Symphysitis during pregnancy, symptoms and treatments. Symphysitis in pregnancy: treatment and prevention are necessary. Symphysitis treatment during pregnancy

Symphysitis is considered a pathology of the pubic articulation, the development of which is based on an inflammatory response in response to the influence of a damaging factor. Physiologically, the connection between the pubic bones of the pelvis is a fixed structure, however, due to various conditions, it is possible to increase its mobility.

This process is caused by a change in the consistency of the ligaments, acquiring a softer shape, as well as the swelling of this area. As a result, the pubic bones gradually move away from each other, and their articulation becomes more mobile.

Most often, such changes are observed during pregnancy or after childbirth. In the case of a slight discrepancy of the bones, it is possible to independently restore the anatomical location. However, sometimes the distance between the bones exceeds 1 centimeter, which requires complex treatment.

During pregnancy, symphysitis can occur from the second half of the term. This is due to the rapid weight gain of the fetus and an increase in amniotic fluid. As a result, a force is constantly exerted on the pubic joint, which contributes to the divergence of the pubic bones.

If symphysitis is observed after childbirth, then this is most likely a consequence of trauma to the joint during labor as the fetus passes through the birth canal.

Symphysitis reasons

It is rather difficult to identify the exact cause of the development of pathology, since several factors can simultaneously affect the occurrence of symphysitis. So, the causes of symphysitis may lie in the excessive secretion of the hormone relaxin during pregnancy. As a result, the ligaments become softer and lose the ability to tightly hold the bones at the desired distance.

A similar process occurs due to changes in hormonal levels and an imbalance of its components. Also, the development of symphysitis can be facilitated by genetic factors that are hereditarily transmitted to a woman.

Causes of symphysitis such as insufficient levels of calcium and other trace elements in the body of a pregnant woman can provoke the discrepancy of the pubic bones.

A high likelihood of developing symphysitis is observed in pregnant women with pathology of bones and joints. You should also not forget about the course of pregnancy, since severe toxicosis, rapid weight gain, excessive exercise and improper nutritional intake can lead to an increase in the distance between the pubic bones and excessive mobility of the pubic junction.

Pubic symphysitis

The hormonal system is one of the main regulating factors for the functioning of the body. During pregnancy, it is rearranged, and the ratio of hormones changes. These processes are necessary in order to provide all the necessary conditions for the growth and development of the fetus.

In the process of hormonal changes, the predominance of the production of certain active substances is possible. So, with excessive synthesis of the hormone relaxin, pubic symphysitis is observed.

Its development is due to the softening of the ligamentous apparatus, due to which the pubic pelvic bones are at a certain distance from each other. So, as the tone decreases, there is a divergence of the pubic articulation and an increase in its mobility.

Pubic symphysitis is also possible in diseases of the bones and joints, when a woman has a predisposition to the development of symphysitis, especially if she has insufficient calcium levels in the body.

Normally, the distance between the pubic bones increases slightly. This is necessary to ensure passage for the fetus through the birth canal. In addition, the method of delivery depends on the degree of divergence of the pubic articulation, since natural childbirth with a large distance between the bones can lead to such complications as ligament rupture.

Symphysitis symptoms

The beginning of softening of the ligaments between the pubic bones can be observed already from the 6-7th months, since it is during this period that clinical signs of pathology appear. Symphysitis symptoms, under certain unfavorable circumstances, may disturb from the 4th to 5th months.

At the initial stage, the pregnant woman feels aching periodic pain in the perineum and pubis. They bother with vigorous walking or climbing stairs. Further, the pain syndrome increases due to the fact that the mobility between the pubic bones increases.

The pain becomes permanent and is observed not only with physical activity, but at rest or a change in body position. In addition, there is discomfort in the area of \u200b\u200bthe pubic articulation. In the future, the pregnant woman acquires a "duck" gait. It helps her to use less pubic junction when walking, thereby reducing pain impulses.

Symphysitis symptoms become more pronounced in the last months of pregnancy, when the force acting on the pubic bones is at its maximum. Pain can spread to the hip, lumbar, groin, and gluteal regions.

Symphysitis of pregnant women

The process of bearing a fetus is a serious burden on a woman's body. During this period, a restructuring of the hormonal system is observed, as a result of which an exacerbation of the existing concomitant pathology of the endocrine system is possible.

In addition, the body of a pregnant woman is exposed to stress from the fetus, since an additional circle of blood circulation appears, as the fetus grows, the uterus gradually rises and in the last stages it reaches the diaphragm, as a result of which it becomes more difficult for a woman to breathe (the respiratory volume of the lungs decreases).

The enlarged uterus also prevents the normal outflow of venous blood from the lower extremities by affecting the blood vessels. In general, the body is undergoing major changes and you should not be surprised if a slight malfunction is possible somewhere.

So, symphysitis of pregnant women is a fairly common pathology, the development of which is based on the relaxation of the ligamentous apparatus that connects the pubic pelvic bones. The diagnosis is made using symptoms and the results of additional instrumental studies.

Postpartum symphysitis

During pregnancy, many factors affect the ligamentous apparatus between the pubic bones of the pelvis, as a result of which it loses its tone and the ability to keep them at a certain distance.

In the case of a discrepancy of the bones no more than 1 centimeter, you can carry out the delivery through the natural way. It sometimes happens that the distance between the pubic bones increases after childbirth.

Postpartum symphysitis occurs as a result of the influence of factors from both the fetus and the pregnant woman. Excessive stretching of the ligaments is facilitated by a large fetus, a narrow pelvis of a woman, severe toxicosis, previous pathology of joints and bones, as well as many other factors.

If the discrepancy has occurred by several centimeters, then with the help of special exercises and a bandage, you can soon get rid of the symptoms of symphysitis or even himself.

Postpartum symphysitis, caused by a significant distance between the pubic bones, requires complex treatment, which includes drug therapy, physiotherapy, wearing a bandage and exercise.

