Symphysitis is not in pregnant women. Symphysitis is an unpleasant surprise of pregnancy. Photo gallery: drugs for the treatment of symphysitis

Undoubtedly, waiting for the appearance of a new little man is a miracle. To feel how life is born and formed in you is very pleasant, unusual and even magical. But pregnancy is a very big burden on a woman's body, and it has a number of "side effects". Therefore, it is often accompanied by various unpleasant symptoms, pain, and complicates simple life activities. And if some of these sensations indicate an increased load, then others may indicate various kinds of diseases.

One of these unpleasant conditions is inflammation in the place where the pubic bones connect, and it is called symphysitis. Let's figure out how to recognize it, how to treat it, and how dangerous this condition is.

Let's first understand what a symphysis is.. In a woman, the pelvis consists of the sacrum and pelvic bones, one on each side. They are connected behind by two sacroiliac joints, and in front - by the pubis. This anterior articulation is called the symphysis.

In a normal healthy state, the symphysis is a cartilaginous disk, in the middle there is a cavity that is filled with joint fluid. But this joint is fixed and limited in mobility. During pregnancy, the woman's body produces the hormone relaxin, under the influence of which the pelvic joints closer to childbirth behave more movably and soften. Nature provided such a function so that during childbirth it would be more comfortable and easier for the child to pass through the birth canal.

So, it happens that the joints become too soft and the pubic joint becomes inflamed and swollen. This pathology is called symphysitis, and pain in the pelvic area is called symphysiopathy. It can appear at any stage of pregnancy, but often it is detected already in the third trimester.

There is a symphysis of the first, second and third stages of divergence:

The divergence of the pubic bones by 5-9 mm. At this stage, most often, patients do not reveal complaints and can give birth on their own.
The divergence of the pubic bones by 10-20 mm. There are pains in the pelvic area. There are indications for a caesarean section.
The distance of the pubic bones is more than 20 mm. This degree is accompanied by severe pain when walking, turning over on one side and moving the legs. In this case, the pregnant woman enters the hospital under strict supervision, and the delivery is strictly surgical.

Causes of symphysitis

It is still not known exactly what exactly influences the development of the disease.. But doctors put forward several main possible reasons why this pathology occurs:

the hormone relaxin is produced in larger quantities than necessary;
beriberi and calcium deficiency.

Also at risk are pregnant women who have:

the presence of diseases in the musculoskeletal system;
possible bone injury;
urogenital infections;
a significant number of births;
large fruit weight - over 4 kg;
strong or "preeclampsia";
chronic problems associated with ion exchange;
heredity.

Often, this disease is detected by the symptoms of a pregnant woman and confirmed during an ultrasound examination (ultrasound), since X-rays and magnetic resonance imaging are contraindicated during pregnancy. Although, as practice shows, during only 40% of women find symphysitis. It can also occur as a result of difficult childbirth, and bring anxiety to a woman after them.

Symphysitis symptoms

First of all, it is by characteristic signs that one can suspect this pathology in oneself. And you should definitely inform your doctor about this in order to take timely measures and not complicate the degree of the disease.

So here are the symptoms to look out for:

pain during physical exertion or pressure in the pubic area, can be given to the coccyx, throughout the pelvis or thigh;
the pain intensifies with the development of symphysitis and can disturb even in a stationary state;
during the movement, clicks or a crunch are heard;
there is a so-called "duck" gait or lameness;
soft tissues in the pubic area swell;
may be subfebrile temperature.

Important! A characteristic sign of symphysitis is pain in the pubic area, if you try to raise your legs while lying on your back.

Basically, symphysitis manifests itself in the second half of pregnancy, but symptoms may appear earlier. Women who give birth not for the first time and have already encountered this problem recognize the signs of symphysitis earlier. Symphysiopathy is especially pronounced at night.. It is painful for a pregnant woman to roll over from one side to another, to get out of bed. During the day, pain interferes with walking, climbing stairs and simply enjoying your beautiful position.

Treatment and prevention of symphysitis

But do not get upset prematurely. To date, there are methods for treating and alleviating the condition of symphysiopathy during pregnancy.. Of course, first of all, you need to contact your doctor, describe all the symptoms that bother you. After the examination, the doctor should prescribe an ultrasound examination (ultrasound) to confirm the symphysitis and identify its stage.

Most often, at stages 2-3, wearing a special bandage is prescribed.. It reduces pressure on the inflamed area and, thereby, facilitates the bearing of the child.

Also, the doctor may prescribe vitamin preparations containing calcium..
But be CAREFUL: do not take calcium on your own, as an excess of it, especially in the last months of pregnancy, can adversely affect childbirth and the baby. The placenta tends to accumulate calcium, which makes it difficult for the baby to get oxygen. And the hardening of the bones of the skull will greatly complicate the birth of a child.
You can contact an osteopathic doctor who will select the right massages, physiotherapy and therapeutic exercises. He will also prescribe medications that are appropriate for your case.
In some, especially acute cases, hospitalization is attributed to a woman, and they are used to relieve pain.

