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Pregnancy is a time when a woman's body and body change significantly. Some changes are obvious and understandable (for example, breast and abdomen enlargement), and some are not. For example, starting from the second half of pregnancy, the expectant mother has unpleasant sensations in the pubic area, over time they can intensify so much that it becomes difficult for a woman to walk or sit. Where did these pains come from and what to do with them?

The pelvis of a woman is a ring and consists of several bones that are attached to the sacral spine at the back, and in front are connected to each other with the help of a fibrocartilaginous disc and ligaments. This connection is called pubic joint(pubic articulation), or symphysis, or pubic.

Usually the symphysis is in a stationary state, but during pregnancy it can diverge, because the pelvis of the pregnant woman becomes wider. There is an expansion of the symphysis due to the fact that the ovaries and placenta synthesize a special substance - relaxin, which is able to relax the ligaments. Under its influence, the ligaments swell, become loose, as a result of which the joints become more mobile and the distance between them increases.

This is especially pronounced in the pubic articulation, it is it that diverges the most. This is a natural, physiological state that facilitates the process of childbirth, because it will be easier for the child to pass through a wide pelvis. When the level of hormones and relaxin reaches the pre-pregnancy state, all these changes disappear - the ligaments and joints become dense again.

How to understand that you have symphysis?

Most often, symphysitis manifests itself in the 3rd trimester of pregnancy, when the action of the hormone relaxin reaches its maximum, and the child weighs more than 2 kg, which significantly increases the load on the ligamentous apparatus of the pelvis.

Symphysitis is characterized by:

• significant swelling appears in the pubic area;
• if you press on the pubic joint, then pain or a characteristic click will appear;
• independent pain in the groin, sometimes in the coccyx, thigh;
• in a prone position it is impossible to raise straightened legs;
• characteristic "duck" (waddling) gait;
• when climbing stairs there is a sharp pain;
• over time, the pain can intensify and occurs not only when walking or moving, but also in a calm state - in a sitting or lying position.

The diagnosis of "symphysitis" is usually made on the basis of the described complaints. In addition, the doctor must prescribe an ultrasound in order to determine the width of the divergence of the pubic joint.

Depending on the degree of softening of the pubic symphysis and the magnitude of the divergence of the pubic bones, three degrees of severity of symphysitis are distinguished:

• 1st degree - from 5 to 9 mm;
• 2nd degree - from 10 to 19 mm;
• 3rd degree - more than 20 mm.

If the signs of symphysitis are pronounced, then most likely it will be required - during natural childbirth, there is a high risk of ruptures of the symphysis. possible if the pubic articulation has expanded no more than 10 mm, the child is medium-sized, and the pelvis is of normal size.

Symphysitis: causes and treatment

Why symphysitis occurs has not yet been precisely established. There are two main theories to explain the excessive dehiscence of the pubic bones:

• excessive production of relaxin, which leads to excessive relaxation of the ligaments of the pubic joint;
• violation of phosphorus-calcium metabolism and lack of vitamin D.

In addition, the following factors contribute to the development of symphysitis:

• hereditary diseases of bones and joints, such as a defect in collagen (a protein in the skin, ligaments, cartilage, bones), leading to excessive joint mobility;
• numerous genera;
• pelvic trauma in the past;
• large fruit weighing more than 4000 g;
• sedentary lifestyle and excess weight;
• symphysitis during past pregnancies.

If symphysitis is already present, then it is unlikely that it will be possible to completely get rid of it, but its manifestations and discomfort can be reduced.

With symphysis you need:

• lie down more often
• when sitting or standing, distribute the weight evenly on both legs;
• sit on a chair with an adjustable back and armrests;
• reduce the pressure of the child on the lumbar and pubic region; to do this, you can put additional pillows under the buttocks, put your feet on a raised platform;
• perform special exercises that reduce pain in the area of ​​​​the pubic joint;
• ask your doctor if you can use special anti-inflammatory drugs to reduce pain in the symphysis area;
• contact a trauma surgeon or osteopath who have experience in treating symphysitis in pregnant women.

With symphysis, you can not:

• take asymmetrical positions: for example, sit cross-legged or stand, leaning on one leg;
• sitting, standing or walking for a long time;
• To climb up the stairs;
• when walking, take steps to the side.

Exercises that strengthen the muscles of the pelvis, lower back and hips

1. Lying on the back, knees bent, feet close to the buttocks. Slowly, as if overcoming resistance, but very symmetrically, spread your knees to the sides and connect again. Repeat 6 times.
2. Lying on the back, knees bent, feet slightly away from the buttocks. Slowly lift the pelvis up and very slowly lower it back. Repeat 6 times.
3. Pose "cat". Get on your knees and lean on your hands, then relax your back muscles, while the head, neck and spine should be at the same level. Next, you need to arch your back up, at the same time lower your head down, tighten the muscles of the abdomen and thighs. Repeat 2-3 times.

