diet. The attending doctor will select a special diet for the expectant mother, which will include the optimal amount of calcium and vitamin D (it is important to coordinate the intake of vitamin complexes with the doctor). Such a diet is especially relevant in the autumn-winter period, since the sun appears quite rarely.

• choose asymmetrical positions (cross your legs, transfer your entire body weight to one leg);
• sit for a long time, especially if the knees are higher than the pelvic girdle;
• walking or standing for a long time;
• sit or lie on a hard surface;
• wear high heels;
• climb stairs too often.

Important! In case of inflammation of the symphysis, pregnant women are advised to keep their knees together when changing body position (getting out of bed, getting into a car). This will help minimize the likelihood of further stretching and damage to the symphysis pubis.

Prevention

Preventing symphysitis is not an easy process, since doctors have not yet established the exact causes of this condition. However, you can reduce the likelihood of symphysis rupture and reduce the severity of pain if you follow the recommendations of doctors. So, pregnant women are advised:

• plan pregnancy and carefully prepare for it, including identifying and treating chronic and gynecological diseases;
• register with the antenatal clinic in a timely manner;
• regularly visit the gynecologist leading the pregnancy (at the beginning of pregnancy - once a month, in the second trimester - once every 2-3 weeks, before childbirth - once every 7-10 days);
• adhere to a proper diet with less fat and carbohydrates and an optimal content of proteins and calcium;
• take vitamin complexes containing calcium and vitamin D (only after consulting a doctor);
• wear a support bandage that prevents excessive stretching of the pubic joint;
• perform certain physical exercises, while simultaneously limiting loads, long walking, and sitting.

When taking preventive measures and following medical recommendations, the prognosis for symphysitis during pregnancy is generally favorable and does not always require a cesarean section. However, if the disease is severe, the doctor may decide on surgical intervention.