With a more gentle first stage, you need:

less walking, respectively, more time to lie down;

stick to a diet;
take vitamins and calcium;
to reduce pain, take painkillers that are allowed in your position;
purchase an orthopedic mattress;
do not stay in one position for a long time;
if possible, minimize walking on stairs;
do exercises to strengthen the pelvic muscles.

Fortunately, symphysitis in pregnant women often disappears after childbirth by itself., so that the treatment is aimed at alleviating the condition of the woman. In addition, since doctors still do not agree on what exactly causes this pathology, it is difficult to say exactly how to prevent it. But still there are some tips for the prevention of symphysitis:

stick to a healthy diet and include calcium-containing foods and B vitamins in the diet;
do not physically overload yourself and rest more;
visit your doctor regularly for check-ups so that you can identify the problem at an early stage of development;
watch your weight so that the load on the pelvis is not excessively high;
when standing, distribute weight evenly on both feet;
when sitting, you should not cross your legs (during pregnancy, this position also harms your baby, so exclude it for a while);
do not sit in one position for more than an hour;
do special exercises for pregnant women.

Exercises for symphysis

There is a set of exercises for symphysitis. Doctors recommend doing it for medicinal purposes in this pathology. Such exercises strengthen the muscles of the pelvis, hips and lower back, and this gymnastics also reduces pain.

Do this easy set of exercises every day, and if you have pain, you can do it several times a day. But remember that during pregnancy you should not overload yourself and do it through force. Do all exercises slowly and smoothly, without sudden movements and with pleasure.

Video: exercises for the prevention of symphysitis during pregnancy

In this video you will find some more exercises during pregnancy for the treatment and prevention of symphysitis.

Supplements in the diet for symphysis

In addition to gymnastics, you can use folk recipes to improve your condition. Introduce foods such as goat cheese, prunes, fish, almonds, or, for example, sesame into your diet. After all, sesame seeds are rich in amino acids and oils, and they contain much more calcium than in dairy products.

Recipe for sesame mixture:

100 g sesame;
honey to taste.

Mix the ingredients and take one tablespoon 3 times a day. Also, this mixture can be used as an additive to cereals, cottage cheese or fruits. It will be very tasty and will ease the pain of symphysitis.

Does symphysitis affect childbirth

As practice shows, symphysitis does not affect the health and well-being of the baby either in the womb or at birth. But the expectant mother can get serious injuries during childbirth. After all, childbirth is a huge burden on the pelvis, and when damage or inflammation in the pubic junction already exists, the likelihood of rupture of the ligament of the pubic bones is high.

Therefore, it is so important to determine symphysitis before childbirth. After all, the recovery period after this can end in months, and sometimes even years. In the most difficult cases, surgery is required. Therefore, in order to avoid such consequences, with symphysis of the second and third degrees, a “caesarean section” is prescribed.

Indications for operative delivery with symphysitis are:

divergence of the pubic bones by more than 10 mm;
narrow pelvis;
fetus over 4 kg;
very severe pain.

Causes of symphysitis after childbirth

It is worth noting that symphysitis can develop just after childbirth. Numerous factors can be the cause. For example, if the fetus is large enough and the pelvis is narrow, then as it passes during childbirth, it can damage the birth canal.

It is worth considering that the physiological processes in the female body during pregnancy are due to softening of the ligaments that hold the pubic bones at a distance from each other and swelling. As a result, the ligaments may partially lose their ability, and the bones simply diverge. Due to swelling during pregnancy, the joints are also exposed to this factor, thereby increasing their mobility.

During preparation for childbirth, the pubic bones can diverge up to 6 mm - this is the norm. But after childbirth, the woman's body must recover on its own and return to its original position. Unfortunately, this is not always the case, and help is needed to recover.

If a woman already has pathologies associated with diseases of bone structures or joints, trauma to the sacrum, as well as severe toxicosis, hormonal disorders or a lack of vitamins, then symphysitis may occur after childbirth.

Treatment of symphysitis after childbirth

In such cases, a woman is prescribed medications containing calcium, magnesium and B vitamins. This often promotes healing and excludes surgery.

Also, after childbirth, it is necessary to wear a bandage with symphysitis. Special corsets have been developed that hold the pelvic bones in the correct position. This gives you the opportunity to take care of your newborn baby at least a little.

It is important to limit the maximum physical activity, and for relaxation it is better to choose a high-quality orthopedic mattress.

If necessary, the doctor will prescribe antibacterial (if there is a urogenital infection) and painkillers or ointments. In addition, physiotherapy, such as ultraviolet radiation, can speed up the healing and recovery process.

Effects

In the presence of this pathology, a woman wants to know how long symphysitis passes after childbirth. Symptoms may appear for quite a long time. It all depends on the degree of damage, but the minimum recovery period will be at least a month, and with a more complex degree - from six months to several years.

A complication after symphysitis may be a change in the functioning of the musculoskeletal system - gait is disturbed. If this disease is not treated, it can lead to further changes and the development of pathologies in the spine. Pain will increase and limit the activity of movement. Inflammatory processes in the pelvic area may occur, which contributes to the development of diseases of the genitourinary system. For the treatment of such pathologies, you should consult a urologist.

In any case, do not ignore the symptoms and delay treatment. First of all, consult with your doctor and let him choose a comprehensive treatment for you.