Complications of symphysitis

The divergence of the pubic bones can have varying degrees, the most serious complications of symphysitis are observed when the distance between the bones is exceeded by more than 1 centimeter. Starting from the first stage, the appearance of a pain syndrome is noted, which periodically worries and has an aching character.

At this stage, the pregnant woman can fight the pain with special exercise and pain relievers. However, as the process progresses and the distance between the pubic bones increases, the pain syndrome becomes constant, regardless of the woman's activity.

Since the pain is observed even at rest, the psychoemotional state is disturbed in the pregnant woman, she becomes irritable and whiny. In addition, the nervous system undergoes the influence of hormonal levels, which change significantly during pregnancy.

Such complications of symphysitis, such as excessive divergence of the pubic bones up to rupture, are severe consequences of ligamentous pathology. As a result, the symphysis pubis loses the connection between its structures, which leads to the inability to walk, stand, or raise the legs.

Symphysitis diagnostics

The process of making a diagnosis includes a thorough questioning of a woman about her complaints, the duration of the disease, as well as identifying the provoking factors that caused the development of symphysitis.

Diagnosis of symphysitis consists of additional instrumental research methods that are used depending on the position of the woman. That is, if a woman is pregnant, then some studies are not allowed, for example, an X-ray method, computed or magnetic resonance imaging. In this case, she is recommended exclusively to carry out ultrasound diagnostics.

In the case of the development of pathology after childbirth, then the diagnosis of symphysitis can use all the methods that are necessary for the diagnosis. With their help, not only the divergence of the bones of the pubic junction is determined, but also the distance between them is estimated.

As a result, after conducting research, further therapeutic tactics are determined. Based on the ultrasound diagnosis of the pregnant woman, the method of delivery is determined, based on the degree of divergence of the pubic bones.

Ultrasound for symphysitis

During pregnancy, it is necessary to exclude all factors that may have a negative effect on the fetus. So, it is allowed to use exclusively ultrasound diagnostics for various purposes (for monitoring the condition of the fetus and amniotic fluid, as well as determining pathology on the part of a pregnant woman).

Ultrasound for symphysitis is the only method that is allowed to be used without harming either the fetus or the future mother. This method is used to determine the degree of divergence of the pubic bones and measure the distance between them.

Thus, with the help of ultrasound with symphysitis, it is possible to identify the first degree of discrepancy, which is characterized by the discrepancy of the pubic bones of no more than 5-9 millimeters. In the second stage, there is a distance from 1 centimeter, and in the third - more than 2 centimeters.

With symphysitis of the third degree, a woman cannot walk, sit and raise her legs, since all these actions cause severe pain. Based on the data obtained after the ultrasound examination, the further tactics of the woman's management, as well as the treatment directions, are determined.

Symphysitis treatment

Depending on the degree of divergence of the pubic bones and the clinical manifestations of the pathology, the treatment of symphysitis may include various methods of assistance.

A prerequisite for therapy is the implementation of specially designed physical exercises that reduce the intensity of pain syndrome, strengthen the gluteal, perineal, femoral and lumbar muscles. Thanks to them, the pelvic structures restore their physiological position.

Symphysitis treatment implies the implementation of some recommendations. Among them, it is necessary to highlight: a decrease in physical activity, in particular, climbing stairs and brisk walking, do not sit in one position for a long time (more than 1 hour), do not place one leg on top of the other in a sitting position, and evenly place the load while standing on both legs.

In addition, you need to monitor your diet and eat more foods containing calcium - dairy products. Also, calcium can be taken in tablet form. It is necessary to control your weight, since excess weight predisposes to the appearance of severe pain syndrome.

Among medications, anti-inflammatory drugs and complexes of vitamins and microelements should be noted.

Bandage for symphysitis

Therapeutic tactics are determined in each case individually, taking into account the degree of divergence of the pubic pelvic bones and the severity of the clinical manifestations of symphysitis. Despite the distance between the bones of the pubic articulation, there are some therapeutic methods that must be used.

A special set of physical exercises and a bandage are the essential components of the treatment complex. The bandage for symphysitis is used to maintain the pelvic structures in a physiological position and prevent further divergence of the pubic pelvic bones.

The bandage for symphysitis is a bandage made of dense material that is able to hold the pelvic bones in a certain position.

However, there are some peculiarities. So, the bandage must be selected for each pregnant or postpartum woman individually, during which she needs to try it on and determine how comfortable it is.

Firstly, the bandage should be put on in a supine position, while fastening rather tightly, leaving room for the palm to enter. Secondly, when lifting, it is necessary to assess how tightly it fits and supports the pelvic structures.

And, finally, thirdly, the bandage should not be used around the clock, but only if you have to stand or walk for a long time. At night, the bandage must be removed to avoid excessive compression of the internal organs.

Exercises for symphysitis

Excessive physical activity is strictly prohibited, as it contributes to an even greater divergence of the pubic pelvic bones and increased pain.

On the other hand, specially selected exercises for symphysitis can not only reduce the severity of pain, but also strengthen the ligaments and increase the tone of the muscles of the perineum, buttocks, thighs and lower back.

Exercises for symphysitis must be performed several times a day, especially with severe pain syndrome. The complex includes several exercises that can help in the fight against symphysitis.

First, you need to take a supine position and place your feet as close to the buttocks as possible. Then you should slowly spread your knees to the sides, hold them in the maximum permissible position and close them again. You can repeat it from 5 to 10 times, gradually increasing the number of exercises.

Next, you should set your feet slightly away from the buttocks so that the lower leg forms a right angle with the floor, and raise the pelvis until a straight line with the body is obtained. However, you need to control the lifting height to avoid discomfort. Repeat up to 6-10 times.