Prevention of pain in the pubic joint

Like any pathology, symphysitis is easier to prevent than to treat. This is easy to do, the main thing is to follow simple rules:

1. Watch your diet! Your diet must be present: milk and lactic acid products, low-fat cheeses, eggs, meat, poultry, fish, greens, nuts.
2. Take care of expectant mothers.
3. Swim in the pool: water relieves the spine and joints.
4. Go for a walk in the fresh air: when exposed to sunlight, vitamin D is produced in the skin.
5. Control your weight, extra pounds often contribute to symphysitis.
6. Take vitamins and minerals.
7. Wear .

Between the bones of the pelvis, in the region of the pubis, there is a cartilage-fibrous junction that forms a slit-like cavity - the symphysis or pubic joint. Many women know the problem associated with excessive softening of this cavity - symphysitis during pregnancy. This is a pathological condition that is accompanied by an inflammatory process that can cause severe complications at the time of childbirth.

Under the influence of the hormone relaxin, which is produced during the period of gestation, the articulation of the pelvic bones softens. This process is necessary for the implementation of the possibility of moving the child through the birth canal. Often, softening of the pelvic bones is hampered by symphysitis. This is a pathology in which the divergence occurs very quickly: the joints move apart, become hypermobile.

Symptoms

Signs may appear closer to the end of 2, but more often - in the 3rd trimester of bearing a baby. A pregnant woman is obliged to closely monitor all physiological changes. Observing this condition, you can notice alarming symptoms in the earliest stages. The first symptom is a dull pain in the pubic region, which appears when walking, especially when climbing stairs. Discomfort is caused by the inflammatory process, which worries the pregnant woman more and more every day.

As the disease progresses, new symptoms are added:

• pain when standing, lying down, or sitting (in the pubis, coccyx, or thighs)
• increased pain and crunch are observed during palpation of the affected area
• increased pain when trying to stand up, lift a leg, turn around
• swelling of soft tissues in the area of ​​the affected area
• difficulty and visual change in gait (so-called duck gait)

The combination of these symptoms indicates a possible symphysitis. In this situation, it is recommended to consult a family doctor or gynecologist, otherwise the disease will bother the woman throughout the pregnancy. The main danger of this condition is the high likelihood of complications closer to the time of birth.

The reasons

There is no single cause of symphysitis suitable for each specific case. Predisposing factors are known that, together or individually, provoke the problem of excessive divergence of the pelvic bones.

hereditary disposition

The hereditary predisposition of a woman to diseases of the musculoskeletal system increases the risk of symphysitis during the period of bearing a baby. Often the problem is caused by Ehlers-Danlos syndrome. This disease is caused by a lack of collagen, and is manifested by excessive joint mobility and bone fragility. As statistics show, the predisposition to symphysitis is transmitted through the female line.

The opinion that congenital features of the structure of ligaments and tissues (connective tissue dysplasia) contributes to the development of symphysitis has a place to be, although not all scientists agree with this statement. It is believed that dysplasia manifests itself in early childhood (the child often suffers from dislocations or subluxations). Weakness of connective tissues is also manifested by other signs:

• heart valve disease
• prolapse of internal organs
• excessive flexibility of bones and joints
• crackling in the joints
• frequent joint pain

A woman suffering from connective tissue diseases suffers from excessive sensitivity and soreness of the ligaments during gestation.

Lack of calcium and vitamin D

During the period of gestation, the expectant mother should consume calcium and vitamin D. This will improve the functionality of bones and joints, and prepare the woman's body for the upcoming birth. The approximate daily intake of calcium for a pregnant woman is at least 1 gram. The need for calcium increases with smoking, drinking strong tea or coffee. If a pregnant woman does not receive enough calcium and vitamin D, the fragility and mobility of the joints increases, and the likelihood of getting symphysitis increases.

kidney disease

Some experts are of the opinion that kidney disease in pregnant women leads to excessive softening and divergence of the pelvic bones. This is due to the rapid excretion of protein from the body.

Previous pelvic trauma

Previously healed injuries in the pelvic area can remind of themselves during pregnancy with severe pain, pathological softening and divergence of the symphysis.

Multiple births

The more births a woman had, the greater the likelihood of manifestations of symphysitis during the next pregnancy. The fact is that in the process of labor, the pelvic bones can be injured, and these injuries complicate the preparation of the body for childbirth. Sometimes excessive body weight, lack of physical activity in everyday life, metabolic disorders in the body, excessive production of the hormone relaxin leads to symphysitis. Polyhydramnios, large fetuses or twins can also cause excessive symphysis symphysis.

Stages of the disease

In the presence of symphysitis, it is important to determine the severity of the pathology, which is characterized by the size of the discrepancy. To do this, use instrumental diagnostics.

