Symphysis Pubis Dysfunction (SPD) or Pelvic Girdle Pain (PGP)

This is a common condition that causes pain in the pelvic joints in pregnancy. It affects up to 1 in 5 women.

It was originally called Symphysis Pubis Dysfunction but health professionals are moving towards calling it Pelvic Girdle Pain because it affects all the joints of the pelvis not just the one called the Symphysis Pubis.

Causes of SPD/PGP

For some women in pregnancy the pelvic joints become stiff or less stable during pregnancy. This can cause inflammation and pain to varying degrees of severity, ranging from a dull ache to severe pain. The majority of sufferers are in the mild to moderate category.

It is usually possible to successfully treat it.

Certain types of movement, such as widening the legs or standing on one leg, can make the pain worse.

For those with bad to severe pain, the condition can cause huge problems in pregnancy, making it difficult to continue doing normal day to day activities. Pain can also affect your sleep, causing your emotional health to suffer.

As SPD/PGP doesn’t affect the baby, sometimes women feel as if they should just put up with it and that it is not a priority. This is not the case and if you’re suffering from it, talk to your midwife. They should be able to refer you to a physiotherapist who has experience of treating pelvic joint pain for treatment.

Symptoms of SPD

  • Pain deep in the pubic area and groin (between the vagina and anus)
  • the pain can be manageable or severe
  • it can be brought on by some types of activity, such as walking, climbing stairs and turning over in bed
  • you may also have pain across your lower back
  • you might have a grinding or clicking sensation in your pubic area
  • the pain can be made worse by parting your legs or by standing on one leg.

What is the treatment?

The treatment might be different depending on your physiotherapist, but it is likely to include the following:

  • Hands-on therapy to restore normal movement of muscles and joints in the pelvis
  • exercises to strengthen your pelvic floor, stomach, back and hip muscles
  • exercises in water
  • advice around labour and birth
  • they may give you a pelvic support belt or crutches if they think these may help you.

You can ask the physiotherapist and your midwife for help in factoring PGP into your birth plan; a water birth might be helpful for example as it can allow you to move more easily. You may also find some labour positions better than others and they can advise you on which may be best.

If you get the right advice and treatment it can really help so don’t hesitate to bring it up with your midwife.

How can I help to ease my pain?

  • Try to avoid the activities that make the pain worse. For example if parting your legs makes the pain worse, roll out of bed and take the stairs one at a time
  • get help with minding other children if possible
  • if you have a toddler and are able to bring them out, do it in a buggy so you can use it to support yourself while walking (and avoid having to carry them). Don’t go too far if you know it will be painful getting back
  • wear flat supportive shoes
  • do your shopping online or ask someone to shop for you
  • avoid breaststroke if you’re swimming and take care with other strokes
  • get dressed sitting down.

Can I do any exercise with it?

Aside from physiotherapy exercises you should still continue to stay active in any way that does not cause pain. Your level of activity is likely to depend on the severity of the pain. It can be very frustrating if you were previously active to find that you have to stop. If you are able to, try different exercises until you find one that works. Some women report that cycling causes no pain while walking is very painful, others say that swimming or aquanatal exercises are fine. If you are signing up to an aquanatal class ask the instructor whether they have experience of SPD/PGP.

If you are swimming avoid the breast stroke as this is likely to cause more pain.

The key thing to remember is to stop any activity that causes pain. 

More information

The Pelvic, Obstetric and Gynaecology Physiotherapists (POGP) are a branch of the Chartered Society of Physiotherapy whose examined membership should be available if you require advice, further information or treatment. The Pelvic partnership has more information and support www.pelvicpartnership.org.uk.

Sources

  1. NHS Choices [accessed March 2015] http://www.nhs.uk/conditions/pregnancy-and-baby/pages/pelvic-pain-pregnant-spd.aspx (next review 17/07/2016)
  2. Pelvic Obstetric and Gynaecological Physioytherapy (2011) Guidance for health professionals. Pregnancy-related pelvic girdle pain, formerly known as Symphysis Pubis Dysfunction (SPD) POGP
  3. The pelvic partnership, Symptoms of PGP [accessed March 2015] http://www.pelvicpartnership.org.uk/symptoms-of-pgp 
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    Can I exercise with SPD?

