When the pelvic bones diverge during pregnancy. Causes, diagnosis and treatment of postpartum pelvic discrepancy

With your own hands
25.08.2019

From the very first days of pregnancy, a woman’s body undergoes significant physiological metamorphoses: changes in gait are observed, the figure becomes more rounded, the taste preferences and habits. A change of this kind includes a phenomenon classified as a natural norm of physiology, namely, the divergence of the pelvic bones during pregnancy.

The process of softening the ligamentous apparatus and slight divergence of bone tissue is very important when the baby passes through the birth canal.

Moreover, narrow pelvis may well become an indication for delivery by cesarean section. The problem of bone discrepancy is often a cause of discomfort, especially in last weeks gestation. Moreover, excessive deviation of the pelvic segments relative to the original position is possible. This phenomenon is one of the pathologies and is called “symphysitis”.

What happens during childbirth

The massive element of the human skeleton, called the “pelvis,” is a ring consisting of bones and cartilaginous tissue. During the period of active growth of the body, bone tissue remains relatively soft and pliable, but upon reaching physiological maturity, which occurs at twenty to twenty-five years, final ossification of the skeleton occurs.

Throughout the entire period of pregnancy, a woman’s body intensively produces the hormone relaxin - a hormone that promotes the mobility of the tailbone, direct softening, increased elasticity of cartilage tissue, and slight discrepancy. Thanks to this physiological phenomenon, the baby’s head moves freely along the birth canal during the period of active labor. labor activity.

Most expectant mothers are interested in this kind of question: when do the pelvic bones begin to diverge during pregnancy. Peak this process occurs immediately at the time of birth, but preparation for delivery begins as early as early stages pregnancy. Many pregnant women note the appearance of the first unpleasant sensations in the pelvic bones in the third or fourth months of gestation.

Causes

The physiological norm is the expansion of the pelvic bones during pregnancy by an amount not exceeding half a centimeter. It is also possible to increase this indicator, But similar phenomenon is pathological in nature, and its main cause is symphysitis. Symphysiopathy of pregnancy can be caused by a number of reasons. The most common of which are:

  • Pathological disorders of calcium metabolism in the body.
  • Physiological deviations in which the ligaments are not sufficiently formed.
  • Lack of important vitamins and microelements, including vitamin D.
  • Hereditary predisposition.
  • Diseases associated with disruption of the structure of bone and cartilage tissues.
  • Diseases of infectious, inflammatory pathogenesis.

If a pregnant woman has severely diverged pelvic bones, a natural birth can aggravate the pathology and cause a rupture of the pelvic joint. In addition, there is a possibility of divergence of the pelvic bones after childbirth. To prevent this, when a diagnosis of “symphysitis” is made during pregnancy, delivery by cesarean section is practiced.

Video

Divergence of the symphysis pubis

Symptoms

The need to treat pelvic bone discrepancies arises only against the background of severe degrees of pathology. Against the background of the first and second stages, it is sufficient to take measures that will prevent the progression of the disease. The main methods of treating pelvic bone pathology include:

  • Taking antibiotics, anti-inflammatory drugs, anesthetics medicines. The use of such medications poses a potential threat to the health of the fetus, and therefore treatment with medications can only be indicated if there are vital indications.
  • Wearing a support corset or bandage. It is necessary to choose such a device according to the recommendations of a specialist. Wearing an excessively narrow bandage can cause pathologies in the fetus.
  • Therapeutic gymnastics, swimming, yoga.

    Regularly performing physical exercises approved by your doctor will help strengthen your muscles and eliminate pain and discomfort.

If there are no contraindications, regular exercise at home will also help cope with pain due to pathology of the pelvic bones. You can do, for example, the following options therapeutic exercises: sit on the floor, pull your feet as close to you as possible, and then carefully spread your knees.

It will also be useful to do next exercise: get on all fours, lower your head as low as possible, and then stretch your back up as much as possible.

