Bearing a child is associated with enormous difficulties that have to endure the female body. Most obvious changes do not have to seek an explanation, but sometimes some changes in the body of the expectant mother are disturbing. One of these exciting factors that needs special attention is the pubic joint. Where is the pubic symphysis, what are the causes of the possible occurrence of pain in its area and how to deal with it, every pregnant woman should know.
Pubic symphysis
The pubic joint, also known as the pubic symphysis, consists of two pubic bones of the hip joint connected by a fibro-cartilaginous tissue in the midline. It is located in front of the bladder above the external genitalia and is attached to the pelvic bones by elastic ligaments.
The body of a woman in the prenatal period is subject to dramatic changes, reflected in her hormonal balance. The effects of hormones such as progesterone and relaxin soften all ligaments. The pubic articulation, where the cartilage is located, also becomes less static. Often this leads to unnatural painful mobility of the pubic symphysis.
During pregnancy, the goal of exposure to these hormones is to increase the flexibility of joints and bone structure, which contributes to a facilitated flow of labor. Meanwhile, pubic symphysis dysfunction is rare in patients and requires immediate action.
Pubic mismatch
The appearance of space between the pubic bones is called the divergence. Such a diagnosis should be ascertained on the basis of complaints described by the pregnant woman. Among the symptoms are often manifested:
- pains in the pubic region, which can respond with unpleasant aching sensations below, “pull” the leg and groin;
- sudden pain during stressful movements (turns from side to side, climbing stairs, etc.);
- a kind of cracking of joints is possible during hip movement;
- Painful pressure on the pubic bone.
To obtain more accurate diagnostic data, an ultrasound of the pubic joint and MRI should be performed.
The latter will help determine the degree and width of the discrepancy, which can reach one of three levels:
- 1 - the width is 5-9 mm;
- 2 - the width is 10-20 mm;
- 3 - width over 20 mm.
Causes of pubic symphysis discrepancy
The pubic articulation during pregnancy is at risk due to impaired metabolism and a lack of vitamin D. For example, hormones produced by the parathyroid gland are involved in the regulation of calcium-phosphorus metabolism. In the case of a lack of calcium intake required for the full development and growth of the fetus, the body begins to draw the necessary substance from the mother’s reserves. The main source of calcium for the unborn baby will be mother's teeth and bones. Also, gastrointestinal diseases and diabetes can cause calcium deficiency. In turn, vitamin D significantly affects the body's absorption of calcium.
The divergence of the pubic joint begins to develop long before the birth of the baby. However, the effects of hormones and the weight of the fetus contribute to the manifestation of the above symptoms only in the II or III trimester. Often, the signs of pathology that have arisen are not given due attention and are attributed to osteochondrosis, radiculitis, and the threat of abortion.
Timely diagnosis is extremely important. It will help to take the necessary treatment measures in time, prevent negative consequences by natural delivery or resort to a cesarean section.
Discrepancy treatment
Typically, when the divergence of the pubic bone does not require any intervention. After a successful delivery, the flexibility, elasticity and integrity of the pubic symphysis should be restored naturally.
Recommendations from obstetrician-gynecologists to reduce the excessive load on the joints and ligaments include:
- wearing a bandage;
- performing gymnastic exercises;
- the appointment of necessary medications (magnesium, calcium, vitamins, especially group B).
A woman in labor should inform obstetricians about the presence of this pathology before starting labor.
A discrepancy that has become more severe is fraught with rupture of the pubic joint. To avoid further spreading of the pubic bones, doctors also strongly recommend limiting physical activity, preferring bed rest.
Rupture of the pubic symphysis
If the divergence of the pubic bones is observed mainly during gestation, then rupture is possible during the birth process.
Among the varieties of breaks, violent and spontaneous are distinguished. The latter occur during spontaneous labor. The cause of violent ruptures is often called the use of additional efforts when removing the fetus, manual separation of the placenta. In addition, the introduction of the arm into the uterine cavity in most cases is a decisive factor in the likely rupture of the pubic joint.
Treatment of pubic symphysis tears
If a gap occurs, the patient needs strict bed rest. The hip area is subject to tight bandaging. It is optimal for this purpose to use a linen wide bandage. On the back of the bed should be installed sled and to attach blocks at the level of the pelvis. The ends of the bandage must be tied on wooden planks, which are tied with cords. These cords pass through the blocks, and at their ends it is necessary to suspend the load, starting from a couple of kilograms and gradually increasing to 10 kg.
Due to the early recognition of the gap restoration of the pubic joint occurs in 2-3 weeks. In case of delayed treatment, the bandage is applied for at least 1 month. Often, bandages from a cloth resembling a hammock are used for this purpose. Its edges are attached to the longitudinal slots. The pelvic bones begin to converge due to the patient’s own weight. The terms of recovery when staying in a hammock are the same.
Musculoskeletal functions of the pelvis are fully resumed with a therapeutic approach carried out without delay. With a more retarded definition of the gap, the inflammatory process of cartilage tissue contributes to difficult adhesion and prolonged rehabilitation.