SPD in pregnancy
Symphysis Pubis Dysfunction (SPD), or pregnancy-related pelvic girdle pain (PPGP) is very common, affecting up to one in five women in pregnancy. It causes many women a constant niggling pain but can be so severe it leaves some stranded on crutches until the birth. Fortunately, there is lots of help available and plenty you can do to ease the pain.
One of the causes of pregnancy back pain, SPD can also feel like a shooting pain in the legs or a teeth-on-edge grinding feeling in your undercarriage. Just what you need when you have four boxes of flatpack nursery furniture to put together.
What is SPD?
SPD is a problem with your pelvis. The 'symphysis' is where your pelvic bones, held together by ligaments, join at the front of your pelvis. There are other 'fixed' joints at each side of the bottom of the spine (sacroiliac), forming the heart-shaped pelvic bones.
You'll also hear some medical professionals refer to it as 'pregnancy-related pelvic girdle pain' (PPGP), though strictly speaking SPD is just one type of pelvic girdle pain. It's a condition crying out for a snappy name, that's for sure.
What causes SPD?
During pregnancy, a hormone called 'relaxin' (fat chance of that) loosens the pelvic ligaments to allow the pelvis to open slightly when you give birth. Obviously this is a positive thing, but it can mean the ligaments in your pelvis loosen too much and too early and so your normally stable pelvis is suddenly a bit more flexible than is ideal. Your joints also get stiff and swollen during pregnancy.
Add to that the increasing weight of your growing baby and it's very easy for the area to become unstable, meaning the symphysis joint can separate, leaving you with the mild to severe pain. It's very common but you are more likely to suffer if you:
- Had SPD in a previous pregnancy
- Have an existing pelvic injury (such as from an accident)
- Were overweight before pregnancy
- Suffer from hypermobility
- Have a very physical job
What does the pain of SPD feel like?
You can feel the pain in your pubic area, groin, the insides of your thighs and hips and one or both buttocks. Some women describe a clicking feeling or sound, others say it feels like their pelvic bones are grinding together. It can often feel like a sharp pain, too, and will get worse when you're doing anything that means your legs being wider apart (No, not that. That'll be the last thing on your mind, trust us.)
The pain makes walking, turning in bed, climbing stairs, getting dressed and getting in and out of a car feel pretty horrific – so pretty much all the things you need to get done on a daily basis.
Tips to ease the pain of SPD/PGPA physio will be able to advise exercises and positions that will help, as well as the ones to really, really avoid. The only way to ease the pain is to do absolutely nothing and rest – not easy though. Don't push a heavy shopping trolley either – that's a killer!
- Stay active with pregnancy-friendly exercise if you can, to avoid the risk of the area seizing up completely
- Keep your legs together as much as possible, especially when getting out of bed, and try not to stand on one leg, for example when putting on trousers or socks
- Take stairs one at a time and don't overreach or stretch – if you can't get up stairs at all try going up backwards on your bottom
- It sounds contrary when you've been told to stay active, but also get plenty of rest. Get someone else to do the housework – particularly ironing and vacuuming, which can be particularly painful – and ask for help with older children
- You can try paracetamol, but most women say it doesn't help much and a warm wheat pack will bring more relief
- Don't lift anything heavy or hold a heavy bag in one hand – get a backpack
- Try to spend some time each day either sitting on a birth ball on on your hands and knees, as this will take some of the weight of the baby off your pelvis
- Don't bend or stretch when lifting
- Avoid pushing heavy things, particularly shopping trolleys
- Try doing jobs you might normally do standing (like prepping food or ironing) sitting down
- If you feel up to having sex, try it kneeling on all fours so you aren't opening your legs too widely
- At bedtime, use a pregnancy support pillow or just an ordinary pillow between your knees to keep your pelvis in line. SPD can often be worse at night, which only worsens the effect of general pregnancy tiredness.
When does SPD usually start?
It can start at any point but it's usually in the second trimester. The bad news is that it doesn't tend to get completely better until after your baby is born, but there are lots of things that can help lessen the pain and manage it better.
Can SPD be treated?I went to a physio about other back problems, described the symptoms and was told it's SPD. They gave me a brilliant corset, and I now use crutches. Also – sleep with a pillow between your knees.
Pelvic pain won't be completely resolved until after the baby is born and hormone levels go back to normal (and that can take some time, too), but there is lots of help available to enable you to manage it. Ask your GP or your midwife at your next antenatal appointment to refer you on.
It's important you get advice from an obstetric physiotherapist because, unlike many other pregnancy-related conditions, it doesn't necessarily get better as soon as you've given birth, so you may continue to need treatment for a while after. Your GP will be able to advise on which painkillers you can safely take while pregnant.
Treatments might include:
- Physiotherapy to restore movement to the area
- Advice on exercises you can (and shouldn't) do to strengthen your pelvic floor and other muscles around the area and protect the pelvis
- Giving you a pelvic support belt or crutches if needed
- Lifestyle changes your physio can advise you on
- Osteopathy or acupuncture
The charity Pelvic Partnership will be able to give you more information on treatment and other advice.
Will having SPD affect my labour and birth?
If managed well, no, it shouldn't cause you any problems and there isn't any need to have a caesarean section if you have SPD. Most women with it have a straightforward vaginal birth. However, there's no denying labour can be a daunting prospect if, during pregnancy, you're so immobilised you're on crutches or in a wheelchair. Here are a few things to consider while you're packing your hospital bag.
It's a good idea to write in your birth plan that you have SPD and make sure your birth partner tells everyone, too, so that the midwives and doctors are aware.
You don't 'need' to have an epidural but SPD is no reason not to and obviously it will numb the whole area, so lots of women choose to. One note of caution: if you are having an epidural, make sure that the width you can open your knees painlessly is measured before the epidural is inserted. This will avoid any damage when your knees are apart for examinations or for delivery, or if you need to be in stirrups if a ventouse or forceps is necessary.
Positions for labourYou may be a little limited for labouring positions when the time comes, but if your pregnancy is problem free other than the SPD, then a pool would help.
Avoid squatting. Standing positions or kneeling upright with support are best if you can manage it. Don't let anyone put your legs in stirrups without first measuring how far you can open your legs painlessly, or hold onto your legs and push back during the second stage (the bit where the baby actually exits). If it helps with the pain of labour, wiggle your hips, but don't 'over-sway'.
Water is great at giving you a feeling of weightlessness, so if a water birth is an option for you you might want to use the pool. Just take care when getting in.
Will SPD go away after pregnancy?
Yes, for most women it slowly eases off in the days and weeks after birth but don't expect it to vanish overnight. In some cases it can linger a while longer and you may need further physiotherapy in the early days post-birth to help see it on its way. In a very small number of cases it doesn't get better and further treatment is needed, but this is very rare.
Interestingly, you may find that once things return to normal, you still get twinges at the time of the month your period is due. This is probably because of hormonal changes softening ligaments again slightly. Take it easy if this is the case but it's not something to worry about.