There are 3 stages of symphysitis:

• 1 stage - 5-9 mm
• Stage 2 - 10-19 mm
• Stage 3 - 20 mm and above

To determine the size of the divergence of the bones, instrumental diagnostics are used.

How does it affect pregnancy and childbirth

If a pregnant woman has stages 2 and 3 of symphysitis, the option of performing a caesarean section is considered. If the diastasis between the bones exceeds 10 mm, the risk of rupture of the pubic joint increases. It is also important to consider the weight and size of the child. When symphysitis is complicated by an inflammatory process, tissue edema occurs, and the body temperature of the pregnant woman rises. This condition is dangerous not only for the expectant mother, but also for the baby. Premature birth may occur, nutrition or fetal development may be disturbed.

Which doctor to contact

Symphysitis is treated by a traumatologist. You can also contact an obstetrician-gynecologist, therapist or family doctor, who will subsequently refer the pregnant woman for a consultation with a specialist.

What happens when a symphysis is torn

A dangerous complication of the symphysis is the rupture of the pubic articulation. This can happen during childbirth or in the last weeks of pregnancy when the baby's head sinks into the pelvis, putting pressure on the inflamed tissues.

What is the risk of breaking

When the symphysis is ruptured, a woman feels severe physical pain, up to a painful shock. In this state, it is difficult to move or change the position of the body. This increases the risk of getting a tailbone crack. A rupture of the symphysis in other words is a fracture of the pelvis. Breaks from 5 cm are a great health hazard. Parts of the bone can damage the organs of the urinary system, as well as internal or external intimate organs.

How to identify pathology

To avoid rupture of the symphysis, it is important to identify the pathology as early as possible before childbirth. For this, a pregnant woman should be examined as soon as she notices swelling and pain in the pubic area. To make a diagnosis and determine the size of the discrepancy, instrumental methods are used: ultrasound, X-ray (for special indications), and more accurate modern methods - CT and MRI.

ultrasound

Ultrasound is the simplest and safest method used to diagnose symphysitis during gestation. It allows you to identify some signs of inflammation, as well as accurately determine the distance between the bones of the pelvis.

X-ray of the pelvic bones

An x-ray of the pelvic bones is more often prescribed after childbirth. Pregnant women are not recommended to use it, but if there is no alternative, then this method allows you to compare the circumference of the pelvis and the head of the fetus.

CT and MRI

Modern diagnostic methods CT and MRI are prescribed after childbirth, and allow you to check the state of bone damage, identify possible complications.

Differential Diagnosis

During the diagnosis, it is necessary to exclude other diseases that are similar in manifestations to the symptoms of symphysitis.

Genital and urinary tract infections often present with pubic pain, which can be confused with symphysitis. In this case, the patient feels a burning sensation and tingling in the pubic area. Often the cause of infection is cystitis as a result of an infectious disease or E. coli.

Acute lumbago, pain in the lower back and back, as a result of pathologies of the spine, are called lumbago. This problem is also characterized by systematic pain in the legs, groin area, pubis. If symphysitis is suspected, it is important to exclude this diagnosis, in which a person's motor activity is difficult.

Lumbago causes diseases:

• rheumatic bone lesions
• osteochondrosis
• hernia
• displacement of the vertebral discs
• spondylarthrosis
• astheoarthritis

Often, attacks of lumbago occur from stress, sudden changes in temperature, strong physical exertion. If a person with a predisposition to lumbago is in one position for a long time, he may also experience a sharp attack of pain in the back, leg, and groin area.

Sciatica is a disease that affects the sciatic nerve. Pain is localized in the lower back, coccyx and groin, spreading to the thigh and knee, up to the lower leg. Sciatica usually occurs as a complication of diseases of the joints and soft tissues:

• arthritis
• arthrosis
• tumors in the pelvis and spine
• muscle problems

Sciatica can also be preceded by infectious diseases, poisoning, hypothermia, and other diseases. In addition to pain, the pathology is characterized by thinning and discoloration of the skin, excessive sweating, loss of sensation and muscle atrophy.

Bone lesions with tuberculosis or purulent-necrotic inflammation are quite rare, but this problem still needs to be excluded in the diagnostic process. For this, instrumental methods are used - X-ray and ultrasound. It is also necessary to identify whether the pregnant woman had previously had tuberculosis. If necessary, laboratory tests are carried out: swabs and cultures are taken for the presence of infection.

Complications

The main complication of symphysitis is the rupture of the pubic articulation. Usually this process occurs gradually, approximately 2-3 days after a rapid or complicated birth. Less often, the ligaments are torn during delivery, while the woman feels a strong sharp pain. A rupture of the symphysis is diagnosed using an X-ray or ultrasound examination. The patient cannot move independently or change position. On palpation of the joint, a divergence of the bones by 6-9 cm can be detected, while the pain increases. It is also possible to deviate the pubic bone by 2-5 cm vertically.