Who has already gone through this test, advise what methods you used, and what most effectively affected the recovery process after symphysitis. Maybe someone knows additional methods of treatment or prevention of this pathology - share your experience in the comments. What methods of pain relief during pregnancy do you know?

There are many changes in the body of a pregnant woman. All of them are aimed at making the birth of a healthy child possible, as well as at making this process as easy as possible.

Changes affect literally the entire body, including the musculoskeletal system. In particular, under the influence of the hormone relaxin, the joints in the pelvic bones soften. This increases their mobility, and it is easier for the fetus to pass through the birth canal during childbirth.

But far from always what nature intended goes according to the scenario. Various failures often occur, as a result of which pathologies arise that leave their mark on the course of pregnancy and the course of childbirth. One of these pathologies is symphysitis.

The word "symphysis" in medicine means the pubic articulation of the bones, what we used to call the pubis. During pregnancy, this joint naturally stretches, gaining some mobility. This, as already mentioned above, is a normal process necessary for the successful completion of childbirth.

However, for one reason or another, this process can go wrong. As a result, the joints soften too much, become hypermobile and strongly stretched, which leads to swelling of the pubis, pain, and discomfort. It is this condition that is called symphysitis.

Causes of symphysitis

Unfortunately, doctors have not yet come to a consensus about what exactly leads to the development of symphysitis. There are several opinions on this matter. In particular, many doctors are confident that the development of this pathology is associated with a lack of calcium in the mother's body. In addition, symphysitis is associated with hormonal disorders, namely with an excess of the hormone relaxin. Since during pregnancy the hormonal background of a woman is not stable, from time to time violations occur in the well-established mechanism.

There are also theories linking this disease with hereditary characteristics and various problems of the musculoskeletal system that could have arisen even before the onset of pregnancy. Not the last place is given in the list of possible causes of symphysitis and directly to the course of pregnancy. There is an opinion that rapid weight gain, physical activity, non-compliance with the regime and an inappropriate diet can affect the hormonal background of a woman, and, consequently, cause symphysitis.

Symptoms and diagnosis of symphysitis

Since the softening of the joints normally begins closer to childbirth, then its symptoms, as a rule, begin to disturb women in the third trimester of pregnancy. However, it is not uncommon for them to visit the patient already in the middle of the 2nd trimester.

How to define symphysitis? With due care, this can be done already at an early stage, when the changes are not yet too strong. First of all, a woman begins to be disturbed by pain in the pubic area while walking, climbing stairs. During this period, it is easy not to attach importance to painful sensations, writing them off as natural changes. Then the disease continues to develop.

As it develops, the pain intensifies and disturbs the woman already in a calm, and sometimes in a lying position. When turning, getting up from a chair or bed, lifting the legs, the pain becomes even stronger.

Pubic edema is also a characteristic symptom of symphysitis. Together, this leads to a strong change in gait. The steps become short, heavy, the woman walks slightly waddle. It is this gait that is colloquially called duck.

If a woman observes all or part of the signs of symphysitis, she must immediately inform her gynecologist about this. After all, this disease is not only painful, it can affect the course of childbirth.

Childbirth complicated by symphysitis

Due to too much stretching of the joints during childbirth, they can tear. And this means several weeks of bed rest, complex treatment, pain and much more, which is poorly combined with happy motherhood. Instead of taking care of her newborn child, the woman will be forced to endure considerable suffering and look for an assistant during the treatment. But not everyone has the opportunity to find a nanny. Yes, and I want to take on these pleasant chores myself. And for one thing, and establish contact with your baby, because this is also very important.

But, despite such serious risks, the presence of symphysitis does not at all put an end to natural childbirth. If the pubic articulation has diverged by no more than 10 mm, the fetus is not large and is in the head position, and the woman's pelvis is wide enough. If one or more of these conditions is violated, then doctors will recommend a caesarean section.

Diagnosis of symphysitis during pregnancy is difficult because it is extremely undesirable for women in position to take an x-ray. For this reason, the initial diagnosis is based on the woman's descriptions of the nature and severity of the pain. Often the doctor conducts a gynecological examination, and an ultrasound is prescribed for clarification. Computed tomography or magnetic resonance imaging can also help to make a diagnosis.

Treatment and prevention

Unfortunately, it is impossible to cure symphysitis. It just goes away after childbirth, when the hormonal levels even out. Relaxin ceases to affect the bones and joints, and they return to normal. Therefore, the treatment of synphysitis during pregnancy comes down to alleviating the condition of the woman and choosing the right birth strategy.

First, it is necessary wear a special bandage on the hips which resembles a tight skirt. It will support the pelvis and hips, preventing further stretching of the joints. This helps relieve puffiness.

Secondly, women with symphysitis do not walk, stand or sit in one place for more than 1 hour . Legs should be kept in a symmetrical position.

Also, include in your diet more foods rich in calcium . For example, milk, cottage cheese, yogurt, cheese, other dairy products, herbs, nuts, fish. It is very important to normalize digestion, as this will increase the absorption of calcium. In addition, excessive weight gain should be avoided, as this increases the load on the softened joint.