Return to the starting position, exhale, relax as much as possible. It should be remembered that you can perform any exercises only after consulting your doctor. An additional, but somewhat controversial method of treatment for pelvic bone dehiscence is the use of medications, foods enriched big amount

calcium. Such a diet and medication can increase the strength of the pelvic bones, but this can negatively affect the course of natural childbirth. Unpleasant sensations and pain can be relieved by wearing a bandage, gymnastics, and swimming. It is important to remember that the measures listed are not radical therapy options, and can only slightly reduce discomfort in the pelvic bones. In severe forms of pathology, a pregnant woman may be prescribed.

surgical intervention

Consequences According to medical statistics, various degrees discrepancies in the pelvic bones are detected in every second woman. But only severe degrees of the disease are considered quite dangerous.

Provided the woman follows the recommendations prescribed by the doctor, the prognosis for pathology of the pelvic bones is favorable. Due to the development of complications, there is a possibility severe consequences , which include rupture, loss of the woman’s ability to move independently, and the development of inflammatory processes. To minimize the risks when making an appropriate diagnosis, a woman is recommended to have a cesarean section.

Prevention

Range of reasons Negative influence which can lead to divergence of the pelvic bones is more than extensive; accordingly, it is extremely difficult to clearly identify preventive measures that could help prevent the development of pathology.

The process of bone separation during pregnancy is a physiologically determined program of preparation for childbirth. At the end of the second trimester, a woman’s body begins to produce the hormone relaxin. This substance is responsible for changing the structure of cartilaginous tissue in the area of ​​the symphysis of the sacral and pubic joints of the iliac bones of the pelvis. Under the influence of relaxin, cartilage joints become softer and more pliable for deformation. This is necessary so that during labor the fetal head can freely come out.

The physiological discrepancy of the pelvic bones is acceptable within 3-5 mm. All changes that exceed these values ​​are considered pathologies. Their therapy requires health care. If no treatment is carried out, then after physiological birth a woman may experience partial or complete paralysis of the lower extremities. Loss of the ability to move also occurs in the case of complete divergence of the pubic and sacral articulation of the bones.

You can prevent the divergence of the pelvic bones during pregnancy by wearing a special prenatal bandage. Also, to strengthen the muscles of the back and anterior abdominal wall, courses of therapeutic exercises and kinesitherapy are conducted. Starting from the 20th week of pregnancy, manual therapy is indicated, which will allow you to safely and effectively carry out pregnancy and prepare the body for childbirth.

Causes of discrepancy of the pelvic bones during pregnancy

The divergence of the pelvic bones, as mentioned above, is a natural process through which nature has programmed the preparation of the birth canal. But with physiological divergence of the pelvic bones during pregnancy, a woman does not experience strong nagging pain and this does not result in her losing the ability to sit, stand up freely or walk.

Program failure and pathological bone separation during pregnancy can occur for a number of reasons. Among them, it is worth mentioning the following pathogenetic influence factors:

  • excess body weight of a pregnant woman - creates an excess load on the pubic symphysis;
  • pronounced edematous syndrome against the background of preeclampsia - body weight increases due to fluid retention in the intercellular space;
  • lack of calcium and some other minerals in food;
  • dehydration of the cartilage tissue of the symphysis pubis as a result of impaired blood microcirculation against the background of dilated veins in the pelvic cavity;
  • posture disorders;
  • incorrect foot placement;
  • deformity of the hip joint.

Predisposing factors may include: hormonal drugs(including those aimed at maintaining pregnancy), wearing tight clothes and improperly selected shoes, polyhydramnios and multiple births.

The development of the symphysopathy process begins with the primary softening of cartilaginous tissue. if the pregnancy develops normally, the woman does not have an increased load on the pelvic joints of the bones, then the entire discrepancy remains within the parameters of 5 mm. If the fetus is large or there is more than one, then the pressure on the pelvic floor increases every day. The pelvic bones begin to diverge more than is required for the normal process of childbirth. When the bones diverge by more than 10 mm, the irreversible process of destruction of the cartilage joint begins. There may be a risk of developing complete divergence of the pelvic bones. This is a threat future disability for woman.

