Not a single pregnant woman is immune from symphysitis. This painful and dangerous condition can significantly complicate the last months of bearing a baby. In this material, we will tell you how to recognize and how to treat symphysitis during pregnancy.
What it is?
In both women and men, the pubic bones are connected by a small vertical symphysis. This connection runs right in the center, the bladder is located behind the symphysis, and the external genitals are located below. Normally, this connection is quite mobile, representing a fibro-cartilaginous disc with a slit liquid cavity inside.
The pelvic bones can be held firmly by the ligaments growing into the disc. The strongest of them are the top and bottom. The anterior and posterior ligaments are somewhat weaker. The pubic symphysis (symphysis pubis) provides stability to the pubic bones of the pelvis.
During pregnancy, the load on all anatomical components of the pelvic zone increases tenfold. Ligaments, muscles, bones undergo changes, including "gets" and the symphysis. Nature intended that the pelvic bones, which form a visual ring, should miss the baby's head during childbirth. To make this possible, the symphysis softens and the pubic bones become more mobile. Sometimes during this process inflammation occurs, the pelvic bones begin to diverge. It is this phenomenon that is called symphysitis in medicine.
To one degree or another, new, not always pleasant sensations in the area of the pubic bone visit all pregnant women at a later date. But not every expectant mother is diagnosed with symphysitis by doctors.
Disease is referred to when the discrepancy of the bones reaches certain values and is accompanied by inflammation.
Causes of occurrence
As already mentioned, the softening of the pubic symphysis is a natural process and is necessary for the normal course of labor. Dilation of the pelvis is the preparation of the female body for the upcoming important event - the birth of a new person. The main question is why for some women this process proceeds without features, within the framework of the program laid down by the nature, while for others it turns into a painful and dangerous state.
The true reasons that lead to symphysitis, science and medicine are currently not known for certain. But there are several versions that are still considered as probable prerequisites:
- First, there is a lack of calcium. In pregnant women, this mineral is mainly spent on the structure of the bones of the child, many expectant mothers, especially in the second half of pregnancy, experience a pronounced calcium deficiency.
- The second likely cause is over-production of relaxin. This hormone, as the name suggests, is designed to soften the bones and ligaments of the pelvis before childbirth. It is produced by the placenta, as well as, in some quantities, by the ovaries of the expectant mother. If the hormone for a number of reasons is produced more than necessary, then the joints, ligaments and cartilage soften to a greater extent, which, in combination with the load on the pelvis caused by bearing a baby who has already become big, gives such an unpleasant effect.
In the first half of pregnancy, the fetus is small, it does not exert strong pressure on the pelvic bones. However, the closer to childbirth, the greater its weight. The closer the date of birth, the more the baby is pressed by the head to the exit from the small pelvis, therefore pressure on the pubic articulation rises.
Risk group
A woman can be warned about the likelihood of developing symphysitis in advance. And all because most often the divergence of the pelvic bones with painful inflammation occurs in certain categories of pregnant women.
Long years of observation of expectant mothers allowed doctors to get an idea of the risk group. It included:
- Women with diseases of the musculoskeletal system. This includes both acquired diseases and hereditary pathologies - congenital weakness of bone tissue, increased fragility of bones, collagen deficiency.
- Women who have given birth more than 2 times. The more births in the history, the higher the likelihood of symphysis instability. Especially dangerous are situations in which the period between births is short - no more than three years.
- Women who have suffered pelvic injuries. Any fractures, dislocations, cracks in the pelvic region, if any in the past, increase the chances of developing symphysitis. Often such injuries are inherent in women who were professionally involved in athletics (running).
- Women who have suffered from symphysitis in the past. If during a previous pregnancy a woman developed a similar pathology, the likelihood of recurrence is almost 100%.
- Pregnant women leading a sedentary lifestyle. If the expectant mother does not load herself physically and tries to lie or sit more, avoids walking, does not do gymnastics, then symphysitis in the later stages is very likely.
- Expectant mothers carrying a large or giant fetus. A large child is considered a child whose expected body weight at birth will be more than 4 kilograms. A baby is called a giant, which, according to preliminary estimates, at birth will weigh more than 5 kilograms.