By the way, it is important to remember that calcium is well absorbed only if there is a sufficient amount of vitamin D in the body. The nuance is that this vitamin is not absorbed by our body from food, but is synthesized under the influence of sunlight. So pregnant women with symphysitis need to be outdoors more often. And in winter, it makes sense to take additional vitamin D. It can be taken together with calcium preparations.

In severe cases, hospitalization may be required. As part of the course, a woman is given physiotherapy, anti-inflammatory drugs, and anesthesia. For special indications, epidural analgesia may be performed. But hormonal therapy for symphysitis, as a rule, is not prescribed.

Prevention of symphysitis is a difficult matter, since the causes of the disease have not been reliably identified. However, it is believed that it is still possible to reduce the risk of the disease. To do this, it is recommended to reduce physical activity, replace them with special gymnastics and exercises that your doctor will recommend to you. It is not worth picking up a course of exercises on your own, since each woman may also have individual contraindications to certain actions.

No less important for prevention is a diet that includes, as in treatment, a large amount of calcium. Taking a multivitamin containing calcium and vitamin D will also not be superfluous. This is especially true in winter, when even frequent walks cannot provide enough vitamin D, since the sun sets early and rises late.

Unfortunately, symphysitis is a fairly common disease. According to statistics, to one degree or another, up to 50% of pregnant women face it. It is noticed that if in the first pregnancy there was a disease, then in the second and subsequent, most likely, the woman will face the same problem.

Fortunately, symphysitis does not affect the child. And for the mother, the risk is minimal: doctors carefully monitor the condition of the pregnant woman, and in case of danger, she simply will not be allowed to give birth herself, but will perform a planned caesarean section. And after childbirth, the hormonal background normalizes, and all bone joints return to their normal state. And along with this, soreness and swelling will disappear.

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Content

Pregnancy is a special state of the female body, in which significant hormonal changes occur. The musculoskeletal system of a woman can sometimes undergo changes during this period. Calcium deficiency, hormonal changes and excessive exercise can cause inflammation of the pubic symphysis or symphysitis in pregnant women. Symphysitis during pregnancy is manifested by pain in the pelvic bones due to their divergence and excessive mobility. Such pains are called symphysiopathy.

What is symphysitis during pregnancy

According to the medical classification, if the name of the disease ends in -it, it means that it has an inflammatory nature. In this case, symphysitis is not only inflammation, but also any changes that the pubic joint undergoes during pregnancy: softening, swelling, stretching, spreading or tearing. During this period, the articulation of the pubis becomes especially mobile in preparation for childbirth. Under a number of circumstances during gestation, this process can develop with pathology: in a woman, the joints soften, diverge - this is symphysitis.

ICD-10 code

ICD-10 is the tenth revision of the International Classification of Diseases. According to it, all diseases are divided into classes according to the clinical picture, and there are twenty-one classes. Symphysitis or symphysiopathy during pregnancy belongs to the class “Pregnancy, childbirth and the postpartum period” (O00 - O99), block O20 - O29, group O26.7 - Subluxation of the pubic joint during pregnancy, childbirth and in the postpartum period.

Symptoms

It is possible to determine such a complication according to the patient's complaints. The main symptom is pain in the pubic area, which is weaker during the day and stronger at night. Causes pain moving the hip to the side. Further, pain sensations spread to the joints and bones of the pelvis, lower back, coccyx. Another additional symptom of symphysitis during pregnancy is pain in the muscles of the knees and walking like a duck, which causes problems with climbing stairs and discomfort can be felt even when lying on the bed. Characteristic is the manifestation of a crunch when pressing on the pubic bone.

It hurts to walk

Already in the early stages of pregnancy, at the initial stage of symphysitis, pain in the pelvis, in the lower abdomen, especially when walking and exerting, may occur. These are symptoms of the natural physiological changes associated with childbearing. They are not strong intensity, unstable and do not cause severe discomfort. If such pain occurs for a period of 2-3 trimesters when walking and even just in a standing position, and sharp pains are not uncommon when the position of the body changes, these may be signs of symphysitis during pregnancy.

Causes

The exact cause of the divergence of the pelvic bones during pregnancy has not been disclosed today, but there are two main versions of the occurrence of this disease. According to the first of them, a calcium deficiency in a woman’s body leads to this, because it is responsible for the condition of the bones. According to the second version, everything is to blame for the excessive content of the hormone relaxin, under the influence of which the bosom becomes mobile and diverges for labor. Contribute to the appearance of symphysitis:

Ehlers-Danlos syndrome - a defect in collagen, in which there is great mobility of the joints, brittle bones and a tendency to sprains;
multiple births;
damage to the pelvis, its muscles, joints;
a child of large size and heavy weight;
low activity, mobility during pregnancy;
conception of the second (third, etc.) baby.

Degrees

Symphysitis can be in various forms in severity, depending on how severe the softening is, how the bones associated with the symphysis have dispersed. The second and third stages of the disease are indications for a caesarean section, which is performed by a doctor, and natural childbirth is possible with symphysitis during pregnancy if the discrepancy is not more than 1 cm, and the child is small. Consider what are the stages of the disease during gestation:

stage one - a discrepancy from 5 to 9 millimeters;
stage two - from 10 to 19 millimeters;
stage three - more than 20 millimeters.

