During pregnancy, serious changes occur in the female body. This also applies to the musculoskeletal system. The pubic joint can become inflamed due to a lack of calcium, excessive physical exertion and changes in hormonal levels. Which in turn can lead to pelvic pain associated with discrepancy and high bone mobility. This pathology is called symphysitis - we will consider the symptoms and treatment during pregnancy in this article.
What it is
All diseases ending in "-it", according to medical classification, are inflammatory in nature. But in this case, symphysitis is understood not only as inflammation, but also any non-standard changes in the pubic joint: swelling, divergence, softening. During the period of gestation, this area becomes more mobile, it is a natural process of preparing the body for childbirth. But in some cases, pathologies can occur, which are called symphysitis.
ICD-10 code for pregnancy symphysitis
ICD-10 is an international classification of diseases where all diseases are collected. Depending on the clinical picture, they are divided into 21 classes. In this document, this pathology is assigned to the class “Pregnancy, childbirth and the postpartum period” (000-099), block 020-029, group 026.7: subluxation of the pubic joint during pregnancy, childbirth and the postpartum period.
Signs
This disease, like most ailments, has its own distinctive symptoms. Symphysitis during pregnancy can be detected by paying attention to them already in the early stages:
- The main symptom is pain in the pubis that occurs when moving or pressing. Here it can be noted that during the daytime pain decreases, and at night they increase.
- Pubic tissue often swells.
- During symphysitis during pregnancy, a woman can feel a crack and click when pressing on a painful area.
- A pregnant woman may experience discomfort even when lying down or when changing her body position.
- Raising the leg causes pain that goes into the pelvic bones, lumbar region and tailbone.
- Difficulty of movement, especially when climbing stairs.
- A common symptom of symphysitis during pregnancy is soreness in the knee area and a duck walk.
It hurts to walk
Already in the first trimester, at the initial stage of the disease, women can feel pain in the lower abdomen, which is especially aggravated by movement. This may be the first sign of symphysitis during pregnancy. At this time, the pain is not particularly intense, it occurs rarely and does not bring serious discomfort. This phenomenon may be considered normal, as it is associated with natural changes in the body during the gestation of the baby. But if the pain does not go away in the second and third trimester, you should seek help from a doctor.
Causes
Currently, the causes of symphysitis during pregnancy are not fully understood. But doctors distinguish two main factors contributing to the development of pathology:
- lack of calcium in the body of the expectant mother - during pregnancy, a large amount of this substance is spent on the formation of the bones of the baby;
- increased release of relaxin - a hormone that is responsible for the divergence and mobility of the pubic joint.
Symphysitis may be promoted by:
- Re-birth. Their number is directly proportional to the likelihood of a disease.
- Low activity during pregnancy leads to the appearance of symphysitis in the later stages.
- Large fruit.
- Pelvic injuries: fractures, fissures, or dislocations.
- Ehlers-Danlos Syndrome. This is a disease in which, due to the pathology of collagen, there is a high mobility of the joints, fragile bones and a tendency to stretch.
- Relapse. If a woman suffered symphysitis in a previous pregnancy, then the probability of a recurrence of the disease is almost 100%.
Degrees
Depending on the degree of divergence of the pubic bone, doctors distinguish three stages of symphysitis during pregnancy. In the second and third, a cesarean section is performed. Ordinary births are possible only with the first degree of the disease and subject to a small weight of the fetus. At the first stage of the disease, the difference between the pubic bones is from 5 to 9 millimeters. At the same time, a woman can feel symptoms such as pulling, pain in the pubic area when walking, pain in the lower abdomen when lifting, there is also a slight swelling.
In the second degree of symphysitis during pregnancy, the discrepancy is from 15 to 20 millimeters. Symptom may be persistent pain in the pubic joint. At rest, they subside, with a load, on the contrary, increase, there is severe swelling in the pubic area, periodically there is a heaviness in the lower abdomen.
With the third degree, the discrepancy of the pubic joint is more than 20 millimeters. This stage is considered the most difficult. Symptoms can be called: extensive swelling, severe and aching pain, radiating to the legs, clicks and crunching when pressed on the painful area, constant heaviness in the lower abdomen. It is impossible to independently determine the degree of symphysitis, this can only be done in a medical institution with the help of an examination.
What is the danger
Symphysitis is not a reason for panic. When making such a diagnosis in the early stages, the probability of successful treatment and normal bearing of the fetus is more than 90%. But still, expectant mothers should know about the dangers associated with this disease. In severe cases of the disease, there may be a risk of rupture of the pubic joint. In this case, only the operation can help. After all, a gap is a serious injury with a long recovery period.