Divergence of the bones of the symphysis pubis during pregnancy

The risk of discrepancy of the pubic bones may occur in women who decide to give birth to their first baby after the age of 30. Usually at this age there are already prerequisites for the development of primary osteoporosis against the background of accumulated pathological changes in cartilage and bone tissue. Therefore, even during pregnancy planning, it is important to carry out full examination. Particular care should be taken to check the state of the phosphorus-calcium metabolic process and the content in chemical composition blood vitamin D.

The divergence of the bones of the symphysis pubis begins at the end of the second trimester of pregnancy, and the following processes occur:

  • the position of the heads of the femurs in the cavity of the acetabulum changes;
  • the width of the feet when walking increases;
  • posture changes with smoothing of the lumbosacral curve of the spine (it becomes almost flat);
  • this entails a change in the sacroiliac joint of the bones;
  • then the hormone relaxin is released and the cartilage joints soften.

This entire process of divergence of the pubic bone during pregnancy in women with a well-prepared body for childbirth is completely painless and almost unnoticeable. Painful sensations during divergence of the bones of the pubic symphysis during pregnancy can be determined in the area hip joints, coccyx and pubic bone. Manual examination is used for diagnosis. Taking an X-ray before the baby is born is not recommended.

Pubic bone discrepancy during pregnancy

The discrepancy of the pubic bone is one of the varieties of this pathology. Appears at 30 - 35 weeks. Pain in the pubic area is accompanied by swelling and hyperemia of the soft tissues. The pain intensifies when trying to sit on a hard chair. Lying on your back painful sensations are decreasing.

Significant discrepancy of the pubic bone during pregnancy provokes pathology Bladder. Hyperactivity may occur, accompanied by urine leakage and mild incontinence. Pain may radiate to the groin area and spread throughout inner surface hips to knee joint.

This pathology of the symphysis pubis can only be prevented with an integrated approach. It is imperative to use a bandage that supports the anterior abdominal wall. It is also recommended that if a vitamin D deficiency is detected, take it in the form of oil drops in strict accordance with the doctor’s prescription.

Feelings, symptoms and signs of pelvic bone separation during pregnancy

Unpleasant sensations when the pelvic bones diverge during pregnancy, if this process does not go beyond the physiological norm, go away quite quickly. A woman is recommended to rest more, experience less physical activity, etc.

Clinical symptoms of bone discrepancy during pregnancy begin to manifest themselves intensively when the process reaches 6-7 mm. At the same time, the woman begins to experience the following sensations:

  • constant pressure on the pelvic floor;
  • frequent urge to empty the bladder;
  • irregular bowel movements, alternating diarrhea and constipation;
  • severe pain in the pubic area, hip joint and sacrum;
  • limited mobility when trying to turn in one direction or the other;
  • pain in the lower abdomen and lumbar region.

Worsening symptoms of discrepancy of the pelvic bones during pregnancy are an indication for surgery C-section. Natural childbirth with this pathology is contraindicated, since there is a high probability of complete rupture of the cartilaginous connection of the symphysis of the pubis and ilium.

Of particular danger are cases of divergence of the articulation of the sacrum and iliac bones. This can cause compression of the radicular nerves, stretching of the ligamentous apparatus and the formation of instability in the position of the vertebral bodies. Such pathologies often lead to further destruction of the cartilage tissue of the lumbar spinal column.

Clinical signs of bone discrepancy during pregnancy can be expressed in pain in the projection of the hip joints, knees and ankles. This is due to the fact that with significant symphysiopathy, they diverge femurs and the position of the foot changes. This leads to improper distribution of the shock-absorbing load on the lower limbs and spinal column.

What to do if bones diverge during pregnancy?

The first thing to do if there is divergence of the pelvic bones during pregnancy is to immediately consult a doctor. An experienced specialist will conduct necessary examination and will reveal the degree of pathological changes. If symphysiopathy is within the physiological norm, then a slight correction of the diet is carried out, and the woman is recommended to wear a prenatal bandage.