    Symphysis pubis dysfunction (SPD) is a fairly common pregnancy condition. It is caused by the way pelvic joints move during pregnancy and the symptoms can range from mild to being so severe that crutches are needed.

Last reviewed on April 1st, 2014. Next review date April 1st, 2017.

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Comments

  • By Anonymous (not verified) on 16 May 2017 - 13:36

    I am awaiting a physio referral but am 33weeks. I have quite severe pain needing paracetamol every day though I try to avoid full dosage every day if possible. They said paracetamol is fine, but I'm not sure the full amount every day is great?
    I'm on early maternity leave so trying to regulate movement. But now I am experiencing burning pains in my pelvis after some activity this morning (school run & mini-supermarket shop). Pain at night can be awful. Generally I have a high pain threshold but I am finding this tough. Any tips whilst I wait on my referral? I'm not sure if it is complicated by placenta previa (grade 3) and a baby that is currently breech . Thanks in advance

  • By Midwife @Tommys on 17 May 2017 - 09:37

    Hi Minicapuccino
    The maximum dosage is 8 tablets of paracetamol (4g) in a 24 hour period. Taking the maximum dosage will not harm the growing baby but might help you to stay on top of your pelvic pain. In fact, your GP or obstetric doctor might need to prescribe you stronger pain relief if you are struggling so much with daily activities. You can visit your day assessment unit or triage in your local hospital for review of your PSD more urgently.
    Lots of rest in between your more active moments will help the body to recover. Any movement (getting on and off the toilet, rolling over in bed etc), should all be done keeping the knees together so that the front part of your pelvis which causes the pain - the symphysis pubis- will be minimally stretched each time these movements occur. You might be given a pelvic support belt by your physiotherapist, but these have varying levels of success from woman to woman. I hope it improves soon, i know that it isn't much fun!

  • By Anonymous (not verified) on 29 Jan 2017 - 16:06

    Im 37 weeks tomorrow i suffer from AS of the lumber spine and arthritis of the hips. For the past 3 days iv been taken paracetamol every 4 hours my back is very stiff and painful and my pubic bone keeps cracking also somtimes my thighs ace could this be spd or more my medical problems? Iv been sitting down for past 3 days with a hot water bottle on my back and it hurts getting in and out of bed also iv been sleeping like 11 hours

  • By Midwife @Tommys on 30 Jan 2017 - 09:22

    Hi there. It is difficult to say. You are now term at 37 weeks and sometimes the weight of the baby, the water and the placenta can take it's toll and feel very heavy and uncomfortable. SPD can occur at any stage of pregnancy, but with your medical history, I would advise that you were seen as soon as possible at your local triage/labour ward to be assessed. If you are so reliant on pain relief, that does not seem to really be helping, then you certainly may require better pain relief and an obstetric review.
    Please take care of yourself!

  • By Midwife @Tommys on 30 Nov 2016 - 14:56

    Hi thanks for posting. I'm so sorry to hear that you are suffering so badly 24 weeks into your 5th pregnancy. The symptoms you describe sound like pregnancy related pelvic girdle pain (PGP). I think you need to see your GP or midwife promptly to get a referral to see a women's health or musculoskeletal physiotherapist who will be able to treat you and make a positive impact on this debilitating condition.
    Please also look at this excellent website for more information and support http://www.pelvicpartnership.org.uk/ the sooner you get treatment the better your recovery will be.
    I am unsure what the significance of the itching is but I would make an appointment today with your GP and ensure that you mention the itching, how long it has been bothering you, what area of your body is affected and what time of day/night it affects you most. Your GP may wish to investigate the reason for the itching further.
    Please feel free to contact us 9-5 weekdays on our Pregnancy Line 0800 0147 800. I hope you start treatment soon.
    Tommy's Midwives

  • By Anonymous (not verified) on 30 Nov 2016 - 14:08

    I am 24 weeks pregnant got told u have spd as i have pains in my pelvic bone and back and belly and wen u turn over it's painful can't hardly walk as it hurts I can't sit down or lay down as i just wanna cry this Is my 5th baby and i get a bath and wash my self today I found my pelvis all swallon and i am always itching every were it's unreal

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