Due to a rupture of the pubic joint, there may be:

• damage to the organs of the urinary system
• soft tissue injury
• urination disorder
• prolonged inflammation, pain, swelling

Improper treatment of a rupture of the lunar joint, or lack thereof, threatens the woman in labor with a violation of gait and chronic pain in the pelvic region in the future.

How to treat in pregnant women

During pregnancy, symphysitis does not affect the development of the child. Usually, unpleasant symptoms disturb a woman before childbirth, and after the birth of the baby they disappear. For this to happen, it is important to plan correctly what kind of childbirth will be: natural or by caesarean section.

The decision on natural childbirth is made if the discrepancy between the bones of the pubic joint does not exceed 8-10 cm, and the fetus is not large. Otherwise, an operation is prescribed to avoid trauma to the pelvis during delivery. Treatment during gestation is aimed at normalizing the general condition of the pregnant woman and preventing the development of the disease. Usually symphysitis disappears after the birth of the baby and the normalization of hormone production.

• take calcium-containing vitamin preparations
• follow a special diet
• move moderately
• wear a support bandage

A pregnant woman needs to sleep on a comfortable mattress, evenly distribute the weight on her legs when standing and walking, and also monitor her weight.

Sprains and ruptures of the pubic joints during labor activity threaten a young mother with restriction of motor activity for the period of rehabilitation, immobilization, and prolonged therapy. For this period, it is necessary to find a person who will take care of the baby instead of the mother.

How to treat symphysiolysis after childbirth

Women who have given birth with a divergence of the pubic dismemberment need long-term treatment. Be sure to prescribe painkillers (non-steroidal anti-inflammatory drugs).

Also may be assigned:

• vitamins
• calcium-containing preparations

The name and dosage of the medicine is prescribed by the doctor for each patient separately. It is important to consider whether a young mother is breastfeeding a baby. If so, then it is necessary to select the drug with extreme caution so as not to harm the child. Physical activity in the postpartum period is required to be minimized. For walking, it is recommended to use a cane, as well as wear a special supporting bandage. It is also recommended to use physiotherapeutic procedures, in particular magnetic therapy, as well as to engage in special gymnastics.

In severe cases, with a rupture of the symphysis, bed rest is indicated. Old gaps that are not amenable to conservative treatment are eliminated with the help of surgery. To connect the pelvic bones, sutures are applied, implants or special metal plates are sewn in.

Prevention

The intensity of pain in the pubic joint during pregnancy can be reduced with the help of preventive measures, which include:

• balanced low carbohydrate diet
• light exercise as directed by a doctor
• swimming and moderate regular walks outside
• obesity prevention
• wearing a protective bandage, starting from the 2nd trimester of pregnancy
• taking vitamin complexes on the recommendation of a specialist

To avoid rupture of the pubic symphysis during labor, it is important to carefully diagnose. In the presence of complications, a caesarean section is prescribed. The best method of prevention is pregnancy planning. Before conception, a woman is recommended to undergo a complete medical examination, which will identify possible health problems and reduce the risk of complications during the period of bearing a baby.

Video: Yoga therapy for symphysiopathy during pregnancy

Symphysitis is an inflammation of the symphysis, that is, the transitional connection between the bones of the skeleton. Symphysitis during pregnancy is not so rare.

The growing fetus puts pressure on the bone joint. And, if a slight divergence of the bones is the norm, then excessive softening of the symphysis is considered a disease and is a direct indication for a caesarean section.

What is symphysitis and the causes of its appearance

During pregnancy, the fetus is constantly developing and growing. At the same time, the uterus increases in size. This leads to increased pressure on the pelvic bones, tension in the pubic region.

In addition to this load on the pelvic bones, the body of a pregnant woman is affected by various hormones.

In large quantities, the hormone relaxin enters, which performs many important functions. For example, the growth and expansion of the uterus, the expansion of the pelvic bones and the weakening of the ligaments, the opening of the cervix during childbirth, etc.

Under the influence of the above factors, there is a softening and divergence of the pubic joint. In addition, the following factors may affect:

• large fruit;
• the structure of the pelvis (narrow lumen of the pelvic bones);
• insufficient intake of vitamins and minerals.

It is difficult to unambiguously identify the cause of symphysitis during pregnancy. All of the above factors can lead to the development of this pathology.

Doctors also believe that a hereditary factor and problems of the musculoskeletal system that appeared even before pregnancy can affect.

Symphysitis during pregnancy can lead to negative consequences. But the prognosis is usually favorable.