The third exercise is known to all as "kitty". It involves performing on your knees and resting on the palm of your hand, arching the back upward, while lowering the neck and head. In this case, the muscles of the press should be tense. So you should stay for 5 seconds and repeat 3 times.

Symphysitis treatment with folk remedies

The pathology of the divergence of the pubic pelvic bones is based on the influence of pathogenic factors that contribute to an increase in the distance between the bone structures.

To combat symphysitis, they mainly use not medications, especially at the first stage, but folk remedies. Treatment of symphysitis with folk remedies includes performing a set of specially selected physical exercises, adhering to a proper diet, and using a bandage.

The effectiveness of these methods depends directly on the woman and the seriousness of the approach to treatment. So, by regularly performing exercises, she will soon strengthen the muscles of the buttocks, perineum, lower back and thighs, which is necessary to restore the physiological location of the pelvic structures.

In addition, due to daily exercises, the frequency of which reaches 3-4 times a day, they help to reduce the intensity of the pain syndrome.

Also, the treatment of symphysitis with folk remedies involves the use of food products that contain a high percentage of calcium. As for the bandage, it is an integral part of treatment and is necessary to maintain the pubic pelvic bones in a normal position, gradually bringing them closer to each other.

Prevention of symphysitis

Identification of the main influencing factor on the development of symphysite is a rather problematic task. In this regard, the prevention of symphysitis also cannot be clearly indicated.

Adhering to some rules and recommendations, it becomes possible to reduce the risk of pathology. So, first you need to reduce the number of loads and perform special physical exercises. Such a course should be selected by a specialist individually for each woman, taking into account her concomitant pathology and contraindications.

In addition, the prevention of symphysitis consists in adhering to the correct diet and lifestyle. It is necessary to eat foods with calcium and spend enough time outdoors.

In addition, pregnant women should wear a bandage to maintain the physiological location of bone structures and internal organs, and also not neglect the implementation of special exercises.

Symphysite forecast

The divergence of the pubic pelvic bones is observed in almost 50% of all pregnancies. It was noted that each subsequent pregnancy is more and more predisposed to the development of symphysitis. So, if during the first bearing of the fetus, softening of the ligamentous apparatus was already revealed, then subsequent pregnancies will also be accompanied by this process.

The prognosis of symphysitis depends on the degree of divergence of the pubic bones and the clinical manifestations that bother the woman. If measures are taken in time to solve this problem, then the prognosis of symphysitis is quite favorable.

In addition, during pregnancy, a woman is under the constant supervision of a doctor who monitors the development of symphysitis and decides on the choice of the method of delivery. Pathology does not have a negative effect on a woman's health, provided that symphysitis is controlled.

After childbirth, there is a stabilization of the hormonal background, a decrease in the swelling of the pubic articulation and a decrease in the severity of pain.

Symphysitis is noted in half of all pregnancies, but subject to proper attention to the pathology and the selection of effective treatment, a woman may not remember symphysitis a few months after giving birth.

Symphysitis and sex

As already mentioned, symphysitis develops as a result of exposure to various provoking factors, which leads to a softening of the ligamentous apparatus between the pubic pelvic bones.

Divergence of bones is accompanied by pain, which makes symphysitis and sex mutually exclusive processes. Pain interferes with the woman's relaxation and enjoyment, which leads to greater nervous tension and irritability.

Even if symphysitis is at the first stage of development and painful sensations do not arise during sexual activity, there is still a high probability of their appearance after sex.

As for the second and more stages of pathology, here sex will contribute to the intensification of the pain syndrome, which always accompanies a woman. This is especially true for active sex and intense movement.

Of course, with symphysitis, physical activity is necessary, only in the form of special exercises aimed at gradually strengthening the ligamentous apparatus and muscles. They are performed slowly and do not cause painful sensations to the woman, but, on the contrary, help to reduce their severity.

Many women are frightened by stories that during pregnancy and childbirth, pelvic bones can rupture, which entails serious treatment and long-term rehabilitation. And they associate any discomfort in the bosom area with such changes. A significant discrepancy of the pelvic bones (symphysiopathy) with a vivid clinical picture occurs in no more than 3-5% of pregnant women. But inflammation and discomfort are much more common. What are the symptoms of symphysitis during pregnancy and when can it pose a threat?

According to the international classification (ICD-10), all such pathology is included in the O26.7 heading "Subluxation of the pubic articulation during pregnancy and childbirth." In practice, many terms are used:

symphysiopathy;
symphysiolysis;
symphysitis;
dysfunction of the pubic articulation.

In principle, these are concepts that describe the stages of one process of changing the pubic articulation during gestation.

Why arises

The pelvis is a kind of ring of several bones (iliac, sciatic, pubic and sacrum). On the borders of each, semi-joints are formed, which include layers of cartilaginous tissue, but differ in low mobility. Under the influence of the gestagenic background, the properties of the tissues of the semi-joints change already in the early stages. This leads to their softening, divergence, increased mobility and the likelihood of inflammation. These processes are necessary for some increase in the size of the pelvis, which is further important in the process of childbirth.

The pubic symphysis is located in the suprapubic region and has some features that contribute to the most frequent trauma and complications in this area. Namely:

it has the maximum load during bearing;
its surface is small, which increases the pressure per unit area.

Under the influence of provoking factors, there is an increase in the production of a special protein - relaxin. It acts on cartilage fibers, reducing their strength and joint stability. Similar processes occur not only in the bosom, but also in other joints, ligaments. But here the picture is most striking due to the additional effects of the uterus and fetus. These are the main causes of symphysitis in pregnant women.

What provokes symphysitis during pregnancy

Symphysitis during pregnancy is quite common. The factors that predispose to its occurrence are the following.