You can also use therapeutic exercises and kinesitherapy. These techniques will help prepare the muscular system for further pregnancy and labor. Manual therapy can be used after pregnancy has reached 20 weeks. Previous use of such techniques is not advisable.

If symphysiopathy reaches 6 mm or more, more serious treatment. It may include osteopathy and special massotherapy. By activating blood microcirculation processes in the area of ​​cartilage joints, it is possible to increase the elasticity of tissues and prevent the risk of complete tearing.

The course of prevention and treatment is always developed individually. We invite you to sign up for the primary free consultation see a chiropractor in our clinic. During the appointment, the doctor will conduct an examination, make a diagnosis and give all the necessary recommendations for prevention and treatment.

The birth of a child is one of the best periods in the life of every woman. However, not everyone has birth process proceeds favorably. This causes the woman unbearable pain, which she nevertheless endures. Despite long preparation, unexpected changes may occur in her body, which can bring her discomfort.

For example, a woman may feel as if her pelvic bones have separated. Could this happen? First, it's worth understanding a little about the anatomy.

What happens during childbirth

When childbirth occurs, the baby must pass through the bony pelvis of its mother in order to be born. This is what happens. On both sides, the pelvis is formed by two bones. They are fused ischium, pubis and ilium. At the back of the pelvis there is a sacrum. The symphysis, or pubic joint, connects the pelvic bones in front, and behind this role belongs to the two sacroiliac joints.

The pubic symphysis is the pubic fusion of the two pubic bones. This is accomplished using a fibrocartilaginous disc. In its center there is an articular cavity similar to a gap. It is logical that there is joint fluid there. Ligaments strengthen the symphysis below, above, behind and in front. Thanks to this, there is no doubt about the strength of the joint. The symphysis pubis is a semi-joint. This means that it has very limited movement access. In normal condition, the width of the symphysis is up to one centimeter. In front of the pubic symphysis there is a pubis, which has a fatty lining and a ligament that raises the clitoris. Vessels and nerves are located under the symphysis. At the back is the bladder and urethra.

The name symphysitis refers to all damage and changes to the symphysis pubis. These are softening, stretching, loosening, rupture, inflammatory process and 11 more components. Most often this occurs during pregnancy, childbirth and after.

So, divergence can indeed occur. It would only be more correct to say that there is a divergence of the symphysis pubis. There are reasons for this.

Causes Why does the symphysis pubis diverge? The reason lies in the physiological changes that occur as an adaptive process. This helps make labor easier. Women who have given birth may object: is childbirth easy? Of course not. However, if there were no physiological changes , it’s impossible to even imagine how the birth would have gone and whether the mothers could continue to remain healthy and alive. Yes, I have normal changes

During pregnancy, the placenta and ovary secrete relaxin. This substance has a relaxing effect. The combined action of relaxin and sex hormones female hormones leads to swelling of the articular ligaments and. They loosen. In addition, additional gaps develop in the joints, which fill with fluid. All this leads to increased mobility in the pelvic joints. Also, the distance between the bones that form each joint increases.

Such changes are most reflected in the symphysis pubis. There is an increase in blood supply. All ligamentous apparatus swells and loosens. As a result, the symphysis pubis increases in width by several millimeters. Small movements down and up of the articular ends of the pubic type may occur. This is similar to the movements of piano keys. The width of the pubic symphysis can reach one and a half centimeters. The divergence of the sacroiliac joint does not increase as much. All these changes gradually disappear. That is, over time, the articular cartilage becomes denser, the ligaments remain dense and elastic, and the width of the gap decreases. However, there are other factors in the divergence of the symphysis pubis.

There is such a thing as symphysiopathy. This is a strong relaxation of the pubic symphysis. It is a manifestation of toxicosis, and the osteo-articular system of the female body is damaged.

Unfortunately, some women are faced with the fact that the above changes occur too actively and become pathological. As a result, a strong divergence of the pelvic joints occurs. In the development of symphysiopathy and, as a consequence, articulation discrepancies, important role

Two factors play a role.