What is dangerous symphysitis

If you have been diagnosed with symphysitis, do not get upset or panic. Early diagnosis, detection during examination guarantees the possibility of 99% successful treatment during gestation. However, there is a need to be aware of the dangers, as in severe cases of symphysitis, surgery is indicated. This is because the probability of rupture of the pelvic joints is too high, and this is a very painful injury that requires a long recovery of health, pain relief to alleviate the condition.

Diagnostics

Diagnosis of symphysitis during pregnancy takes place in several stages, it consists not only in ultrasound, but in a comprehensive examination of the state of the body of the future woman in labor:

analysis of complaints that have arisen during pregnancy - how long ago the pain in the pubis began, are there any changes in gait, in which trimester complaints occur;
analysis of the lifestyle of a pregnant woman - pelvic injuries, operations, taking vitamins, foods, lifestyle in general;
analysis of previously identified gynecological diseases in a future woman in labor, their treatment;
Ultrasound of the pubis - to identify the stage of the disease in a woman.
consultations of related specialists in the 2nd and 3rd trimesters - orthopedists, physiotherapists.

Ultrasound of the pubic joint

In the case of such painful symptoms during pregnancy, an ultrasound method is used. The procedure for ultrasound of the symphysis during pregnancy is practically the only way to conduct a high-quality diagnosis, while not fearing for the condition of the mother and her baby. Based on the facts revealed, an action plan is drawn up for the expectant mother and a suitable treatment for the disease is selected.

Treatment

After the diagnosis, the doctor will tell you how to treat symphysitis. There is no specific prescription, but pregnant patients are often prescribed vitamins - calcium preparations. Any physical activity and heavy lifting are contraindicated. In addition, in the later stages, wearing a pelvic bandage will be required to support the abdomen on the sides and reduce pain. It is useful, on the recommendation of a specialist, to receive therapeutic massage of the lower back and do special therapeutic exercises. The pain disappears on its own within a few weeks after childbirth.

Bandage

To hold the bones in the required position and reduce the distance between them, a bandage is used in late pregnancy. This is a bandage made of rigid material, which must be selected individually, based on the condition and your own feelings. Such a bandage is worn during pregnancy lying down, slowly and tightly, but so that the hand passes. Standing should not feel uncomfortable. The bandage should support, but in no case press the belly of the pregnant woman. If you are lying down, be sure to remove the bandage, otherwise you will get an extra load on the internal organs.

Exercises

do not cross your legs;
in a standing position, evenly distribute the weight on both legs;
do not sit or lie on too hard surfaces - this is an important rule during pregnancy, which is better to remember;
change the position of the body more often - do not sit for a long time, do not stand, do not lie down;
if you are lying, first turn the upper body to the side, and then the pelvis to anesthetize the aching part of the body;
strictly control weight with symphysitis;
eat foods with calcium: sour-milk, fish, nuts;
provide yourself with walks - under the rays of the sun, the skin produces vitamin D, which is necessary for the absorption of calcium during pregnancy, try to avoid drafts;
sleep on an orthopedic mattress.

There is also a set of specific exercises for expectant mothers in early and late pregnancy:

Lying on your back, bend your knees and pull your legs towards your buttocks. Slowly spread your knees, return back. Repeat 6-10 times.
The position is the same, but the feet are slightly set aside from the buttocks. Slowly lift your pelvis up, lower it back down. In the 3rd trimester, simply lift your pelvis off the floor. Raise 6-10 times.
Get on your knees, relax your back. The back, pelvis, neck and head should be at the same level. Bend your back up, while lowering your neck and head down. Tighten your abdominal and thigh muscles. Repeat 3 times.

Prevention

Since the causes of symphysitis during pregnancy are not known for certain, recommendations for its prevention cannot be made clearly. But there are a few actionable tips for now:

with symphysis, eat foods containing calcium: cheese, herbs, nuts, fish;
during pregnancy, take drugs that improve digestion: enzymes, lacto- and bifidobacteria;
ensure optimal physical activity, if this does not contradict indications during pregnancy (gymnastics, swimming);
take multivitamin complexes during pregnancy;
perform therapeutic exercises for symphysitis, aimed at strengthening the muscles of the back, abdomen, buttocks, stretching the ligaments of the pelvic floor.

Childbirth with symphysis

This diagnosis is a serious reason for the conscious choice of a suitable method of childbirth. If the patient complies with all the necessary instructions and the discrepancy is no more than 1 cm, natural childbirth is possible. But at the same time, the choice of method cannot be made before 37 weeks, because for this, at 38-39 weeks, the specialist must assess the condition of the cartilage and take an x-ray. If the discrepancy is small and there are no other contraindications to the natural method, it will be chosen. After childbirth, the condition of the pelvic bones is restored.

Pain in the pubis, its swelling, difficulty walking may indicate symphysitis during pregnancy. This is inflammation at the junction of the pubic bones, which is called the symphysis. There is dense connective tissue here, in other words, cartilage, which stretches and softens during inflammation, causing increased bone mobility.

What is symphysis and symphysis?