Heredity. The pathology of the pubic joint is more common in people with "English roots", as well as in girls whose grandmothers or mothers had similar problems. Most likely, this is due to the pathology of the connective tissue, which forms the cartilaginous layers.
Pelvic injury. Previous operations, fractures disrupt the anatomy and predispose to discrepancy and inflammation of the pubic symphysis. Including if symphysitis or symphysiolysis were in previous births.
Hormonal disorders Early menstruation, long-term use of hormonal contraceptives, and intake of corticosteroid hormones affect bone structure.
Large fruit. The larger the baby, the more weighty the load on the pubic articulation is created. Therefore, most often its inflammation or discrepancy occurs during repeated births, when the children are larger.
Impaired calcium metabolism. Diseases of the thyroid and parathyroid glands, calcium deficiency in case of insufficient intake of it causes "washing out" of its bones, which reduces the strength of all compounds. Symphysitis signs in this case may appear already in the 1st trimester.
Kidney disease. Pathology is accompanied by a violation of mineral metabolism and increased excretion of nutrients. As a result, the body is forced to "borrow" calcium, sodium and other elements from the bones.

When to suspect a problem

Most often, signs of symphysitis during pregnancy appear at the end of the 2nd trimester due to the increasing load on this area. But even a significant separation of the pubic bones can be almost asymptomatic up to a certain point. It is believed that the entire clinical picture appears when inflammation joins.

Pain in the womb. It can be sharp, give to the leg, groin, sacrum. Sometimes this causes a change in gait, it becomes "duck". But more often these are aching unpleasant pains that intensify when walking, especially with sudden movement and significantly decrease in a calm state. Less often, women note discomfort during intimate relationships, during urination and defecation. When pressing on the pubic articulation, its soreness is also noted.
Signs of inflammation. A slight swelling and redness may appear above the bosom area.
Other unpleasant sensations.Sometimes expectant mothers note “clicking” in the pubic bones, especially when walking and turning the body.

Diagnostics

The diagnosis begins with a general examination and clarification of the woman's complaints. Sometimes with symphysitis with a large discrepancy in the area of \u200b\u200bthe bosom, a depression is determined. The safest diagnostic method is ultrasound. In this case, it is even possible to reveal the degree of divergence of the pubic bones:

1 degree - up to 1 cm;
2nd degree - up to 2 cm;
3 degree - more than 2 cm.

The norm for the divergence of the pelvic bones during pregnancy is a distance of 0.5 cm.
Routine blood and urine tests are unchanged. Radiography, CT and MRI are practically not used, since the risk from the procedure is unjustified. They are carried out, if necessary, after childbirth.

Symphysitis may have a blurred clinical picture. In this case, it is necessary to carry out differential diagnostics with diseases similar in manifestations. The main differences are described in the table.

Table - With what it is necessary to differentiate symphysitis

Disease	What does it look like symphysite	What is different from symphysite
Osteochondrosis (spinal hernia, lumbago, lumbodynia, lyubimishalgia)	- The pains are also shooting in nature; - given to the leg, groin, sacrum	- I also had similar symptoms before pregnancy
Transient muscle spasm	- Feeling soreness in the womb and groin	- While taking medications with calcium and magnesium, the symptoms disappear
Hernia	- Painful swelling appears	- The swelling goes away while lying down
Pinched sciatic nerve	- Pain appears at a later date; - can be acute	- With pressure on the bosom, there is no pain
Urinary tract infection	- Pain may be in the groin	- There are changes in urine tests
Pathological processes in the bones	- Pain is localized in the bosom, sacrum and other parts of the pelvis	- There are changes in analyzes
Thrombosis of the vein of the thigh	- Pain in the groin and thigh area	- Arises abruptly; - there is tissue edema; - most often there is concomitant varicose veins

Only a specialist knows how to identify symphysitis and distinguish it from other diseases during pregnancy. Therefore, if you have any complaints, you need to seek medical help.

Why is the condition dangerous?

Thinking about the danger of symphysitis during pregnancy, it must be emphasized that all women with a similar problem have the likelihood of a serious discrepancy of the pubic bones during childbirth. This can be accompanied by rupture of the bladder and other organs and structures of the small pelvis.

There are no consequences for the fetus, except for the possible negative effect of drugs that a woman can use to relieve pain.

How to treat

Experiencing unpleasant sensations and even more difficulties when walking, every woman thinks about how to relieve symphysitis without endangering the baby during pregnancy. It is important to understand that there will be no radical treatment until the moment of delivery. All recommendations are aimed at reducing the severity of pressure on the bosom, reducing inflammation and pain.

Wearing a bandage. If there is a slight discrepancy, on the recommendation of a doctor, you can use a regular pregnancy belt. In more serious cases of symphysitis, special fixation bands are needed that pass through both trochanters of the femur.
Pain relievers. It is allowed to use "Diclofenac" ("Ortofen"), "Fastum-gel", "Apizartron" - only in the form of topical ointments, and with caution in the 3rd trimester. For more severe attacks, rectal suppositories with papaverine and tablets can be used. The names of permitted and prohibited pain pills for symphysitis in pregnant women are indicated in the table below.
Physiotherapy. To relieve pain, cold compresses on the bosom area, acupuncture, UFO help.

Table - How can you relieve pain with symphysitis

Prevention of pathology

Exercise "Cat". It is necessary to stand with emphasis on your knees and palms. Then bend and lower your back, rhythmically moving your head in the opposite direction. The exercise can be performed at any time.
Exercise "Frog". In the supine position, the legs should be bent at the knees and brought to the stomach. Next, you need to slowly spread to the sides and bring your knees.

It is equally important to monitor body weight so as not to create additional stress on the pubic articulation. It is useful to take complexes of vitamins with calcium, magnesium, and also eat a balanced diet.

Forecast

In most cases, symphysitis does not affect gestation, but disrupts the woman's activity, bringing pain. To prevent more serious complications, it is important to determine the method of delivery at the end of pregnancy. For this, clinical data and research results are compared. And even a womb divergence of 1 cm is not always a contraindication to natural childbirth, especially with a medium-sized fetus. If even the slightest suspicion of complications arises, a cesarean section is performed.