Symptoms

Symptoms of symphysitis during pregnancy most often appear towards the end of the second and beginning of the third trimester. For inflammation of the symphysis, the following symptoms are characteristic:

1. Swelling in the region of the pubic joint. At first it is insignificant, but with the progression of the disease, the swelling becomes stronger;
2. Pain in the pelvic and pubic region, as well as in the groin, coccyx and thighs. Painful sensations change the gait of the pregnant woman, she walks waddling from side to side;
3. Pain and clicks on palpation of the pubic region;
4. Sharp pain when changing the position of the body, when climbing stairs;
5. Constant feeling of heaviness in the pelvic area;
6. Inability to raise straight legs in a prone position due to sharp pain;
7. With the progression of the disease, painful sensations appear at rest. It is difficult for a pregnant woman to find a comfortable position in which pain is reduced.

Symphysitis treatment

How to determine symphysitis during pregnancy? This question worries women who have certain symptoms of the disease.

Before making a diagnosis, it is necessary to conduct additional diagnostics (see also the article What tests are taken during pregnancy ?>>>).

The symptoms of the disease are usually pronounced and there are no problems with the diagnosis. But ultrasound with symphysitis during pregnancy will help to identify not only the disease itself, but also its stage.

There are three stages in total:

• the first, in which the expansion is 5-9 mm;
• the second, with it a distance of 10 to 20 mm;
• third, the distance between the bones is more than 20 mm.

In the treatment of symphysitis during pregnancy, calcium preparations are prescribed. But only if there is evidence, since in the last months of pregnancy, calcium can do more harm than good.

In the third stage of the disease, bed rest may be prescribed.

By the way! Currently, special corsets have appeared on sale, which are designed to hold the pelvic bones. When using such a corset, bed rest is not so strict.

With severe pain, a pregnant woman can be hospitalized. At the hospital, she will be given physical therapy to help ease the pain.

Why is symphysitis dangerous during pregnancy?

Fortunately, the disease does not affect the health of the baby.

But this disease cannot be called harmless. Inflammation of the pubic area subsequently leads to its loosening and weakening + pain brings a lot of discomfort to the expectant mother.

In addition to the pain symptom, a woman may be forbidden to give birth naturally.

Attention! Some pregnant women are very worried about this, because they wanted to give birth on their own. But with such a diagnosis, it is important to take into account the opinion of doctors.

Prevention of symphysitis

1. Reception of additional vitamins should be only on the basis of a clinical blood test;
2. It happens that calcium-phosphorus metabolism is disturbed in the body, which prevents the body from absorbing calcium in the required quantities from food;
3. In this case, you can visit a homeopathic doctor who will help correct this violation. Homeopathy is safe during pregnancy.

I'll tell you my personal experience.

Starting from the second pregnancy, approximately from the 20th week of pregnancy, my pubis began to hurt terribly.

After every walk or load around the house, I wanted to lie down and lie down. By the end of pregnancy, it was even painful to roll over from one side to the other during sleep.

All these are signs of symphysitis.

It is important not to panic if the doctor makes a similar diagnosis, but be sure to ask the diagnostician to measure the distance of the symphysis at the next ultrasound in order to understand what the discrepancy is.

Despite severe pain, my discrepancy was small. those. your feelings are not a marker of the severity of the condition.

According to the blood test, my calcium was normal.

• During pregnancy, in addition to observation in the antenatal clinic, I was also observed by a private midwife, who was very closely involved in my nutrition and we tried to correct the pain through nutrition;
• Every week I was told to boil the jelly and consume this natural gelatin so that the ligaments were stronger. So I did. The condition is not strong, but improved;
• In addition, for long walks, she always wore a bandage to reduce the load on the pubic bones.

She gave birth herself, no one even talked about caesarean.

In the third pregnancy, the condition was similar, I was already mentally prepared for it, so I treated it as an inevitable situation - apparently my body is just prone to such a course of pregnancy.

Particular attention should be paid to preparing for childbirth: to train proper breathing, not to push ahead of time in childbirth, to push correctly so that the load on the symphysis is adequate.

I talk about these moments in an online course. Easy childbirth: how to give birth without ruptures and protect the baby from birth trauma >>>

It is also very important to take care of yourself after childbirth:

1. The hormone relaxin leaves the body gradually, so for the first 10 days, try to spend the maximum amount of time on bed rest so that weak ligaments do not get damaged;
2. Slowly increase the load. If you feel that while walking or carrying a child in your arms, there are unpleasant sensations in the pubic region - buy a bandage or gird a tight scarf under your stomach;
3. Also, be sure to visit an osteopath during pregnancy and immediately arrange an appointment with him after 40 days after childbirth. He will correct all your muscles and ligaments so that the body returns to normal faster.