  1. There is such a thing as symphysis pubis dysfunction (APD). It may also include its divergence. Three periods and corresponding conditions can be distinguished in which DLS is observed, however, the exact etiology of DLS has not yet been fully studied.
  2. Prenatal: genetics, pelvic pain from previous pregnancies, history of low back pain, excessive or insufficient mobility, use of oral contraceptive methods, back or pelvic trauma. DLS is sometimes observed among multiparous women.
  3. Childbirth: vaginal operative delivery or delivery of a post-term fetus. Postpartum period: breast-feeding

and hip joint.

Symptoms It is clear that discrepancy of the symphysis pubis is symphysiopathy. It is worth noting that it may begin to appear before childbirth. As calcium starvation occurs, brittle nails, tooth decay, paresthesia, night leg cramps, fatigue, muscle contraction and twitching begin to develop. If the symphysis is not very wide, flying pains appear in the pelvic bones and lower back. This is usually regarded as or. Sometimes we're talking about about the threat of termination of pregnancy. In the 2nd and 3rd trimester there are discomfort And severe pain

in the pelvic bones, especially when standing and walking.

  • Such conditions are becoming more common. However, symphysiopathy may not manifest itself before childbirth, that is, it may occur in a latent form. The second half of pregnancy is characterized by holding back the pubic joints by tightening the abdominal muscles. This occurs due to uterine enlargement. After childbirth ends, the abdominal muscles immediately become flabby. The discrepancy can reach two centimeters. There are three degrees of divergence of the symphysis.
  • 5-9 mm;
  • 10-20 mm;

more than 20 mm.

Diagnostics

It is not difficult to diagnose discrepancies of the symphysis pubis of the second and third degrees. Pain in the symphysis area becomes more pronounced. It intensifies when a woman tries to change her position in bed, move her legs and even walk. Therefore, in a supine position, a woman usually takes on the “frog” pose, that is, she lies on her back, but her knees are slightly bent and her hips are turned outward. There are cases when the discrepancy exceeds two centimeters. In this case, the woman will move with a duck-like gait.

To clarify the diagnosis, the doctor may palpate the damaged area. If he presses on the symphysis pubis, pain will be characteristic both from the side of the vagina and from the front. The discrepancy itself is determined in the following way: if you try to press in your finger, then its pad will fit there quite easily.

  1. Of course, it is important to conduct instrumental diagnostics to exclude the occurrence of other pathologies and make an accurate diagnosis. Two methods are useful. X-ray. X-rays can detect discrepancies, but bone pathology is not determined. In addition, X-rays have bad influence
  2. for the fruit.

During the diagnostic process, it is important to determine the concentration of magnesium and potassium in both the blood and urine. When the articulation diverges, their level in the blood is reduced by almost half. When examining urine, a slight increase in their content is detected. These methods help make a diagnosis when the pregnant woman does not complain of discomfort or pain in the pelvic area.

Treatment

If the pubic symphysis diverges, surgery is usually not performed. If the discrepancy is insignificant, after childbirth or during pregnancy, doctors recommend limiting physical activity. It is important to wear a brace. It is advisable to sleep on an orthopedic mattress. It is also necessary to take calcium supplements, however, their form must be well absorbed by the body. You need to take fish oil, B vitamins, and take ultraviolet radiation.

If the discrepancy has reached the second or third degree, during the treatment it is necessary to bring the pubic bones, or more precisely, their ends, closer together. The pelvic bones must be held in a certain position. This effect can be achieved with bed rest. From two to six weeks after giving birth, you are not allowed to walk or even stand up. You should also use a bandage and tight bandaging. In the first 24 hours after birth, cold is used, and then physiotherapeutic procedures are applied, which are aimed at the pubic symphysis. Doctors prescribe calcium supplements and painkillers. If symphysitis, that is, inflammation, joins the discrepancy, treatment is added antibacterial therapy. The foods a woman eats should contain a lot of calcium.

In order to determine the success of treatment, an X-ray control is carried out, after which the woman needs to wear a bandage.

Today, special corsets have been made to help keep the pelvic bones in the desired position. This method helps to extend bed rest.