If a woman falls into a risk group, this does not mean that symphysitis will necessarily begin. It is necessary to coincide with risk factors, for example, bearing a large fetus against the background of a lack of calcium or a pelvic injury in the past against the background of increased production of relaxin.
Symptoms and Signs
Symphysitis is manifested by rather characteristic sensations, which are not difficult to determine. It usually starts with a pronounced pain syndrome. The further you go, the stronger the pain. Women complain of pain in the pubic area. It becomes stronger at night, when the woman relaxes, and becomes somewhat dull during the day. With the progression of the disease, the pain syndrome begins to persist in the daytime.
Divergence of the pelvic bones leads to the appearance of pain in the lumbar and sacral regions... A woman may complain of unpleasant painful sensations in the hip joints. Walking becomes difficult. The same "duck" gait appears, in which the woman clearly waddles from side to side when walking, and she herself feels "clicks" in the joints of the pelvis during the step.
Symphysitis can be diagnosed by asking the woman to spread her legs to the sides. With dilution, the pain in the pubic articulation increases.
The most difficult for a woman with symphysitis is climbing the feet of the stairs, bending forward. There is practically no opportunity to raise straight legs up from a supine position. All attempts to do this end in the occurrence of severe acute pain and a feeling of limited movement. Pain can also appear during sex. Sometimes a woman has problems with defecation - it hurts to push, constipation occurs. Most expectant mothers with symphysitis can get out of bed only from a position on their side in several steps, independent lifting from a horizontal position on their back becomes impossible.
At the onset of the inflammatory process in the pubic region, swelling may be visualized. The more neglected the disease, the more swelling. With the separation of the bones, there is a feeling of heaviness in the lower abdomen. Many expectant mothers take him for a threat of premature birth and go to the doctor for this very reason.
The severity becomes more pronounced after being upright for a long time. If you lie down, then it temporarily decreases somewhat.
Most often, the first symptoms of symphysitis appear at term 28-36 weeks and later. In some cases, the symptoms characteristic of this ailment develop before 28 weeks, but this is extremely rare. Also, the first symptoms of symphysitis may appear after childbirth, and then the appearance of the problem will be associated with injury to the pubic articulation during the passage of the baby through the birth canal.
More than 70% of expectant mothers are characterized by discomfort in the pubic area in the last 2-3 months of pregnancy, do not confuse them with symphysitis. True symphysitis differs from physiologically justified aching unpleasant sensations in that there is a limited range of motion, pain becomes intolerable.
Types of disease and forms
Problems with divergence of the pubic bones of the pelvis can be associated with pregnancy and the puerperium. There are several degrees, which are determined by the magnitude of the discrepancy:
- The divergence from 5 to 9 mm allows you to establish a symphysitis of the first degree.
- The discrepancy from 10 to 19 mm is the basis for the establishment of symphysitis of the second degree.
- Discrepancy from 20 mm is the third degree of symphysitis.
Dangers and consequences
Symphysitis is not at all dangerous for a child. To a greater extent, he threatens the health of a woman, because after childbirth she may remain disabled. If the discrepancy is less than 1 centimeter, the forecasts are most favorable, with such symphysitis, natural childbirth is even allowed. Symphysitis of the 1st degree is the easiest, and therefore it is easy to treat.
A discrepancy of more than 1 centimeter, which corresponds to 2 and 3 degrees, does not cause such rosy forecasts of doctors. It all depends on how fast this distance is increasing. Usually a woman is advised to have a cesarean delivery.
Excessive divergence of the symphysis can lead to rupture of the ligaments, and this is considered a severe pathology of the musculoskeletal system. A woman who has experienced a breakup cannot stand, raise her legs, or walk. She could get a disability.
A discrepancy of more than 5 centimeters is considered the most dangerous. In this case, in addition to injury to the pubic articulation, the edges of the bones can injure the bladder, urethra. Hemorrhage occurs in the area of the hip joints. Later, this almost invariably leads to the development of arthritis.
Rupture can occur at the time of delivery if the cartilage disc is excessively depleted. It is for this reason that natural childbirth with a discrepancy of more than a centimeter (11 mm, 12 mm, etc.) is considered undesirable. Caesarean section avoids possible rupture of the pubic articulation.