Diagnostics
To diagnose symphysitis, a comprehensive examination of the body of the future mother is carried out. This is necessary to accurately determine the causes and stage of the disease. The leading doctor analyzes the overall clinical picture: he finds out when the pain appeared, whether the gait has changed, what complaints the pregnant woman has. It is also important what kind of life a woman in labor leads, her injuries and the operations that have taken place. An ultrasound scan of the pubic area is performed to identify the degree of symphysitis. At later stages of pregnancy, a consultation with an orthopedist and a physiotherapist is prescribed.
Ultrasonography
Ultrasound for this pathology is the main diagnostic method. This is how you can make an accurate diagnosis, determine the degree of complexity and not harm the health of the future mother and her baby. Based on such a study, you can choose the right treatment and draw up an action plan.
Therapy
A treatment plan for symphysitis during pregnancy is made after the diagnosis. Basically, this is the intake of vitamins and preparations containing calcium. Medicines designed to relieve inflammation are prohibited during the entire period of pregnancy. Therefore, therapeutic measures are carried out only in order to reduce the discomfort of the woman in labor. It should be noted that symphysitis does not affect the development of the baby.
Exercise and weight bearing are also limited. In the last months of gestation, a special bandage is appointed that supports the stomach to reduce pain during symphysitis during pregnancy. In addition, special exercises for strengthening muscles and massage of the lumbar spine have proven themselves well. After giving birth, the pain disappears by itself.
Bandage
One of the main preventive measures is wearing a bandage made of a special dense fabric. Wear a bandage with symphysitis during pregnancy begin in the third trimester, and for prevention - in the second. It is selected individually for each woman. It should not tighten the stomach and cause uncomfortable sensations. Put on a bandage while lying on your back, slowly pulling it on your stomach. It should be tight enough and perform a supporting function well. In this case, a hand should pass between the body and the bandage. If a woman is resting, it is important to remove it so as not to get an excessive load on the body.
Recommendations
There is a list of recommendations to help reduce pain in symphysitis during pregnancy:
- Do not sit with your legs crossed;
- do not stay in one position for a long time, often change your posture;
- when standing, try to keep the weight evenly distributed on both legs;
- Do not sit or lie on too hard surfaces;
- if possible, buy an orthopedic mattress during pregnancy;
- watch your weight;
- walk more often, the sun's rays contribute to the production of vitamin D, which in turn helps the absorption of calcium;
- eat more calcium foods;
- wear a bandage;
- Do not neglect therapeutic exercises;
- climb the stairs less;
- take warm baths, they relieve pain in the area of the hip joints;
- when walking, move smoothly, without sudden movements, try to walk in small steps;
- at night, according to reviews, with symphysitis during pregnancy, women are advised to put a pillow between their legs, which will make sleep more comfortable;
- when walking for a long time, often stop breathing;
- in a prone position raise your legs;
- while resting, put a roll of towel under the buttocks, this will raise the pelvis and reduce pain.
Exercises
There is a special gymnastics that helps reduce pain. It can be performed only with the permission of the attending physician and only if it does not cause discomfort:
- "Kitty". This exercise is performed in the knee-elbow position on a flat, solid surface. You need to alternately bend and arch the back and shoulders. Repeat 10 times.
- "Bridge". In the supine position, you need to bend your knees (the feet remain on the floor), raise the pelvis, hold this pose for several seconds, then slowly lower the pelvis to the floor. Repeat 10 times.
- "Intimate gymnastics." Lying on her back, a woman strains her hip muscles, as if she wants to keep urination. Repeat this exercise 20 times.
Prevention
Due to the fact that the causes of this disease are not fully understood, there are no clear recommendations for the prevention of symphysitis during pregnancy. But despite this, there are good tips that can still help avoid the disease:
- Pregnancy planning. This will provide an opportunity to identify risk factors in advance.
- Early registration for pregnancy will help to learn about the disease in the first stage and prevent its development.
- Taking vitamins during pregnancy.
- A balanced diet that includes foods high in calcium. It is also worth noting that the amount of carbohydrates in food must be reduced.
- Wear a bandage for prevention can start from the second trimester. This will significantly reduce the load on the lumbar and hip.
- Therapeutic exercises for pregnant women or yoga perfectly strengthen and stretch the muscles, which leads to an easier process of childbirth.
How to give birth
With this diagnosis, the attending physician, on the basis of studies, decides how the birth process will take place. If the discrepancy in symphysitis does not exceed one centimeter, natural childbirth is allowed. In this case, the pregnant pelvis should be wide enough, and the fetus is small. Presentation of the fetus should be the head.
In other cases, a cesarean section is performed. The choice of method occurs no earlier than 37 weeks on the basis of ultrasound with symphysitis during pregnancy. In most cases, a couple of months after birth, the woman’s body is restored, and the pain goes away by itself. Symphysitis should be treated as soon as possible. The disease should not be brought to a dangerous stage, since not only the woman’s future gait, but also the ability to endure another pregnancy depends on the time of the treatment.