Pregnancy related symphysis pubis

dysfunction – a part of pelvic girdle pain

This leaflet explains what pubic dysfunction is and outlines exercises you
can do to manage your symptoms and to reduce the problem.

Introduction
Pregnancy related symphysis pubis dysfunction is common, and comes under the umbrella
of what is called ‘pelvic girdle pain’. This is because it can also occur with other symptoms. If
identified early, the pain can be managed while you are pregnant. Around 25% (1 in 4) of all
pregnant women will experience this. Symptoms can be different for everyone and some
women may experience more severe symptoms than others. Sometimes, it can be worse in
subsequent pregnancies compared to your first, especially if you had any previous low back
or hip problems. In a small percentage of women, pain may continue after birth, particularly if
left untreated.

What is pubic dysfunction?

• Occurs when the symphysis pubis joint becomes
looser and moves about due to pregnancy
hormones. This allows instability in the pelvic girdle.
• The pain is often felt over the pubic bone at the
front with shooting, stabbing, burning, grinding,
audible clicking or persistent discomfort.
• Pain can also radiate to the lower abdomen (belly),
groin, perineum (the tissue between your vagina
and anus), thighs and back.

What are the symptoms?

You may experience:
• difficulty walking
• pain when standing on one leg, e.g. climbing the stairs, dressing or getting in or out of the
bath
• pain and/or difficulty moving your legs apart, e.g. getting in and out of the car
• clicking or grinding in the pelvic area
• limited or painful hip movements, e.g. turning over in bed

Management
Avoid activities which cause discomfort, e.g. lifting, carrying, prolonged standing, walking
and strenuous exercise.
• Avoid straddling and squatting movements e.g. when getting in and out of a car or bath.
• Adopt good posture, avoid bending and twisting.

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• Use a pillow between your legs at night to keep your hips in alignment.
• Log-roll in and out of bed, pushing yourself up with your hands.
• Swivel to get in and out of the car, keeping your knees together.
• If swimming, try to avoid breast-stroke.
• Take regular painkillers if required.
• Ice packs can be used for 10 minutes at a time e.g. wet sanitary pad, put in the freezer
and then put in between two underwear.
• Wear pelvic support belt over lower abdomen and pelvic area, this can help ease the pain.
Once you have been assessed by the physiotherapist, she will highlight which
exercises you need to do to help manage the pain.

Pelvic floor muscles

The pelvic floor muscles are sling-like muscles that lie at
the base of the pelvis, supporting the internal organs,
including the womb and your baby. They help you to
control your bladder and bowel, as well as enhancing
sexual intercourse. Exercising these muscles now will help
increase your awareness of how they work. This is
important to help you recover from the pregnancy and
delivery when these muscles are weakened. Weakness in
these muscles can result in leaking of urine/faeces during
activities of daily life. To try and prevent this, you should do
pelvic floor exercises daily.

Exercise 1: ‘Slow ones’ (these also help with urge incontinence and urgency)
• You can begin exercising your pelvic floor lying on your side with knees bent, or sitting
comfortably.
• Tighten the back passage as if trying to hold in wind and then bring this contraction
forward as if trying to stop urine.
• Do not use your tummy or bottom cheek muscles when doing this exercise. You should
not see any external movement.
• Aim to hold this contraction for 3-5 seconds. Build up strength within your pelvic floor until
you can hold for 10 seconds. Always remain in control of the contraction and relaxation –
do not let the contraction “melt away”.
• Keep breathing throughout and then relax your pelvic floor for at least 6 seconds in
between each contraction.

Exercise 2: ‘Quick ones’ (these can also help with stress incontinence)
• You should begin exercising your pelvic floor lying on your side with knees bent.
• Tighten the back passage as if trying to hold in wind and then bring this contraction
forward as if trying to stop urine.
• Do not use your tummy or bottom cheek muscles when doing this exercise. You should
not see any external movement.
• Hold for 1 second and relax for 3 seconds. Repeat 10 times.
Try to build these exercises into your routine, for example, try to use these muscles to
support you by tightening them before you cough, sneeze, lift baby, or stand from sitting.