The nature of the birth affects the likelihood of rupture With a stormy and rapid delivery, the likelihood increases. Also, natural childbirth in a woman with symphysitis, pregnant with twins or triplets is considered risk factors for unwanted consequences. An anatomical feature such as a narrow pelvis is also a factor provoking a rupture of the womb.
Most often, the rupture occurs gradually during childbirth, and you can guess that it happened 2-3 days after the baby is born. The pain will intensify and the ability to move will disappear. Much less often the rupture occurs suddenly, then a woman during childbirth can hear a characteristic sound accompanying damage to the ligaments.
A woman after a break cannot turn over on her side on her own. She has the only position in which she feels some relief - the so-called "Frog pose".
If the bladder is injured, the outflow of urine becomes difficult, edema and symptoms of intoxication appear.
Diagnostics
If a woman develops characteristic symptoms and complaints, she should definitely see a doctor. If you suspect symphysitis, an examination is prescribed. The fact is that the magnitude of the divergence of the pubic articulation is not always directly related to the intensity of pain. With a small discrepancy, a woman may experience a fairly strong pain syndrome, and with a large discrepancy, the pain may be insignificant. That is why it is important to find out exactly what the discrepancy is and what degree of symphysite it corresponds to.
For this, Ultrasound of the pubic articulation... Diagnostics is carried out by an external sensor, it allows you to measure the discrepancy and determine if the expectant mother has signs of inflammation. After the examination, it is possible to choose further tactics of pregnancy management and choose the optimal and safe method of delivery for the woman's health.
Methods such as radiography and MRI can provide significantly more diagnostic information. But pregnant women, for obvious reasons, are not prescribed them. Such diagnostic methods are widely used after childbirth if symptoms of symphysitis do not disappear or there is a suspicion of a joint rupture.
In the process of diagnosis in pregnant women it is important for the doctor to distinguish symphysitis from some other pathologies that are similar in their manifestations. Pubic pain can be caused by problems with the sciatic nerve (sciatica), pain in the spine (lumbago), infections of the genitourinary system, and tuberculous bone lesions.
Treatment
The usual uncomplicated symphysitis does not need special medical treatment. It passes on its own several months after childbirth, less often the clinical symptoms of softening of the symphysis persist for the first year after the birth of the baby. But it is imperative to treat the rupture of the pubic articulation, if it occurs. Without proper and timely therapy, a woman can remain disabled for life. The gap is healed exclusively by surgery and long-term (for several months) fixation. The operation is aimed at reconstructing the affected ligaments.
With symphysitis during pregnancy, therapy is primarily aimed at relieving pain and preventing rupture of the womb ligaments. The treatment regimen may include analgesic anti-inflammatory drugs - antispasmodics, such as "No-shpa", "Baralgin", "Paracetamol". They are allowed to be taken only in doses approved by the doctor and only in those cases when the woman has to spend a long time in an upright position. Uncontrolled and frequent use of pain relievers can cause drug addiction.
Non-steroidal anti-inflammatory drugs in the form of ointments, such as Indomethacin ointment, are often recommended. It is used topically to relieve pain and swelling in the pubic area.
Regardless of the degree of the disease, the pregnant woman is prescribed relative rest. The pubic symphysis should not be subjected to heavy loads. With a mild degree of symphysitis, it may be recommended to reduce the usual loads, with 2 and 3 degrees, bed rest is often prescribed. Expectant mothers with suspected symphysitis or a confirmed ailment are not recommended to walk up and down stairs, long sitting, standing in one position, long walking.
A woman is recommended to take multivitamins, complexes created specifically for expectant mothers with a high calcium content, or calcium supplements in addition to the vitamins she takes. To arbitrarily start taking calcium in any form means to endanger the baby, because an excess of this mineral in the body of the expectant mother can harm the baby, especially in the third trimester of pregnancy. It is generally not recommended to take calcium before childbirth for several weeks.
With an insignificant degree of symphysitis, it is enough to add foods with a high mineral content to the diet - milk, cottage cheese, chicken eggs, spinach, fresh herbs, nuts.