What else can help you to slow down the progression of symphysitis:

• Change in body position. In order for the blood in the small pelvis not to stagnate, you can not sit in front of a computer or in front of a TV for a long time. From time to time you need to get up, you can do a couple of simple exercises;
• In the third trimester, it is necessary to wear a special bandage that will reduce the load on the pelvic bones;
• If possible, go up the stairs less often;
• All movements should be smooth, both when walking and when changing body position;
• Watch your diet, the diet should be enough vitamins and nutrients. But also, excessive weight gain should not be allowed;
• While resting, raise your legs, put a small pillow under your buttocks so that the pelvis is slightly raised.

As you can see, the disease brings a lot of inconvenience during pregnancy, but you can survive everything and give birth yourself.

Therefore, a positive attitude is our everything!

Ask your questions in the comments, I will help in any way I can.

Slight pain in the pelvis during childbearing is a variant of the norm, if they do not violate the general well-being or ability to move. But sometimes they hide the symptoms of symphysitis - softening and divergence of the bones of the pubic joint. The disease can develop acutely or gradually, it affects the course of pregnancy and the choice of method of delivery.

Features of the pelvis in pregnant women

Anatomically, the female pelvis differs from the male: the bones are connected at such an angle that a cylindrical channel is formed inside, and the coccyx does not tuck inward. By adolescence, all bones fuse into a fixed, rigid pelvis. The exception is the connection of the left and right pubic bones between themselves and the cartilage between the sacrum and the ilium.

The pubic articulation is formed by a cartilaginous plate and ligaments that run from four sides. The strength of this area is individual. Studies have shown that it can be either an immovable fusion or a semi-movable joint.

In women, the state of cartilage tissue is subject to hormonal influence and biochemical fluctuations in the body. During pregnancy, substances produced by the placenta join the usual hormones. This affects the state of the ligamentous apparatus, which adapts to gestation and childbirth.

What leads to the appearance of symphysitis

The causes of symphysitis, or dysfunction of the pubic joint, have not been precisely established. Several theories have been developed, but none of them is the final version.

During pregnancy, the placenta produces relaxin - a hormone that causes softening of the connective tissue in the pelvis, together with other active substances, enhances the growth of the mammary glands. The cartilages that form the symphysis swell, loosen, so the pubic bones become more mobile. The discrepancy can reach 1-2 cm. But they say about symphysitis if the diastasis exceeds the physiological norm of 5-6 mm.

The effect of relaxin on the state of cartilage tissue has been proven, but there is no direct relationship between the severity of the condition and the concentration of the hormone. At the 10th week of pregnancy, its concentration is minimal, but some women may experience severe symptoms of the disease. Relaxin reaches its maximum in the blood at week 32, but not all pregnant women in this period show signs of symphysitis.

Scientists consider the disease as one of the manifestations of metabolic disorders, associate the first symptoms with the initial stage of osteomalacia - softening of the bones. The risks of symphysitis increase in the presence of the following diseases and conditions:

• transferred syphilis;
• tuberculosis;
• various types of jaundice;
• hemorrhagic diathesis;
• arthritis;
• trauma of the pelvis, muscles of the lower back and hips in history.

A theory has been developed that links dysfunction of the pubic symphysis with impaired calcium metabolism and spasm of the pelvic muscles.

The risk of symphysitis increases if similar symptoms of the disease bothered you in a previous pregnancy. But a direct relationship with the following factors has not been proven:

• body mass index (large weight);
• the number of births;
• method of delivery;
• weight of children born and gestation;
• interval between births;
• smoking;
• mother's age;
• taking hormonal.

In pregnant women with symphysiopathy, more often than in other women, there are diseases that indicate systemic dysfunction of the connective tissue:

• mitral valve prolapse;
• osteochondrosis;
• phlebeurysm;
• myopia;
• Marfan syndrome.

Some researchers consider excessive relaxation of the ligaments of the womb as a form of toxicosis of pregnant women.

Symptoms that cause concern

Statistics on the incidence of symphysitis ranges from 0.12 to 56% of all pregnancies. This discrepancy is due to the following factors:

• standard criteria for diagnosis have not been developed;
• not all women pay attention to pelvic pain;
• Not all doctors are attentive to pelvic pain.

It is difficult to determine symphysitis on your own, the divergence of the pubic articulation is a normal process, if it does not exceed the physiological value. The severity of the pain syndrome does not always correspond to the severity of the condition.

The first signs of dysfunction of the pubic symphysis appear in the early stages of pregnancy, from the moment of an increase in the hormonal function of the chorion. But most often pronounced symphysitis manifests itself in the 3rd trimester.

A woman notices soreness in the pubic bone area, which increases with movement and disappears after rest. Pain in symphysitis is given to the lower back, inner thigh, groin and perineum. By nature, they are aching or shooting. Unpleasant sensations are aggravated by turning in bed, getting up, walking. It is painful for a pregnant woman to stand on one leg, lean forward, go down and up stairs. Many complain of increased fatigue.

Some women complain of a crackling or grinding sensation in the joint. In severe cases, there are problems with urination and defecation, pain during intercourse.