The term "symphysis" doctors call the pubic articulation of the bones, which we in ordinary life call the pubis. During pregnancy, the joint becomes mobile, as it begins to naturally stretch. This is quite normal for a subsequent delivery. In this case, such a development of events is also possible that the stretching process will not proceed correctly. The result will be excessive softening and hypermobility, while the expectant mother will feel this fact on herself according to the following signs: swelling of the pubis, discomfort, soreness. This set of symptoms is called symphysitis.

When a woman is not pregnant, the pubis is absolutely motionless, but when pregnancy occurs, under the influence of the hormone, the symphysis tissues gradually stretch. The closer the birth of a child, the more supple the pubis becomes, because the main task is the free passage of the baby during childbirth. With normal indicators, the pubis expands by 5-6 mm (maximum 10 mm) down and up. As a result, the width of the pubic articulation is 15 mm. These metamorphoses disappear in the postpartum period: the cartilages are placed denser, the ligaments are more elastic, and the joint space is narrower.

Photo of symphysitis during pregnancy:

Symphysitis is called an increased divergence of the pubic bones, that is, when the indicators are more than 6 mm. Symphysitis during pregnancy has several degrees:

1 - discrepancy from 6 to 8 mm;
2 - from 8 to 10 mm;
3 - from 10 mm.

Causes

Symphysitis during pregnancy is accompanied by the following symptoms, which should be reported to the doctor:

Painful sensations in the pubis with pressure, movement;
Swelling of tissues on the pubis;
Clicking, crunching when moving;
Duck gait, lameness.

Pain can occur when walking, trying to raise the leg up from a prone position, turning the hip, turning over on the bed, squatting, getting up. They become especially strong at night.

In general, symphysitis is understood as a number of pathological changes in the symphysis, which can occur not only during pregnancy. This joint can soften, swell, stretch, diverge, tear, become inflamed after a pelvic injury, strenuous running.

Symphysitis during pregnancy has no prerequisites for its development. But there are two significant assumptions that explain the excessive divergence of the pubic bones and the formation of inflammation in the pubic symphysis:

Deficiency of calcium (the main element of bones). A girl in position is required to receive almost 1,000 mg of calcium per day.
Exceeding the norm of the production of the hormone relaxin, produced by the placenta and ovaries, it helps to relax the pelvic ligaments.

Symphysitis during pregnancy is formed for a number of reasons:

Diseases of the musculoskeletal system, inherited, causing excessive joint mobility and other disorders;
Multiple births;
Injury to the pelvic bones;
Large fetus (weighing more than 4 kg.)
Inert, immobile way of life;
The presence of symphysitis during previous pregnancies.

How will childbirth go with symphysis?

Symphysitis during pregnancy can cause artificial delivery, that is, with the help of a caesarean section, it all depends on the severity of the disease.

A large fetus, a voluminous baby's head and a narrowing of the pelvis - these signs indicate that with such a picture, a discrepancy of 10 mm is critical. Natural childbirth is possible only with a discrepancy of up to 10 mm, a medium-sized child and a normal pelvis.

Symphysitis during delivery can cause a rupture of the pubic joint. Basically, at the birth of a baby, the symphysis creeps slowly, because women in labor complain of pain in the pubic area during movement and a few hours or days after the birth of the child.

It also happens that a young mother feels a sharp pain during childbirth in the pubic area, and there may also be a sound from the ligaments that are torn. As a result, even the voluminous head of the crumbs easily passes and falls through the bone ring.

The rupture of the symphysis may be accompanied by injuries of the bladder, the appearance of hematomas on the pubis and labia, which are manifested by the accumulation of clotted or liquid blood.

Even a light touch on the pubis can then become a source of severe pain, while the bones of the joint have a high level of mobility, and the symphysis area may have a step or depression at the site of tissue divergence. To eliminate damage to the symphysis, operational measures will be required using metal structures.

Treatment of symphysitis during pregnancy

It will not work to completely eliminate symphysitis during pregnancy, so you have to wait until the baby is born. In the postpartum period, the hormonal background stabilizes and everything will fall into place. At the same time, you can improve the situation with proper nutrition, taking vitamin and mineral complexes, and courses of therapeutic measures that your doctor will prescribe. In the presence of infections, you will also have to undergo treatment.

Symphysitis during pregnancy in the first stage can be stabilized in several ways:

Decreased physical activity, more rest;
Sleep on an orthopedic mattress;
Taking drugs based on easily digestible calcium;
Taking B vitamins and eating foods that contain them;
Ultraviolet procedures;
Taking painkillers approved by your doctor;
Strengthening exercises.

At 2 and 3 degrees, you will have to resort to holding the pubic bones in a position close to each other. The expectant mother will:

Observe bed rest in strict order;
Wear a bandage in the form of a skirt or apply tight bandaging;
Eat a diet rich in calcium and drink calcium supplements.

To date, there is also a special bandage for symphysitis, which helps to fix the bones in the correct position. Such a bandage makes it possible to move more, which is of particular importance for women in labor, because they need to take care of their babies.