If diagnosed with symphysitis, more careful weight control will be required.Excessive weight gain increases the load on the weakened pubic articulation, the risk of rupture increases proportionally. A woman is recommended a universal diet for pregnant women, the correct drinking regime, as well as fasting days. Starting from 6-7 months of pregnancy, a woman can wear a prenatal bandage corset, it will support the growing belly and reduce the load on the bosom. You can buy a bandage at any pharmacy or orthopedic salon.
After childbirth, you will need another bandage, the wearing of which is designed to reduce the distance between the pelvic bones. It can also be purchased from an orthopedic salon. In some cases, postpartum women are advised to walk using a cane or crutches.
Far from the last place in the removal of painful and painful symptoms of symphysitis is given to physiotherapeutic effects, for example, magnetotherapy. But a gynecologist and an orthopedist will give a referral to such procedures only when the expectant mother has no threat of termination of pregnancy and other contraindications.
A woman with identified symphysitis should not sleep on a very hard surface, during sleep it is imperative to put a small pillow or roller under her feet, and a small blanket or blanket rolled up in a "tube" will do.
Similarly, the pelvic area is raised - a pillow is also placed under the buttocks.
A pregnant woman is prescribed a set of special gymnastic exercises that are effective for symphysitis. They help reduce pain:
- Cat pose... A woman on a flat surface takes a knee-elbow position. Then she flexes her back and shoulders, straightens them and arches them. At the same time, the chin drops and the abdominal muscles are slightly tense. This exercise should be repeated 10 to 15 times.
- Kegel gymnastics. These exercises are aimed at training the muscles of the pelvic floor. The woman needs to lie on her back and tighten her pelvic muscles in the same way as when trying to control urination. Tension should be maintained for a few seconds, then the muscles relax. The exercise is done 15 to 20 times per gymnastics session.
- Bridge Pose... Lying on her back, a woman should bend her knees, raise her pelvis and hold it in this position for a few seconds, then gently and gently lower herself. The exercise is repeated 10-15 times per lesson.
Such gymnastics should be done only with the permission of a doctor and only if the exercises do not cause an increase in pain.
If the pain becomes stronger, you should refuse to perform these exercises; in no case should you force yourself to do gymnastics by force.
Prevention
There are no specific measures for the prevention of symphysitis during pregnancy. Even for those expectant mothers who fulfill all the doctor's prescriptions, visit their obstetrician regularly and take all the tests necessary in an "interesting position", there is a risk of developing the disease. Oddly enough, it will help to reduce the likely risks correct planning of pregnancy. If a woman has had diseases of the musculoskeletal system, pelvic trauma, metabolic problems, special attention should be paid to planning pregnancy.
Do not neglect visiting a doctor while carrying a child. It is only at first glance that such visits are of no use - they weighed, measured their stomach and released. In fact, at each appointment, the doctor controls the weight, measures the size of the pelvis, the incipient symphysitis will not escape the professional eye.
From the very first weeks of pregnancy, a woman should make sure that her diet is correct - low in carbohydrates, with sufficient calcium, magnesium and other substances and vitamins necessary for healthy bones and joints. You can not overeat and "feed" the baby to large and gigantic sizes.
Do not limit your physical activity if problems with the pubic articulation have not yet appeared. A woman needs to do special gymnastics for expectant mothers, you can do yoga, swimming, take half-hour walks in the fresh air. Moderate physical activity will help keep all muscles and ligaments, including the pubic ones, in good shape.
If a woman's work involves sitting for a long time in one place, you need to arrange small warm-ups every hour. But heavy loads should be abandoned, as well as climbing stairs on foot, especially in the second and third trimesters of pregnancy.
If symphysitis does happen and the doctor recommends a cesarean section, you should not insist on natural childbirth - the risks of rupture are too great.
Reviews
Young mothers often leave reviews about the transferred symphysitis. Most describe their condition as associated with severe pain, which interfered with sleeping, walking, dressing on their own. However, there are also cases when the woman did not have any complaints until the very birth, and the symphysis ruptured during childbirth.
According to reviews, doctors most often prescribe calcium preparations and "Indomethacin" in tablets and ointments. After childbirth, painful sensations for most mothers who left their reviews disappeared after about 1-2 months.
See the following video for reviews of real people about symphysitis during pregnancy.
