SYMPHYSIS PUBIS DYSFUNCTION
A Self-Help Guide
Unfortunately this condition sometimes occurs during pregnancy as a result of abdominal weight
gain and the relaxation of muscles. Even if you don’t have the problem, some of the advice
below is relevant for all pregnant women.
ANTENATAL
REST AS MUCH AS POSSIBLE!
Try not to be on your feet for too long.
If possible, sit down to do activities, e.g. ironing, preparation of food, changing nappies.
Avoid walking. When you do walk, take small steps.
Rest in a position which is comfortable, e.g.
1. Lying with knees bent and supported;
2. Lying on side with pillow between knees;
3. Sitting with knees slightly apart;
4. Avoid sitting with legs crossed.
Avoid pain-provoking activity.
Avoid lifting and putting strain on your back, e.g.
- Lifting shopping, toddlers, washing. If you have to lift, use your legs
NOT your back, BUT keep knees together and avoid squatting.
- Loading/unloading washing machine (put chair in front of washing
machine.
- Pushing shopping trolleys, buggies.
Avoid straddle movements, i.e. activities with knees apart, e.g.
- Getting in and out of car (keep knees together)
- Getting out of bath – shower if possible – otherwise use another person
for support, sit on bath edge and swing round with knees together.
Getting in and out of bed, keep your knees together. It may help to squeeze a pillow or
two between your knees as you get in and out of bed.
Rolling over in bed, again keep your knees together. DON’T push through one foot as
this will make your pain and problem worse – push equally through both feet to move
about the bed.
Take extreme caution with sporting/leisure activities, e.g.
a. Avoid breaststroke when swimming
b. Avoid exercise classes, which involve repetitive weight bearing
c. Aqua-aerobics – take care not to over-stretch
d. Cycling
e. Gardening – sit or kneel where possible and avoid heavy work.
Being pregnant is an exercise in itself!
Avoid activities which involve standing on one leg, e.g.
a. Getting dressed – sit down to put on underwear, socks, leggings
b. Stairs – try backwards to avoid pain, placing both feet on each step, or go
up and down on your bottom, remembering to push equally through both
feet. If using crutches, go up and down stairs as you were taught by the
physiotherapist.
To speed up the recovery.of your symphysis pubis pain, you must:
a. Ice it: Use an ice-pack (or make your own by wrapping ice cubes or a
small bag of frozen peas in a wet cloth) to place over the painful area
under your underwear. Leave it there for about 10 minutes. Repeat this
every 2-3 hours. This helps to reduce the swelling and pain. An
alternative method is to massage the area with an ice cube – wiping dry
when it gets wet, for 10 minutes (may need more than one ice cube).
Repeat every 2-3 hours.
b. Knee-squeezing exercise: Hold something firm that is the size of your
fist between your knees (e.g. child’s toy), squeeze knees together and
hold for 10 seconds and repeat up to 10 times. This exercise can help to
re-align the symphsis pubis bones, and you must do it 2-3 times a day,
even if it is a bit painful. As your problem improves, it will become less
painful.
c. Do your pelvic floor exercises as you were taught by the physiotherapist.
Because these muscles attach to the back of the symphysis pubis bones,
strengtheneing them will also help your problem.
d. Do your pelvic tilt exercise as you were taught. Again this exercise helps
speed up the healing of your symphysis pubis pain as well as
strengthening your tummy muscles.
LABOUR AND DELIVERY
Prior to delivery, with your partner make a note of the distance you can part your knees
before it hurts. Try to avoid going any further during labour.
Adopt a position of comfort in all stages of labour. You will be able to discuss these with
your midwife.
Be aware that pain killers (though making your labour more comfortable) will lessen your
awareness of your pelvic pain.
POST NATAL
Same advice as for antenatal, except avoid walking at all in the first 3 weeks. If pain
persists, avoid walking for another 3 weeks. You will be using elbow crutches.
Your 6 weeks post-natal check should be with an Obstetrician in St. Helier Hospital
rather than with you GP.
Avoid lying on your side as this will aggravate your pain and problem. Lying on your
back to sleep should not be a problem after delivering.
Avoid rolling in bed.
No lifting anything other than the baby and avoid that if someone else is around to help.
Do not do any housework/shopping/taking other children to school for at least 3 weeks
and possibly for 6 weeks.
Use a walk-in shower if possible. Avoid showers in a bath or bathing. Strip wash or use
a bidet instead.
Do not do any sport or physical exercise until discussed with your physiotherapist.
If you still have pain while you are on the ward after delivery, speak to the
physiotherapist on the ward and she will arrange a follow-up outpatient appointment.
If you have any queries, contact the PHYSIOTHERAPY DEPARTMENT on 020 8296 2722 and
ask to speak to the Obstetric Physiotherapist. If left untreated, this problem can cause a lot of
pain and disability for many months.