After a few days of wearing such a corset, a woman can not only get up, but also take care of the child, but the limitation physical activity is still present. The corset is used for 3-6 months.

Consequences

Symphysiopathy and, as a consequence, divergence of the symphysis pubis, usually proceeds favorably. If this condition occurs before childbirth, this is not an indication for cesarean section. Depending on the degree of discrepancy, it is determined obstetric tactics delivery. If the symphysis diverges very much and there is a danger of injury to the bone pelvis, a cesarean section is performed.

It seems that the most unpleasant consequence symphysis pubis discrepancy is a prolonged stay in bed and limited activity. This is wrong. If the articulation diverges by more than two centimeters, the symphysis may rupture. However, this rarely happens. Typically, a rupture occurs during childbirth, in which surgical delivery is used, but if a narrowed pelvis is combined with active labor.

The rupture may be accompanied by bladder injury and hematoma formation. An inflammatory process may also occur. If the symphysis pubis is very badly damaged, surgery may be necessary, after which the ability to work is restored after three or four months.

Correct lifestyle before childbirth, that is good food, regular walks and moderate physical exercise will help avoid such consequences and the discrepancy itself.

Every woman should remember that the condition of the baby depends on her health. .

The woman's pelvis has two pelvic bones on the sides, which are connected in front by the pubic joint -

The pubic symphysis is a fusion of the pelvic bones through a fibrocartilaginous disc, in the center of which there is an articular cavity in the form of a slit filled with articular fluid. In front, behind, above and below, the symphysis is strengthened by ligaments that give strength to this joint. The pubic symphysis is a semi-joint, i.e. has an extremely limited range of movement. The normal width of the symphysis, i.e. the distance between the pubic bones can be up to 1 cm.

In some situations, the pubic symphysis may become inflamed and become mobile. This condition occurs during pregnancy and after childbirth. These changes and damage to the symphysis pubis may imply: softening, stretching, expansion, divergence, rupture, inflammation, etc.

Disjunction of the symphysis pubis is a physiological process designed to facilitate childbirth; those. these are normal changes. During pregnancy, the ovaries and placenta secrete a substance called relaxin, which has a relaxing effect. Relaxin levels begin to increase at about 10 weeks of pregnancy and return to normal within 4-12 weeks after birth. Under the influence of relaxin, as well as female sex hormones, articular cartilage and ligaments swell, loosen, additional gaps filled with fluid appear in the joints, resulting in increased mobility in the pelvic joints and an increase in the distance between the bones. These changes are especially pronounced in the symphysis pubis. The width of the pubic articulation increases by 5-6 mm, small movements (up to 10 mm) of the articular ends of the pubic bones up and down are possible.

After childbirth, all these changes gradually disappear - the cartilage in the joints becomes denser, the ligaments acquire their former elasticity and density, and the width of the joint space decreases.

In some women, the above-described changes in the structure of the joints go beyond the physiological processes, acquire a pathological character and lead to excessive divergence of the pelvic joints - symphysiopathy. There are three degrees of divergence of the symphysis (above the physiological discrepancy of 5-6 mm):

I degree - discrepancy by 5-9 mm;

II degree - by 10-20 mm;

III degree - more than 20 mm.

The choice of delivery method depends on the magnitude of the divergence of the symphysis pubis. If there is pronounced divergence of the symphysis during pregnancy and there is a risk of injury to the pelvic bone during childbirth, delivery is performed by cesarean section. When the pelvis is narrowed and relatively large size For a fetus with a voluminous, dense head, the critical divergence distance should be considered 10 mm.

Such a severe form symphysis rupture It is rare and is characterized by a violation of the integrity of the joint. Rupture of the symphysis pubis with damage to the ligaments is often combined with damage to one or both sacroiliac joints and occurs, as a rule, during labor with surgical delivery (obstetric forceps) or when a narrowed pelvis is combined with violent labor.

Why is this happening?