Treatment of symphysitis can take place with an osteopathic doctor who specializes in diseases of the musculoskeletal system and will be able to choose the most effective means and physiotherapy methods to eliminate the problem. Massage, as well as special gymnastics, will be relevant for women who have given birth.

Severe pain can be a reason for treatment in a medical facility. At the hospital, the woman will be prescribed physical therapy, as well as anti-inflammatory and pain medications to relieve symptoms and speed up recovery. Hormonal preparations are not used.

Symphysitis must be treated with special exercises. At the same time, gymnastics should be started already when the first signs of the disease appear during the period of bearing a child.

In the prone position, the expectant mother should bend her legs, and pull her feet up to her buttocks. Next, the knees slowly spread apart and linger in this position for 30 seconds. Then the knees are brought back. Repeat this exercise 6 times.
An equally popular exercise for dealing with symphysitis is the well-known “kitty”. It got its name due to the fact that when performed, a woman resembles a stretching cat. To perform this exercise, the expectant mother should kneel and rest her hands on the floor. The back should be relaxed and the spine in a straight position. The head should neither fall nor rise. Then the woman begins to arch her back, raise her head, simultaneously tensing the muscles of the abdomen and thighs. "Kitty" must be performed three times.

To achieve the result, the exercises are performed at least three times a day.

Complications with symphysis

The future baby will not in any way experience complications from symphysitis. Ultrasound will demonstrate the normal development of the crumbs in the absence of other pathological conditions.

The main complications can arise from damage to the pubic ligaments during delivery. After that, it will take a long time to fully recover. Sometimes surgery may be needed if the risk of rupture is high. But basically, symphysitis during pregnancy goes away after the birth of a child by itself. If you want to avoid the consequences of grade 2-3 symphysitis, you will have to agree to a cesarean delivery. Main indications:

divergence of bones by 10-15 mm or more;
severe pain syndrome;
the weight of the baby is more than 4 kg;
anatomically narrow pelvis.

Each specific situation should be discussed with the doctor who leads the pregnancy, as well as with the doctor who will take care of the birth. Quite often these are two completely different people. If the expectant mother has doubts, it is better for her to consult an osteopath, as well as other gynecologists.

If the diagnosis revealed 2-3 degrees of symphysitis, then doctors recommend giving birth by caesarean section. It is really better for a pregnant woman to listen in order to avoid breaks and, subsequently, a long period of treatment and recovery. After all, the gap is complicated by the presence of inflammation. It also entails limited motor activity, and elementary things cause difficulties, for example, getting out of bed.

Bed rest is a prerequisite for the treatment of ruptures of the symphysis. Naturally, this leaves its mark, since the care of a newborn should take place almost continuously. Moreover, a large tear may require surgery followed by staples and a cast.

But if the problem is detected in a timely manner, then the likelihood of maintaining health is much higher. Numerous reviews of women who have been diagnosed with symphysitis during pregnancy claim that even with this problem, a significant discrepancy can be avoided and a child can be born with minimal complications. The keys to success are a balanced diet, as well as gymnastics. By the way, some women were able to completely overcome this disease.

Prevention of symphysitis

In order to prevent symphysitis during pregnancy, active prevention of the disease is needed. This will allow you not to resort to treatment completely. But there is one caveat: the exact causes of the disease have not yet been established. Although recommendations for expectant mothers can achieve good results.

Pregnancy planning, that is, the maximum preparation for conception, helps to identify many diseases even before a new life appears in the womb of a woman. A complete examination and effective treatment are important here.
Timeliness in registration. The expectant mother should visit the doctor no later than 12 weeks after conception. And it is even better to do it as early as possible, especially if there are certain indications.
Regular scheduled check-ups with doctors.
Normalization of the diet - the exclusion of fried, fatty, flour and sweet. Focus on protein foods: meat, beans, milk, dairy products.
Take vitamin and mineral complexes, which include calcium.
The use of a prophylactic bandage.
Performing gymnastic exercises that are allowed during pregnancy.
Refusal of excessive physical exertion: long walking, standing or sitting.
Exclusion of psycho-emotional stress. If you can't keep calm, ask your doctor to prescribe sedatives.
Objectively and rationally approach the assessment of the situation and the need for a caesarean section.

Diet for the prevention of symphysitis

Symphysitis during pregnancy can be prevented if you follow a diet enriched with minerals that are involved in the formation of bone tissue: zinc, magnesium, calcium, phosphorus, manganese. Also, to enhance the effect, you will need vitamin D. This means that the diet of a pregnant woman should include not only milk and dairy products, but also fish, eggs, seafood, mushrooms, nuts, legumes, greens. At the same time, it is necessary to exclude food that contributes to the active set of extra pounds, because weight gain is an additional burden on the spine and joints.

Expectant mothers are suitable for walks in the fresh air, especially in sunny weather, as the sun's rays contribute to the production of vitamin D, which positively affects the health and skeletal system. In addition, moderate physical activity strengthens the muscles of the abdomen, back and buttocks, and also stretches the pelvic muscles.

The expectant mother should be attentive to her health in order to prevent possible complications and facilitate the course of pregnancy.

Folk recipes

Alternative methods will help relieve symphysitis during pregnancy. But the main thing to do is to consult a doctor first so that the use of improvised means does not turn into an unpleasant experiment with your health and the health of your baby.