There is no data on whether symphysitis can decrease during pregnancy. Studies show that after the first signs of pathology appear, the condition either stabilizes or gradually worsens. The cause of the disease is pregnancy, therefore, after childbirth, in most women, discomfort quickly disappears. Pain persists for up to 6 months and more in only 3% of puerperas.

What is dangerous divergence of the womb

The influence of pathology on the course of pregnancy has not been proven. But expectant mothers with symphysiopathy have an increased risk of the following complications:

• premature rupture of amniotic fluid;

Why is symphysitis dangerous during pregnancy?

An increased risk of postpartum complications. With a slight dysfunction of the pubic joint, the risk increases during the use of obstetric forceps, shoulder dystocia, extraction of the fetus by the pelvic end, and when a child is born weighing more than 4 kg or.

The consequences of symphysitis appear immediately after childbirth in the form of a rupture of the pubic joint. The puerperal complains of pain in the pubis, which intensifies when trying to get out of bed, spreading her legs. When trying to feel the area of ​​the symphysis, there is a small dip under the fingers, up to 1-2 cm wide. The bosom swells, palpation is painful.

With a rupture of the symphysis, a long-term rehabilitation treatment is carried out. It stretches for a period of at least 3-5 weeks. A woman needs to observe bed rest. Accelerates the recovery of cross bandaging. Some doctors recommend changing the bed to a hammock. In this state, it is difficult for a young mother to take care of a child, so constant help from loved ones is required.

Rupture of the symphysis, with proper treatment and following the recommendations, goes away in most women. But there is a chance of the transition of the disease into disability. Subsequent pregnancies with past pathology should end with a caesarean section.

Examination for suspected disease

Diagnosis begins with a medical examination. Visually, swelling is noticeable in the symphysis area; on palpation, the pregnant woman feels pain. With fingers, the doctor can determine a slight divergence of the bones, but with a minimal degree this is not always possible. Additional tests help in the diagnosis:

• unilateral or bilateral Trendelenburg symptom;
• positive sign of Lasegue;
• sometimes a positive Patric test;
• duck gait with short waddling steps.

With simultaneous pressure on the wings of the iliac bones, the pain in the pubis increases. Some develop soreness in the paravertebral muscles, piriform ligaments, buttocks.

The intensity of the pain syndrome is assessed on a visual analogue scale (VAS), where 0 points is the absence of pelvic pain, 1-2 points is mild, 3-4 points is moderate, and 5 is severe. This allows the doctor to assess the patient's condition.

Pain in the womb area with pressure does not always speak in favor of symphysitis. Therefore, instrumental methods are needed. For a long time, x-rays were the gold standard. But exposure harms the baby.

Ultrasound is the safest way. Sonography can be used several times to monitor the condition and plan the tactics of childbirth. On ultrasound, you can notice diastasis of the bones of the womb, which is less in older women. The norm of discrepancy is up to 5 mm. Exceeding this indicator indicates a possible dysfunction of the pubic joint. The degree of the disease depends on the width of the lumen:

• 1 degree - 5-9 mm;
• 2 degree - 10-20 mm;
• 3 degree - more than 20 mm.

With a discrepancy of 4-5 mm, most pregnant women experience discomfort and unexpressed pain. A discrepancy of 6-7 mm leads to the appearance of radiating pain.

Signs of the disease on ultrasound are also a fuzzy image of the ends of the pubic bones, reduced echogenicity of the peri- or intrasymphysial space. Ultrasound allows you to assess the condition of the soft tissues of the pelvis and ligaments. Doppler ultrasound during ultrasound shows the state of blood flow. For pregnant women with 1 degree of discrepancy, a highly resistive type of blood flow is characteristic. With symphysitis of 2 degrees or more, a low-resistance type is detected.

Additional diagnostic method -. It is not associated with radiation exposure, so it is safe during pregnancy. But due to the length of the procedure and the need to lie on your back, it is difficult to use it for a long period of pregnancy. Women develop inferior vena cava syndrome due to uterine pressure and impaired blood flow to the upper torso.

Laboratory methods do not help to accurately diagnose the divergence of the womb. But according to studies, in pregnant women with symphysitis, the activity of type II and IV interleukins, tumor necrosis factor, increases in the blood. The relationship between the concentration of progesterone, estrogens and symphysiopathy has not been established.

Symptoms of the disease are non-specific, they may mask other pathologies. Therefore, it is necessary to appoint consultations of specialized specialists: a neurologist, an orthopedist, a surgeon. Differential diagnosis is carried out with the following diseases:

• lumbago;
• inguinal hernia;
• urinary tract infection;
• thrombosis of the femoral vein;
• damage to the intervertebral disc;
• osteitis;
• osteomyelitis and infection of the pelvic bones.