Finally, the question of whether it will be possible to give birth itself with symphysitis during pregnancy is decided closer to the end of gestation after examination and examination by the necessary specialists. Reviews of women and doctors prove that the right approach helps to avoid more serious consequences.

Symphysitis is a serious pathology that is characteristic of the gestation period and after childbirth. The deviations identified in time and the correct tactics will help to avoid a serious womb divergence. Treatment of symphysitis during pregnancy consists of conservative measures - anesthetic ointments and tablets, physiotherapy. Operations to restore the integrity of the pubic articulation are performed only after childbirth.

Content

When carrying a child, a woman may find discomfort and pain in the pubic area. Often these sensations are of high intensity, leading to limitation of activity. The reason for this is the movable bones of the pubic symphysis, which, under the influence of various provoking factors, diverge too far. Such a pathology can significantly worsen a woman's well-being during pregnancy, complicate childbirth.

Overview of Symphysitis in Pregnancy

In the area of \u200b\u200bthe chin, sacrum, pubis, sternum and intervertebral discs there is a symphysis - a cartilaginous or fibrous connection between the bones of the skeleton. During pregnancy, in the area of \u200b\u200bthe pubic articulation, it weakens. This process is normal as it helps the woman prepare for childbirth. With intense exertion, symphysiopathy can develop during pregnancy. The disease is characterized by the separation of bones over a long distance, the formation of edema. Symphysitis brings discomfort to the expectant mother, accompanied by pain, limited mobility.

Symphysitis signs during pregnancy

The first signs of the disease appear at the 4th month of pregnancy, the complete clinical picture is found in the 3rd trimester. The following common symptoms of symphysitis are distinguished:

Swelling in the pubic area. At first, it appears slightly. An increase in the symptom occurs as the inflammatory process develops.
Pain in the pubic area. Has a aching, pulling character. The symptom worsens when climbing stairs, walking for a long time. If a woman is at rest, the pain gradually subsides. With an advanced stage of symphysitis, the nature of sensations changes, a feeling of pinching, lumbago appears. The discomfort persists throughout the day.
Severity in the lower abdomen. It is formed under the influence of a rush of blood to the small pelvis, edema and the process of bone separation. This symptom of symphysitis increases when the woman takes an upright position, decreases at rest.
Clicking, crunching, sharp pain. They occur during physical exertion or when touching an inflamed area. After a decrease in motor activity, the formation of edema is possible.

Symphysitis reasons during pregnancy

Modern scientists cannot identify the exact factors affecting the formation of symphysitis. The following are the probable causes of the development of the disease during pregnancy:

Lack of calcium. Having a great need for this element, the growing fetus draws it from the mother's body. With its critical deficiency, a woman develops pathologies of joints and bones. For this reason, symphysitis develops in late pregnancy.
Increased level of relaxin. The production of this hormone occurs actively before childbirth. The substance is necessary for the female body in order to favorably transfer the process of the birth of a baby into the world. The production of this hormone is in some cases excessive. As a result, the consistency of the symphysis softens.
Diseases of the musculoskeletal system. The discrepancy of the pubic symphysis during pregnancy often occurs in women with such pathologies. Difficulties in movement, curved posture of the patients lead to the fact that the load given by the fetus is unevenly distributed, therefore, symphysitis is formed.

Along with the main causes of symphysitis, risk factors are distinguished, in the presence of which the likelihood of illness during pregnancy increases significantly. Among them:

urogenital infections;
low physical activity of a woman;
child's weight exceeding 4 kg;
frequent childbirth;
previous injuries to the pelvic bones;
the presence of pathology in a previous pregnancy.

The degree of divergence of the pubic articulation

On examination, the doctor can determine not only the presence of the disease, but also the degree of its severity. Symphysitis in pregnant women has the following stages:

First degree - the distance between the pubic bones varies from 5 to 9 millimeters. This stage is characterized by pulling pains with prolonged walking, localized in the bosom, and slight swelling. After climbing the stairs, the patient may experience discomfort in the lower abdomen. The disease at this stage is not dangerous for a woman, its symptoms disappear with a decrease in the intensity of the load, sufficient rest. A pregnant woman should be under the supervision of a doctor in order to prevent the progression of the pathology.
The second degree is characterized by an increase in the gaps inside the pubic articulation up to 15-20 millimeters. The disease is manifested by pronounced edema, constant pain (the intensity depends on the woman's activity during pregnancy), heaviness in the lower abdomen, which occurs when the body is upright. At this stage, the likelihood of rupture of the pubic articulation increases, therefore natural childbirth is not recommended.
The third degree is severe. It is characterized by the separation of the bones at a distance of more than 20 millimeters. At stage 3, pronounced symptoms appear: pain, lumbago, extensive edema. When palpating (probing) the inflamed area, specific clicks are found. With 3 degrees of symphysitis, childbirth is carried out only with the help of a cesarean section. For the period of pregnancy, the patient must be provided with rest, bed rest.

Symphysitis treatment during pregnancy

It is impossible to completely cure the disease during pregnancy, but the implementation of some recommendations will help to significantly alleviate the patient's condition. At the first stage of symphysitis, it is necessary:

ensure bed rest, minimize physical activity during pregnancy, the patient needs to spend more time at rest;
take easily digestible calcium supplements, B vitamins;
apply procedures with ultraviolet light;
regularly perform exercises aimed at strengthening the pubic articulation;
for the period of pregnancy, choose orthopedic mattresses for sleep;
avoid being in one position for more than 60 minutes, long walking;
take pain relievers that are safe during pregnancy as needed.

