Symphysis Pubis Dysfunction (SPD)

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.

Share your experience of SPD, and swap tips with others in the same boat in BabyCentre’s friendly SPD support group.

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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  • Woman holding her back in discomfort.

    Blog

    Aches and pains

    Having suffered with back pain for about a year since I slipped a disc, I was worried that pregnancy may cause me increased problems. Sure enough it has!

  • Pregnant woman with yoga mat and water bottle in park.

    Can I exercise with SPD/PGP?

    Symphysis pubis dysfunction (SPD), also known as pelvic girdle pain (PGP), is a fairly common pregnancy condition. It is caused by the way pelvic joints move during pregnancy. It can make exercise more difficult but there are things you can do.

Last reviewed on April 1st, 2015. Next review date April 1st, 2018.

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Comments

  • By Aimi (not verified) on 14 Aug 2018 - 12:37

    I had severe spd with my first. I am just over 12 weeks and have the worst pains in my hip. I can’t lie on on side very long, I sit on a seat all day at work like a straddle stool and that makes it worse. The pain feels the same as last time, which I needed crutches. Is it possible to have this again so early on? Xx

  • By Midwife @Tommys on 16 Aug 2018 - 10:23

    Hi Aimi,
    It would be very early but it is possible, particularly if the gap between your first baby and this pregnancy has not been very long. If you haven't already, I would suggest to ask your GP or midwife to refer you to a physiotherapist so you can get support in early on to try to manage your pelvic pain as best as possible.
    Best wishes
    Tommy's midwife

  • By Kelsey (not verified) on 31 Jul 2018 - 22:37

    Hi

    I have severe pain in my pelvic I struggle to move in bed, get up or sit down and even walk now. I am 38 weeks pregnant will I be able to have a normal delivery still ?

  • By Midwife @Tommys on 1 Aug 2018 - 10:45

    Hi Kelsey
    I am sorry to hear that you are struggling so much with spd pain
    If you have not already done so, please be seen in the hospital in the triage/day assessment unit for review by a midwife and obstetric doctor. They can assess your movement range and help you decide if a natural birth is possible for you, or if you might need a c/s. It would be best to have a plan in place for you.
    All the best
    Sophie Tommy's Midwife

  • By Ellie (not verified) on 26 Jul 2018 - 18:24

    I’m 37 weeks with a rash all over my belly I’ve taken allergy tablets and used cream it’s seemed to die down but the constant itch I now have lots of discomfort while walking moving/doing anything even walking and lots of pressure what can I do ?

  • By Midwife @Tommys on 27 Jul 2018 - 12:40

    Hi Ellie,
    Sorry to hear that you are suffering so, and the heat can make itching worse. Continue to keep well hydrated and the itchy area well moisturised, also can help to wear cotton and breathable fabrics. If you are feeling itchy elsewhere on your body or it is not improving then do see your midwife for review. Also continue to monitor your baby's movements closely, any changes see your midwife straight away.
    Best wishes
    Tommy's midwife

  • By Lillian (not verified) on 7 Jun 2018 - 20:52

    I am 66 years old and have SPD. Everything I’ve read is about pregnant women. I am not pregnant. What doctor should I see?

  • By Midwife @Tommys on 8 Jun 2018 - 13:13

    Hi Lillian,
    If you are having hip pain then we would advise for you to see your GP for a review.
    Best wishes
    Tommy's midwife

  • By Jay (not verified) on 31 May 2018 - 22:12

    Hi I've been experiencing what seems to be PGP through most of my 2nd pregnancy never had this with my first.

    I'm currently 19 weeks.

    I get pain when walking, turning in bed and notice it when I work my long days at work.

    I did some internet searching and some sites suggested a maternity belt might help.

    I purchased one (a canteloupe) and have found it to really help I wear it most days for between 8-10 hours is this ok?

    Are there any concerns/ harm it could cause to my baby?

    Any evidence or research?

    I read on a support group that it may affect growth and shape of baby's head?

    It's got me worried..