Pregnancy management and treatment methods

How to treat the disease depends on the severity of the symptoms. Due to the unknown cause of the condition, it is impossible to choose therapies. Treatment is reduced to alleviating the condition, inhibiting the progression of the disease and preventing rupture of the womb during childbirth.

Be sure to wear a bandage. A double-sided corset is recommended, which can be used before and after childbirth. The bandage should be wide enough to grip the skewers of the femur. It will help guide the pelvic bones, evenly distribute the load and reduce pain.

You can relieve pain with symphysitis with the help of non-steroidal anti-inflammatory drugs, but you must first consult a doctor. Drugs in this group can lead to accelerated maturation of the cervix and provoke an early onset of labor. Especially dangerous are Ibuprofen, Indamethacin. Let's say paracetamol. Other drugs - only after consultation with the doctor and assessment of the potential risk to the fetus.

Drug treatment is supplemented with B vitamins and calcium, zinc, and magnesium preparations. A diet rich in natural trace elements is recommended. In the diet, you need to increase the amount of animal products, low-fat cottage cheese, cheese, dairy products, meat, eggs, cereals.

Treatment of symphysitis during pregnancy is supplemented with physiotherapy methods:

• electromyostimulation;
• outdoor heat;
• cooling methods.

You can anesthetize and reduce swelling with the help of acupuncture, but you should be careful when choosing a specialist. Lumbar massage can relieve muscle tension. Avoid too intense pressure and sharp, painful techniques.

To relieve severe pain that cannot be stopped by other methods, they are used from the 2nd trimester. A 0.1% solution of Bipuvacaine mixed with Fentanyl is injected into the epidural space of the spine. Anesthesia is continued for 3 days. Subsequent treatment is carried out with the help of non-steroidal anti-inflammatory drugs and physiotherapy. This gives good results and allows you to bring the pregnancy to the desired date.

In foreign clinics, surgical methods are used to strengthen the pubic joint, which allow you to get rid of unbearable pain and allow women to give birth on their own.

How to give birth with symphysis

The choice of method depends on the degree of discrepancy: 1-2 are not an indication for caesarean section in the absence of other aggravating circumstances. Symphysitis of the 3rd degree is dangerous with the possibility of rupture of the pubic joint, therefore, a caesarean section is preferred.

Operative delivery is needed for women who had a rupture or discrepancy of the 3rd degree during a previous pregnancy.

The final assessment of the condition should be done at 36 weeks of gestation. It is necessary not only to diagnose the condition of the symphysis, but also the size of the pelvis, the estimated weight of the fetus, which can affect the outcome of childbirth.

Prevention options

It is difficult to predict the development of the disease, since the causes of its occurrence have not been established. Prevention of symphysitis includes general measures to improve the well-being of a pregnant woman.

All pregnant women are recommended to wear an obstetric bandage from 25 weeks. It increases lumbar support, unloads the ligamentous apparatus of the pelvis. The size of the bandage is selected depending on the volume of the pelvis. But if discomfort appeared in the period of 20-22 weeks, the bandage can be used earlier. This will prevent the progression of the disease.

It is important to follow the rules for wearing a corset. He is dressed in a prone position, placing ribbons on the lower back and under the stomach. The bandage must be worn constantly throughout the day. Take it off for rest.

A rational mode of work and rest helps to prevent the development of symphysitis during pregnancy. It is not recommended to walk a lot, especially with the appearance of aching pain in the pelvis, to lift weights. At least once a day, you need to take a horizontal position, you can raise a little leg to improve the outflow of blood.

Pregnant women need to take vitamin and mineral complexes that make up for the deficiency of essential trace elements. To clarify the state of mineral metabolism, it is possible to establish a lack of calcium in a biochemical blood test and take it additionally.

When resting on your side, place a pillow or rolled-up blanket between your thighs. If you need to roll over to the other side, this is done gradually: first, both legs, brought together and bent at the knees, followed by the torso. Most of the homework is recommended to be done in a sitting position, not standing. No need to make movements that cause discomfort or pain in the pubis. This will cause the condition to worsen.

Exercise will help strengthen the muscles of the pelvis and hips. You can perform the following exercises even before pregnancy:

1. Sit on a chair, hold a soft ball between your knees. Keep it under the count to 10. Later you can complicate it - take an elastic ball, and squeeze and relax your knees, but do not let the ball fall.
2. Sitting on a chair with the ball clamped in your knees, try to get up and sit down. It is necessary to ensure that the back is even, do not lean forward or to the sides, and distribute the load on the legs evenly.
3. Squats in a position with your back to the wall on an imaginary chair with a ball clamped.

Avoid exercises with twisting and turning the torso, relying on one leg and breeding the hips. You can not do leg swings, wide steps and lunges, lift weights.

Despite the methods of prevention, it is not always possible to prevent the onset of the disease. This is especially true for women with extragenital connective tissue diseases.