It is believed that two factors play an important role in the development of symphysiopathy: disturbances in phosphorus-calcium metabolism and lack of vitamin D. There are not enough studies aimed at elucidating the role of predisposing factors causing the development of symphysiopathy. Possible factors discussed in the literature include: genetic predisposition, early menarche, application oral contraceptives, multiparous women, symphysitis during previous pregnancies, previous pelvic pathology or trauma (surgical or accident), excessive mobility, etc.

Symptoms of symphysitis

The main symptom of symphysitis is pain in the pubic area and thighs. The pain may be bothersome when walking, when rising from a low chair, at rest, or when applying pressure. The pain makes itself felt when a woman raises her leg, for example, when walking up the stairs, getting dressed, even turning over in bed. A characteristic symptom is pain in the pubic area when trying to raise a straight leg from a lying position. The pain often radiates to the back, groin, perineum, and leg. There may be audible or tangible clicking, crackling or grinding sounds in the pubic area. The gait becomes waddling or duck-like with characteristic short steps.

Some women notice pain as early as the first trimester of pregnancy, while others may experience it during labor or even a few days after giving birth.

The diagnosis is clarified by x-ray and ultrasound diagnostics. During pregnancy, preference is given to ultrasound diagnostics, taking into account the harmful effects of X-rays on the fetus. Typically, an X-ray of the pelvis reveals some degree of discrepancy of the symphysis pubis, but there are no pathological changes in the bones.

What can you do during pregnancy?

Since the etiology of the appearance of symphysiopathy has not been definitively established, treatment is not always effective. One thing is clear that this disease is associated with pregnancy, and therefore delivery is the best method therapy. The goal of treatment is to reduce pain. The disease is not dangerous for the mother and child, she can continue her normal lifestyle, but it is important to take some precautions.

1. When planning pregnancy and during pregnancy, do exercises to strengthen the pelvic muscles.

2. Wear a support belt (bandage) during pregnancy

3. Avoid exertion and heavy lifting, limit climbing stairs.

3. Don't stand for a long time. If possible, do the work while sitting.

4. Don’t sit cross-legged

5. While standing, distribute weight evenly on both legs

6. Avoid squatting, twisting movements of the body

7. Take calcium supplements and foods containing calcium

8. Sleep with a flat pillow between your legs.

Paracetamol is used for pain relief; nonsteroidal anti-inflammatory drugs (NSAIDs) and opiates are used to eliminate postpartum pain. Be careful when taking NSAIDs during pregnancy. Transcutaneous electrical neurostimulation, ice or external heat, and massage are also used. After delivery, women with symphysitis are recommended to carry out exercises according to a special program and, if they cannot achieve success, they resort to consultation and help from other specialists (orthopedists, etc.).

If the symphysis pubis is very badly damaged, surgery may be necessary, after which the ability to work is restored after three or four months.

To reduce the likelihood of developing symphysitis during pregnancy, you need to exercise, healthy image life and eat right before pregnancy.

The site administration does not evaluate recommendations and reviews about treatment, drugs and specialists. Remember that the discussion is being conducted not only by doctors, but also by ordinary readers, so some advice may be dangerous to your health. Before any treatment or taking medications, we recommend that you consult a specialist!

One of natural processes that occur in a woman’s body on later pregnancy - softening and some stretching of the sedentary interosseous pelvic joints. In this way, nature makes sure that it is easier for the child to move through the birth canal during birth. But in some cases, the pubic symphysis becomes excessively mobile, causing severe divergence of the pelvic bones. This condition during pregnancy is called symphysitis or symphysiopathy.

Symphysis is scientific name pubic symphysis. Essentially, this fibrocartilaginous disc is a semi-joint with limited mobility. This joint performs the function of fixing the pelvic bones together in the groin area. During pregnancy with female body many changes occur, including changes in the pubic symphysis. Gradual development child, his growth and weight gain cause an increase in pressure in the pubic area. As a result, physiological stretching of the semi-joint occurs and the pelvic bones diverge by 5–6 mm. This process does not cause pain in the pregnant woman.