The treatment strategy for stages 2 and 3 of symphysitis during pregnancy involves keeping the pelvic bones as close as possible. If severe pain occurs, a woman can be admitted to a hospital. In the hospital, it is necessary to undergo courses of medications with anesthetic and anti-inflammatory effect, physiotherapy. If therapy is performed on an outpatient basis, pregnant women suffering from symphysitis are advised to:

strictly observe bed rest;
wear a special corset, bandage or apply tight bandage;
eating a diet that includes foods high in calcium
take painkillers and vitamin preparations prescribed by a specialist, allowed during pregnancy.

Physiotherapy

Lie on your back, pull your feet to your buttocks, bending your knees. Spread the lower limbs at a slow pace, fix the position for 30 seconds, then bring it together again. Repeat the exercise 6 times.
Move the heels from the buttocks by 30-40 cm. Raise and lower the pelvic area. Movements should be slow. At a minimum distance from the floor, try to hold your position as long as possible. The pelvis must be raised by 2-3 cm. Repeat the exercise 6 times.
Do the Cat exercise. Get on all fours. Keep your spine straight and relax your back. Do not lower or raise your head. Arch your back while contracting your thighs and abdominal muscles. The head must be raised. Do 3 reps.

Childbirth with symphysitis

In the process of childbirth, in the presence of such a pathology, damage to the ligaments of the pubic bones may occur, up to their rupture. The recovery process after an injury takes a long time. In the event of a severe rupture of the symphysis, surgical intervention is required. In some patients, the disease goes away on its own after childbirth. The second and third stages of symphysitis are indications for a caesarean section. Prompt delivery helps prevent complications (especially in women with a narrow pelvis).

Prevention

To prevent the manifestation of symptoms of symphysitis, preventive measures should be taken. It is required to observe the following recommendations:

Pregnancy should be planned. It is necessary to prepare for this period, undergo a full examination, and cure the detected diseases.
When pregnancy occurs, you need to register with a gynecologist no later than 12 weeks.
Be sure to undergo all routine examinations prescribed by a doctor in order to determine the onset of symphysitis in time.
Provide yourself with proper nutrition. Avoid eating sweets, fatty and fried foods. During pregnancy, eat more meat, legumes, and dairy products as they are high in calcium.
Take vitamin and mineral complexes prescribed by a specialist.
To prevent symphysitis, wear a bandage and take time to exercise.
Refuse excessive physical exertion, prolonged sitting, standing, walking.
Try to eliminate psychological stress. If necessary, take an anti-anxiety medication approved for pregnancy.

Video

Symphysitis during pregnancy is not an exceptional phenomenon. About half of expectant mothers face pathology. Anatomical science calls the symphysis the site where the pubic bones join. During pregnancy, a rapidly gaining weight fetus exerts significant pressure on the bony articulation, which makes it mobile. A slight discrepancy of the pubic bones is considered a physiological necessity and a prerequisite for a comfortable birth, and excessive softening of the joint is attributed to diseases of the musculoskeletal system and is called symphysitis.

In a non-pregnant woman, the pubic symphysis is a strong, motionless joint. With the appearance of the fetus in the maternal body, the tissue between the pubic bones is greatly softened. An overly mobile joint becomes under the influence of the hormone relaxin, which is secreted in the body of the expectant mother in large quantities. How the pubic joint, constrained by symphysitis during pregnancy, looks like, is shown in the photo:

Scientists cannot say that the reasons for this metamorphosis have been thoroughly studied. It is still not clear why the pubic articulation in some pregnant women softens in moderation and does not cause them significant inconvenience, while in others the pathology is so pronounced that it practically constrains all movements. Nevertheless, doctors have certain guesses about the prerequisites for the development of the disease. The following factors contribute to the appearance of symphysitis:

Insufficient calcium concentration in bones.
A significant deficiency of vitamins in the body of a pregnant woman.
Excessive synthesis of the hormone relaxin under the influence of an "interesting" situation.
Heredity.
Diseases of the musculoskeletal system, which appeared in a woman even before pregnancy.

Symphysitis symptoms during pregnancy

Faint echoes of the disease make themselves felt as early as 4 months of the "interesting" situation. The complete clinical picture of symphysitis unfolds in the 3rd trimester of pregnancy - painful symptoms reach their apogee. Here are the most indicative and common ones:

The pubic joint at first slightly swells, over time the inflammation and, accordingly, the swelling increases.
Soreness of movement forces the expectant mother to walk, waddling from side to side like a duck. Sometimes a woman begins to mince - this minimizes the mobility of the hip joint when walking.
If you feel the inflamed area, the woman will feel severe pain. On palpation, single clicks or crunching can be heard.
The pain is also felt when changing the position of the body.
In the lower abdomen, every now and then there is a feeling of heaviness.
Due to severe pain, the woman is unable to raise her straightened leg.
As you climb the stairs, the intensity of the unpleasant symptoms increases.
As pregnancy progresses, symphysitis also progresses, bringing discomfort to the expectant mother even during passive rest.

What threatens symphysitis during pregnancy

Immediately, we note that during pregnancy, pain with symphysitis is inconvenient only for a woman, without affecting the condition of her baby. True, some doctors are sure that the depressed state of a woman who is exhausted by pain may not affect the child in the best way, but there is no reliable confirmation of this.

A woman suffering from symphysitis has problems of the following nature:

during natural childbirth, the risk of rupture of the symphysis increases - the loose tissue of the joint is so weak that it may not withstand the pressure that the fetus will exert when passing through the birth canal. The rehabilitation period takes a long time (more than two weeks), while the woman is shown exclusively bed rest;
the method of delivery is changing - with a divergence of the pubic articulation, it is safer to resort to a cesarean section than to give birth on your own;
after childbirth, symphysitis will remind the woman of herself for some time. And this significantly complicates the new way of life for a young mother, when taking care of the baby, the need to visit various specialists and perform a complex of therapeutic exercises, and so it takes a lot of energy.