    Thank Jay

  • By Midwife @Tommys on 1 Jun 2018 - 12:06

    Hi Jay,
    Sorry to hear that you are suffering so much with pelvic pain. There is no evidence to show that the belts will affect the shape of the baby's head or the baby's growth. However we would recommend that you have an appointment with a physiotherapist for an assessment and support advice as the belts are not always suitable for everyone. Have a chat with your GP or your midwife who will be able to refer you.
    Best wishes
    Tommy's midwife

  • By Stephanie (not verified) on 25 Apr 2018 - 04:46

    I’ve been over doing “nesting” at 32-33 weeks, and my body finally has had enough... that’s what I figure anyways, husband works shift work so only able to get major spring cleaning done when he’s home so feel the pressure on his days off.
    I’ve also been having this maternal feeling that baby will be early.
    Anyways by the end of the day today I’ve been nearly debilitated. Sharp excruciating pain in pubic/pelvic region when I walk, almost making me feel like I need to hunch over .
    After my 3 year old was done stories tonight I made it to bed and that’s it .
    Would a belly band help in this instance? And will the pain subside overnight? I see a chiropractor in 2 days and my prenatal doctor tomorrow.
    Can massage help?

  • By Midwife @Tommys on 27 Apr 2018 - 10:49

    Hi - Thank you for your message. It sounds as though you are gearing up for the birth with all the nesting and spring cleaning!
    It does sound as though you may have over-exerted yourself. Hopefully, after a good nights rest you are feeling better - but if the pain and discomfort is still there, it is best to contact your maternity care provider and be reviewed.

  • By Ana (not verified) on 16 Mar 2018 - 04:15

    I had SPD while pregnant and symptoms never fully went away. The pain decreases, but certain activities can trigger the SPD. I manage and try my best to be active and healthy. I would love to have another baby. Do you think this will persist or even get worse with a third pregnancy?

  • By Midwife @Tommys on 19 Mar 2018 - 11:48

    Have you seen a physiotherapist or an osteopath? They may be able to give you some exercises to help with this. Also before you get pregnant again try to ensure that you are a healthy weight and that good diet and exercise are part of your daily routine. While these things can't fully protect you from SPD they can have an influence.

  • By Becca (not verified) on 18 Feb 2018 - 22:19

    I keep reading online how COMMON this is and I went to a pregnancy class of 10-15 pregnant women and I was the only one suffering. I’m 32 weeks tomorrow & ive been to physio, I’ve tried swimming, I have a support band and I physically cannot do anything. They keep suggesting to not do anything that triggers it but sitting down, standing up, turning over in bed, going up and down the stairs, getting dressed, putting my shoes and socks on, getting in and out the bath/shower, literally EVERYTHING is triggering and there is absolutely nothing I can do to settle it. The doctor prescribed me codeine but I don’t like to take it. Does anyone have any idea at all what I can do to help?

  • By Midwife @Tommys on 19 Feb 2018 - 16:31

    Hi Becca, That sounds so painful for you. While SPD is quite common, this extreme form is not at all common though it is not unknown. You have done everything possible to reduce your symptoms and I respect you for trying all the options. You're right that taking codeine is not routinely recommended in pregnancy, but there are situations where it is the best option. Discuss again with your GP if you are unsure. This link may help https://beta.nhs.uk/medicines/codeine/
    I understand that there are several weeks until your delivery but please keep in mind that this pain should reduce very quickly after your baby is born. Keep going and best wishes from Tommy's midwives x

  • By nickol (not verified) on 6 Feb 2018 - 22:52

    I'm 16 weeks pregnant this is my 4th pregnancy with only one full term baby a few weeks ago I started getting pains that felt like someone punched me in the pelvic looked around online and sumbed it up as to every pregnancy is different and things were streching and moving for the baby but over the last two weeks it's gotten worst a constant pain and feeling of having a bowling ball crushing my pelvic iv tried exercises, stretching, heat, ice ,Tylenol but no relief it never goes away and sometimes will get so pain full I can't move or walk something as simple as sitting on the floor, chair, walking up steps, or getting up from sleeping to use the restroom can take my breath away the fact that it never goes away and is always painful worries me and is making me feel miserable. I'm going to my Dr in a few days but open to hearing what you might think ... Thank you

  • By Midwife @Tommys on 7 Feb 2018 - 12:14

    Hi Nickol
    It does sound as if you are experiencing early onset SPD, also known as pelvic girdle pain. Your doctor should be able to get your referred for physiotherapy support, you may also benefit from wearing a support belt that your physiotherapist can refer. In addition, your physio can go through what exercises and movements to adopt/avoid during your ongoing pregnancy.Please feel free to call us on 0800 0147800 if you wish to talk any of this through in the meantime!
    All the best
    Sophie,Tommy's Midwife

  • By Emily (not verified) on 27 Jan 2018 - 22:30

    Hi, I'm 26+3 weeks. Just over a week ago I slipped over and landed heavily on my lower back - went to hospital to check baby was ok and he is - however since then my lower back has been sore and for the last week it's been painful everyday on the left side, it hurts when I walk and particularly when baring weight on my left leg e.g. stairs & getting in and out of the car etc. Could I have developed spd or do you think it's something I've damaged by falling? Thanks for your help

  • By Midwife @Tommys on 29 Jan 2018 - 14:38

    Hi, Really sorry to hear that you have this pain. From your description it seems most likely that the pain is linked to your fall. Have you been prescribed any pain relief? My advice is to go and see an osteopath or a physiotherapist. Both are qualified to assess and treat these conditions. Unfortunately referral on the NHS can take a long time so if your midwife can't refer you quickly, it may be worth considering an appointment privately. Please ensure that your practitioner is qualified to assess pregnant women and I hope you get the relief that you need.