IN in rare cases stretching of the symphysis and divergence of the pelvic bones becomes pathological. Scientists and doctors have not yet been able to establish with certainty why a pregnant woman experiences this problem. The most common opinion is a combination of factors such as:

  1. Hormonal changes in the body of the expectant mother. Excessive effects of the hormone relaxin on the joint tissue that connects the pelvic bones and experiences increased load while embroidering a child.
  2. A history of problems with the musculoskeletal system in a pregnant woman.
  3. Insufficient intake of micro- and macroelements into the woman’s body, in particular calcium.

Symphysiopathy is classified into 3 stages:

  1. The divergence of the pelvic bones is 5–9 mm.
  2. The divergence of the pelvic bones is 10–19 mm.
  3. Divergence of the pelvic bones by 20 mm or more.

At the same time, symphysitis does not always progress to the 2nd or 3rd stage. Quite often, timely measures can stop the stretching and progression of the pathology.

If the pelvic bones diverge during pregnancy beyond the physiological norm, the woman begins to feel discomfort, changes in gait, pain when walking and at rest. This is explained by the beginning inflammatory process in the symphysis, the appearance of edema of fibrocartilaginous tissue. The greater the divergence of the pelvic bones, the stronger pain syndrome in a pregnant woman.

Experts identify risk factors for developing symphysitis during pregnancy:

  1. Genetic predisposition to the development of symphysiopathy. As well as hereditary pathologies of bone, articular or connective tissues, injuries to the pelvic bones.
  2. Decreased collagen synthesis levels.
  3. Multiple pregnancies.
  4. Significant maternal weight gain during pregnancy and/or large fetus.

Moreover, pathological discrepancy of the pelvic bones can occur (or worsen) not only in the 3rd trimester of pregnancy, but also after childbirth.

Signs of development of symphysiopathy

Symptoms of symphysitis begin to appear in the 6–7th month of pregnancy and, if no action is taken, worsen by the 8–9th month. In rare cases, when several unfavorable factors are combined, the pathology makes itself felt already at the beginning of the 2nd trimester of pregnancy.


Symptoms of symphysitis begin to appear in the 6–7th month of pregnancy and, if no action is taken, worsen by the 8–9th month.

At first, aching pain in the pubic area appears only during increased physical activity and goes away after rest. In the later stages of divergence of the pelvic bones, pain begins to bother the pregnant woman around the clock. There are also additional signs symphysitis:

  1. The appearance of swelling in the pubic area.
  2. The appearance of a feeling of squeezing and heaviness in the lower abdomen.
  3. The appearance of signs of an inflammatory process, for example, an increase in local temperature.
  4. The development of a so-called “duck” gait in a pregnant woman, which helps relieve stress on the symphysis and reduce pain.

The intensity of pain and heaviness in the lower abdomen increases when the woman is in an upright position.

If the divergence of the pelvic bones occurred during childbirth, clinical manifestations pathologies occur during the first days after delivery. Moreover, in such a situation, the severity of symptoms may not increase, but be strong initially.

Treatment methods: is surgery necessary?

Treatment of symphysitis, even stages 2–3, does not require surgical intervention. However, if the doctor does not prescribe a cesarean section if the pelvic bones are severely separated, rupture of the symphysis pubis (symphysiolysis) may occur during childbirth. In such a situation, it is most likely impossible to do without surgery.

Therapeutic measures to eliminate symphysitis:

  1. Compliance with bed rest for 1–2 months (or, according to the gynecologist, until childbirth).
  2. Wearing a personal orthopedic corset(bandage).
  3. Taking a doctor's prescription (!) medications– calcium supplements, vitamin-mineral complex, non-steroidal anti-inflammatory drugs or analgesics.
  4. Performing simple preventive physical exercises.


One of the methods for eliminating the symphysis is wearing an individual orthopedic corset (bandage).

Conclusion

Disjunction of the pelvic bones is a pathology that can cause a woman a lot of unpleasant and painful sensations, spoil the pleasure of pregnancy. However, symphysitis is a condition that does not require surgical treatment. To eliminate the problem or stop the progression of the pathology, simple complex therapy is sufficient.