Diagnosis of symphysitis during pregnancy

The obstetrician-gynecologist makes the diagnosis of the pathological condition of the pubic joint, taking into account the results of the examination and the complaints of the pregnant patient. Symphysitis symptoms during pregnancy are quite eloquent, so, as a rule, there are no problems with the definition of the disease.

After the introduction of the ultrasound examination procedure into the practice of diagnostic medicine, specialists received an excellent opportunity not only to identify the disease, but also to obtain maximum information about it. With the help of ultrasound with symphysitis during pregnancy, you can determine the stage of development of the disease:

complication of the first degree is expressed by the expansion of the pubic junction gap by 5 - 9 mm. If there are no other deviations, the woman can still hope for a natural birth;
the second degree of symphysitis is placed if the crack between the pubic bones has increased by 10 - 20 mm. The doctor will have to decide on the method of delivery;
the third degree of pathology is indicated by the large distance between the bones of the pubic articulation (more than 20 mm). The birth of a child is possible only through surgery.

Symphysitis treatment during pregnancy

Symphysiopathy is one of those rare conditions that exists only for a certain period of time (in this case, the last months of pregnancy), and then “resolves” without any medical intervention. The most difficult thing is to wait for this moment, because the divergence of the pubic articulation is accompanied by a rather severe pain syndrome. The delicate position of a woman puts a taboo on the use of effective anti-inflammatory and analgesic drugs, since their active substances can harm the fetal development of the child. The choice of available techniques to eliminate discomfort from symphysitis is not very large, nevertheless, it is better than nothing at all:

As prescribed by a doctor, a pregnant woman can take calcium supplements. However, despite the criticality of the position of the expectant mother with symphysitis, this step is rather controversial. When there is very little time left before childbirth, the amount of this trace element in the diet of pregnant women, as a rule, is shown to be limited in order to prevent the development of complications during childbirth. Of course, calcium makes a woman's bones stronger, but at the same time, the bone tissue on the eve of childbirth cannot be purposefully compacted, since its elasticity is important for a normal delivery. In addition, increased calcium intake thickens the baby's skull, and this can make it difficult for him to move along the tight and strong birth canal.
Special therapeutic exercises will help to suspend the stretching process and reduce the severity of the clinical signs of symphysitis. The set of exercises is aimed at strengthening the pelvic, lumbar and thigh muscles. The exercises are best done under the supervision of an instructor in a specialized medical facility. Physical activity not associated with therapeutic exercises should be limited to a minimum.
A bandage serves as an excellent support for muscles weakened by symphysitis. The expectant mother must wear it.

Exercises for symphysitis during pregnancy

To make the course of pregnancy with symphysitis less painful, you need to do gymnastics every day - this is the only way to strengthen the pelvic, sacral, lumbar and femoral muscles.

Gently lie with your back on the mat. Bend your knees and move your feet to your buttocks as close as you can. Now slowly and very smoothly begin to spread your knees to the sides. Hold this position for a few moments, and then bring your knees together as smoothly. Repeat 4-6 times.
Still lying on your back, place your feet so that the calf muscles are perpendicular to the floor. Now gently lift your pelvis up. Remember your position and don't be too zealous - just lift your buttocks just a few centimeters. Smoothly lower yourself to the starting position. When you almost touch the floor surface with your coccyx, try to delay this moment for a few moments and only then lower yourself to the floor. Do 5 to 6 repetitions.
The complex is completed by the well-known exercise "cat". Get on all fours and relax your back. The head, neck and spine should be in the same line. Round your back very slowly and lower your head and tailbone down. Ideally, you should feel the hip and groin muscles tighten. Now carefully return to the original position. Repeat the exercise 2-3 times.

Important! If possible, therapeutic exercises should be performed several times a day, especially at moments of severe pain.

How to prevent a pregnant woman from developing the disease

The divergence of the pubic articulation is not dangerous for a woman's life, but in combination with certain factors (a narrow pelvis of a woman in labor and a large fetus, for example) can have serious consequences. Also, the degree of symphysitis during pregnancy depends on how well the expectant mother will feel in the last months before childbirth.

Obviously, a pregnant woman should pay maximum attention to the prevention of symphysiopathy, especially if she has all the prerequisites for its development. The main preventive measures are considered to be the use of vitamins, regular swimming in the pool and moderate exercise. It is also very important to discuss with the attending physician the specifics of the diet - every day the body of a pregnant woman should receive a sufficient amount of calcium.

If some signs of symphysitis have already made themselves felt, the pregnant woman needs to prevent the further development of the disease at all costs. The following recommendations will help to suspend the progression of symphysiopathy and ease the pain of symptoms:

Change your body position as often as possible. You can't sit in front of a TV or computer for a long time, hunched over and with legs crossed - this position blocks blood circulation in the pelvic area and lower extremities.
Throughout the third trimester of pregnancy, you need to wear a special bandage that reduces the load on the pelvis and pubic articulation.
Do a daily set of exercises to strengthen the muscles of the thighs, pelvis and lower back.
In moments of exacerbation of the disease, do not hesitate to use various devices that will ease the load on the sore area - a walker, cane, wheelchair.
To lie down, first gently sit on the bed, then gently bend to the side to tuck your upper body, and then simultaneously lift both legs, pressed together, and place them on the bed. Use the reverse sequence to get out of bed. Turning from one side to the other, always keep your legs together.
Use the ladder as little as possible if possible.
Too soft and too hard surfaces for seating are contraindicated in symphysitis.
When walking, move smoothly, taking not very wide strides.
To get into the car painlessly, first put your ass in the passenger compartment, and carefully bring the legs together with the trail.
Swimming in warm water quickly relieves pain in the pubic area.
According to many women who have experienced bouts of symphysitis during pregnancy, it is most convenient to sleep at night with a small pillow between your legs.
Beware of asymmetry in body position.
Never sit cross-legged - in your situation, this is the strictest taboo.
When standing, do not shift the center of gravity by one leg, but evenly distribute the load on both legs.
Try not to lean on one elbow / arm.
Prolonged sitting, especially if your knees are above pelvic level, is not for you.
Avoid long walks. Alternate periods of mobility with short rest as often as possible.
Take your body weight under strict control: the less extra pounds, the easier it is to cope with the discomfort that the divergence of the pubic joint brings you.
At all times, try to relieve the baby's pressure on the lower back, pelvis and pubis. The following tricks will help you achieve this:

while resting, put your feet on a hill;
when lying down, place a rolled-up towel under your buttocks so that your pelvis is in a slightly raised position.