  • By Chloe (not verified) on 16 Jan 2018 - 16:36

    I’m currently 20 weeks and keep getting really bad pains all across my lower back. It’s there constantly but every few days it will immobilise me. I also have syatica which is just adding to the issue. I have a nursing chair, a big pillow, heated and cold pads. I’m looking at starting yoga soon. Is there any thing else I can do to stop it getting worse as I get bigger I am on my feet for 13hour shifts at work. Many thanks in advance

  • By Midwife @Tommys on 17 Jan 2018 - 14:47

    Hi Chloe. I'm so sorry that you are experiencing such bad back pain/SPD. Has your GP/Midwife referred you to a Physiotherapist? If they haven't, it would be a good idea. They can provide a support belt and crutches if needed later on in the pregnancy. They can also go through exercises with you that will strengthen the pelvis. I also think it might be a good idea to discuss these long hours with your manager. As your pregnancy progresses, so too will the effort it will take to get through a 13 hour shift. If there was another temporary option, this might be worth doing.
    Feel free to call us on 0800147800 if you wish to talk anything through in more detail.
    Sophie,Tommy's Midwife

  • By Jess (not verified) on 9 Jan 2018 - 13:54

    Hi there I’ve been getting pains on the outer of of pelvis especially when I’m lying on my side. I’m 20 weeks and my scan has been all good but it’s really disrupting my sleep as I often wake up in agony to be honest. Also I work on my feet all day and I’ve started getting pain within my hip just on the one side, it starts to get very tight and stiff and I feel the need to ‘click’ my hips

  • By Midwife @Tommys on 10 Jan 2018 - 11:54

    Hi Jess
    It sounds as if you are sufferring with SPD.This is very common in pregnancy, and can be very painful indeed! Please see the link below to our web page on this and how to proceed with seeking referral and support on this.
    https://www.tommys.org/pregnancy/complications/symphysis-pubis-dysfunction-spd
    Please feel free to call or email us on 08000147800 or [email protected] if you need any further info

    Sophie,Tommy's Midwife

  • By kat (not verified) on 5 Jan 2018 - 17:27

    I have been almost bed ridden for a week now. 31 weeks pregnant. It started of the pubis pain and like in my hips that made me move like a duck but last week it moved to the right side of my lower back and goes down my leg. I can't make more than a few steps before my body seizes in pain and I need assistance to sit down. Takes about half hour to "relax" after that. When I try and roll in bed I still feel pain but not as intense and I can feel crackling around my spine. I've seen my GP but not much help from him, seeing midwife in few days maybe i'll get referral to a physio. Atm I am unable to live a normal life. I feel like crippled and my mental health is going downhill. Not being able to do simple make me cry everyday.

  • By Midwife @Tommys on 8 Jan 2018 - 15:24

    That sounds really uncomfortable and painful. I really feel for you. Unfortunately GPs are often not the best place to be with back pain and a referral to a physiotherapist can take ages. If you can, I would suggest that you go to see an osteopath. Please make sure that anyone you see is registered with the General osteopathic council and is qualified to treat pregnant women. I hope you get back on your feet soon as unfortunately bed rest doesn't help improve things. Best wishes

  • By S.naaz (not verified) on 1 Dec 2017 - 02:15

    As am in 19week of pregnency n it's my first pregnency...still am nt feelng any type of movements from my baby??is it problematic??is my baby healthy??what are the tips to feel my baby movememts??

  • By Midwife @Tommys on 1 Dec 2017 - 12:03

    Hi,

    At 19 weeks of pregnancy it is very normal to not yet be feeling your baby move especially as it is your first pregnancy. Most women will first feel their baby move between 18-24 weeks, if you have not felt your baby move by the time you are 24 weeks then do speak with your midwife to be reviewed. You should also have a scan soon if you have not had one already which will look at your baby in detail and how well they are developing and growing.

  • By Minicapuccino (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 Bethany ayre (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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