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** Repeat each exercise (slow and fast) 10 times, 3-4 times a day**

Abdominal muscles
As your baby grows, your abdominals will be stretched and weakened. Your abdominals act
as a corset supporting your back and your baby. It is important to maintain the strength in
these muscles to provide support for your back.
Transverse abdominis:
• Start lying down with knees bent and feet resting on the bed. Take a breath in, and then
as you breathe out gently draw your lower abdomen in towards your spine.
• Try to hold this while continuing to breathe, and then relax.
• Try to increase the hold until you can hold for the count of 10 and repeat 10 times;
• Always draw these muscles in to support you when you are doing any abdominal
exercises and in any activity involving your back e.g. lifting anything, including your baby;
rising from sitting; getting out of bed; and bending over. This is another good habit for life.

Pelvic tilting:
• Start lying down with knees bent and feet resting on the bed, draw in your lower abdomen,
as in exercise 1. (You can also do this exercise in standing, against a door, or on hands
and knees)
• At the same time tuck your tailbone under, flattening the curve of your lower back.
• Keep breathing while holding this position for a few moments and then relax.
• This exercise can be done at any time and is also very good for easing an aching back.
Repeat this exercise 10 times.

Strengthening exercises

Wall squats:
• Stand leaning against a wall.
• Slowly bend your knees and “slide” your back down the wall
until you are in a squat position.
• Hold for 10 seconds.
• Repeat 10 times, 3 times per day.

Pillow squeeze:
• Start by lying down with your knees bent and feet flat.
• Draw in your belly button towards your spine and hold.
• Place a pillow or rolled up towel between your knees
• Squeeze the pillow together between your knees
• Hold this for 10 seconds and then slowly relax
• Complete 10 repetitions; continue to breathe throughout the
exercise.
• You can also complete this exercise while lying on your side or
sitting

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Bridging:
• Start by lying down with knees bent and feet flat.
• Draw in your belly button towards your spine and hold.
• Squeeze your bottom muscles and tuck your bottom under,
slowly rolling up into the bridge position.
• Then slowly roll your back down.
• Progress this exercise by holding the bridge position for 4-5
seconds, but remember to use your abdominals to support you.
• Complete 10 repetitions; continue to breath throughout this
exercise

Stretching exercises
Hamstrings:
• Sitting down onto a chair.
• With the leg you are wanting to stretch – put that leg straight out in
front of you so your heel is resting on the floor with your toes pointing
to the ceiling.
• Ensure your hips and shoulders remain level.
• Keeping your back straight, lean forwards slightly until you feel a
gentle stretch down the back of your leg.
• Hold this position for 6-8 seconds and then relax. Then switch to other
leg.

Cat / cow stretch:

• Kneeling down onto your hands and knees either on
the floor or on your bed.
• Draw your belly button in towards your spine.
• Curve your spine upwards (as in picture 1).
• Then flattened this curve and flex the other way so
you are arching your back downwards (as in picture 2).
• Hold each position for 2-3 seconds and then slowly transition into the other position and
do this 10 times.
• Continue breathing throughout the exercise.

Self-adjustment exercises
Hip flexion – superior:
• Start by sitting on a firm chair i.e. dining room chair.
• Lift leg up.
• Place hands on top of thigh and apply pressure as if you are
pushing leg back towards floor.
• Continue to lift leg upwards against resistance provided by your
hands.
• Hold for 6 seconds, repeat 4 times.

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Hip extension – inferior:

• Lie on your hand side.
• Bend your knee by bringing your foot towards the buttocks.
• Partner to place hand on the back of thigh and apply
pressure.
• Push leg backwards against resistance provided by partner.
• Hold for 6 seconds. Repeat 4 times.

Hip adduction – posterior:

• Lie on your back with the outside of your leg against a wall.
• Push your leg out towards the side, against the wall.
• Hold for 6 seconds. Repeat 4 times.

Hip abduction – anterior:

• Lie on your back. Knee bent and foot flat
• Partner to place hand on inside of left knee and apply pressure.
• Push knee inwards against resistance provided by partner
• Hold for 6 seconds. Repeat 4 times

Please ring 0118 322 7811/7812 if you need to speak to a pelvic health physiotherapist.

To find out more about our Trust visit www.royalberkshire.nhs.uk

Please ask if you need this information in another language or format.

RBFT Pelvic Health Physiotherapy, February 2024

Next review due: February 2026

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