These simple rules will help you cope with unpleasant symptoms of symphysitis while waiting for a baby. If the pain is so severe that it completely knocks you out, be sure to inform your obstetrician-gynecologist about it.

The prognosis of symphysiopathy during pregnancy is favorable, provided that the expectant mother will responsibly follow all the recommendations of the attending physician. Note that it is impossible to cope with symphysitis on your own - only a qualified specialist can choose the correct tactical approach to solving the problem.

Discrepancy of the pubic articulation after childbirth. Video

Symphysitis manifests itself most often in the third trimester of pregnancy, in the second trimester this pathology is very rare

Typical symptoms of symphysitis:

swelling in the pubic area (pubic articulation)
the so-called "duck" gait of a pregnant woman
sharp pain when pressing on the pubic bone, audible clicks during this action
pain when changing body position
walking is characterized by small steps
pain and a feeling of heaviness when climbing stairs
pain and discomfort in the pelvic area, groin, coccyx, thigh, pubis
lying down there is no way to raise straightened legs up

It is imperative to tell the doctor about the symptoms noticed.

Signs

This pathology tends to develop, pain sensations will become even more expressive. Not only will movement be painful, but a woman may feel pain while lying down.

Similar signs may indicate other changes in the mother's body. It would be wrong to diagnose this disease yourself, but if there are suspicions, go to the doctor right away. Otherwise, the disease will progress. Since an X-ray is not done during pregnancy, the doctor will make a diagnosis, guided by the woman's complaints and examination.

Causes

Let us repeat: the true causes of symphysitis have not yet been clarified.

And yet today doctors are inclined to believe that the lack of calcium is "guilty" of it.

Of course, hormonal changes during pregnancy cannot be ignored. The hormone relaxin allows the bone tissue to soften, and therefore the symphysis is stretched. And although this process is natural, so nature prepares the mother's body for delivery, sometimes such complications arise.

So, there are 4 main reasons for symphysitis:

lack of calcium
hormonal changes
hereditary factor
problems with the musculoskeletal system before pregnancy

What is dangerous (and is it dangerous?) During pregnancy?

For mum
This disease cannot be called harmless. It causes a lot of suffering for a woman and affects how exactly she will give birth.

The course of pregnancy, the size of the baby, the number of previous births can affect the fact that a woman will give birth by caesarean section. In the maternity hospital, the doctor should be aware of this diagnosis, because during natural childbirth with symphysitis, there is a high risk of rupture of the pelvic joints.

The latter will entail a long recovery, bed rest for at least 2 weeks, special exercises, consultations with many specialists. Having a newborn baby in her arms, a woman will not be able to painlessly walk this path, so there is no need to risk it.

But if the pubic fissure has diverged by a maximum of 10 mm, the size of the pelvis is normal, and the fetus is small, natural childbirth is quite possible.

For baby
For the child, this pathology is not dangerous, except for the suffering of the mother during this period. Therefore, it is better to follow the doctor's recommendations for relieving symptoms, if only because your anxiety and stress do not affect the baby's condition.

Treatment and prevention

Let's face it - it is difficult to fight this pathology. It is impossible to completely remove the diagnosis, if it is sufficiently pronounced. But it is quite possible to relieve symptoms, reduce pain.

Treatment of the disease will be as follows

Taking special medications with a high calcium content... But in the later stages, this is problematic, since problems may arise during childbirth, and the bones of the baby's skull will be stronger, which is undesirable during this period. Therefore, the doctor will select a certain compromise option, or the pregnant woman will take such drugs until a certain time.

Wearing a bandage... Restricting habitual physical activity, but at the same time, performing special exercises.

Taking anti-inflammatory devices... Inpatient treatment is possible.

To avoid the progression of the disease and protect yourself from pain and discomfort, you should heed the following recommendations:

distribute the weight evenly on two legs, do not cross your legs, do not sit in an asymmetric position
do not sit for more than an hour, change your position
avoid stairs if possible
don't sit on hard
only move back and forth, try to avoid deviations to the side
in case of an acute attack of pain, sit in an easy chair or lie on the bed
don't walk a lot and don't stand for long

Prevention

will consist in a healthy lifestyle before pregnancy, sufficient intake of foods high in calcium, exercise.

Features of pregnancy and childbirth management

Symphysitis is not a sentence, not a doom to suffering, and not a guarantee of childbirth by means of KS

Regular observation by a doctor, following recommendations, taking medications, and inpatient treatment will reduce the risks of complications, relieve pain and discomfort.

Symphysitis often leads to childbirth by caesarean section, but you should not be afraid. Firstly, such childbirth will be prescribed with concomitant factors (large fetus, large discrepancy of the pubic fissure, narrow pelvis), and secondly, in comparison with the possible consequences, the operation is the safest way of delivery.

So, syphmisitis is not the rarest pathology of pregnancy. If a woman is faced with such a disease, she must remember:

You can not be silent about the symptoms of the disease, a trip to the doctor is required!
Symphysitis does not threaten the life and health of the child
Comprehensive treatment will significantly ease pain
If the doctor insists on hospitalization, you should not refuse
Symphysitis is often an indication for CS, but this is a necessary measure that will save a woman from ruptures in the pubic articulation and subsequent difficult and prolonged recovery
Avoid poses, positions that are painful, walk less stairs, give up long walks