A mixture of honey and sesame seeds is quite effective and useful. Sesame seeds are enriched with calcium, so eating them will have a positive effect on health. To prepare the mixture you will need:

100 gr. sesame;
honey to taste.

The components are mixed, cooked must be consumed during the day. The course of admission lasts until the soreness passes.

goat cheese;
fish;
almond;
prunes.

These products can be used alone or in combination with other products. Health is determined primarily by the diet, therefore it is necessary to continue the diet aimed at the prevention and treatment of symphysitis even with complete recovery and the disappearance of pain.

Among other folk methods that help alleviate the condition are Corvalol drops. To do this, you need to lubricate the pubis with medicine, rubbing a little. You can repeat the procedure several times a day.

Pathological changes in the tissues of the pubic symphysis during pregnancy, accompanied by a divergence of the pubic bones. It is manifested by shooting or pulling superficial pains above the pubis, which are aggravated by walking, turning, other physical exertion, changes in gait, and the inability to perform certain movements. It is diagnosed with the help of ultrasound of the pubic joint, radiography of the pelvic bones. For treatment, calcium preparations, anti-inflammatory and analgesic agents are used. Choosing a method of delivery, take into account the severity of the disorder. In most cases, a woman is able to give birth on her own, if indicated, a caesarean section is performed.

General information

Soreness in the pubic area is observed in 48-56% of pregnant women, which is associated with the natural mechanisms of preparing the pelvic ring for the upcoming birth. Symphysiopathy (symphysitis) is spoken of when severe pain occurs and instrumentally confirmed pubic bones divergence is more than 5 mm. Since the softening of the ligaments that strengthen the pubic symphysis begins at 6-7 months of gestational age, the clinical symptoms of the disease usually occur in the third trimester of pregnancy, less often in the second, extremely rarely in the first, during or after childbirth. In exceptional cases, symphysitis is not associated with pregnancy or childbirth, but is the result of injuries, significant physical and sports stress.

Causes of symphysitis

The etiology of symphysiopathy has not been finally established to date. Probably, inflammatory processes in the area of the pubic symphysis are associated with the peculiarities of metabolic processes in a woman's body during pregnancy and after childbirth. In obstetrics and gynecology, two theories are considered to explain the key causes of symphysitis:

Increased secretion of relaxin. To compensate for the loads experienced by the osteochondral ring of the pelvis, long before the birth, the ovaries and placenta of the pregnant woman begin to produce relaxin. This hormone has a specific loosening effect on the ligaments and articular joints, which contributes to the expansion of the pelvis and the free passage of the child through the birth canal. With an excessive level of relaxin, overstretching of the pubic symphysis occurs.
calcium deficiency. During pregnancy, the female body's need for calcium is at least 1.0 g per day. This mineral is necessary for the formation of the fetus and the preparation of the musculoskeletal system of the pregnant woman for future childbirth. Hypocalcemia is provoked by a diet low in calcium and vitamin D, lack of natural insolation, smoking, drinking large amounts of coffee, strong tea, and caffeinated tonic drinks.

A number of predisposing factors have been identified, in the presence of which the likelihood of developing symphysitis increases significantly. The disease is often detected in patients with a hereditary pathology of the musculoskeletal system - Ehlers-Danlos syndrome, in which there is excessive joint mobility caused by an abnormal structure of collagen. The risk group also includes women who have given birth many times, patients with pelvic injuries and a history of symphysitis, pregnant women who carry a large fetus, lead a sedentary lifestyle, suffer from chronic pyelonephritis and other urological diseases accompanied by increased calcium excretion in the urine.

Pathogenesis

With the normal development of pregnancy, under the influence of relaxin, the ligaments, cartilaginous tissue of the pubic symphysis, and other articular joints of the pelvis loosen and swell. As a result, the pelvic ring expands - the distances between the articular surfaces increase, and the joints themselves become more mobile. With a normal calcium concentration, these processes are compensated by sufficient muscle tone and adequate bone remodeling. Hyperproduction of relaxin causes excessive relaxation of the ligamentous apparatus, while against the background of increased mobility of the pubic symphysis, local microcirculation is disturbed, edema occurs, inflammatory mediators are released, which enhance pathological processes and reduce the pain threshold of receptors. The situation is exacerbated by calcium deficiency, leading to neuromuscular disorders, weakening of connective tissue and increased permeability of cell membranes. Additional pathogenetic links that affect the development of symphysitis after childbirth are an increased load on the pubic symphysis when the child is expelled from the birth canal and increased hypocalcemia due to high calcium consumption during the secretion of breast milk.

Classification

The systematization of the forms of symphysitis associated with pregnancy and childbirth takes into account the magnitude of the divergence of the bones of the pubic joint. The choice of classification criterion is due to the direct relationship between the clinical picture of the disorder and the distance between the bones that connect the pubic symphysis. Based on this parameter, obstetricians-gynecologists distinguish 3 degrees of severity of the disease:

I degree: bones of the pubic articulation diverge by 0.5-0.9 cm;
IIdegree: the magnitude of the discrepancy in the symphysis is 1.0-1.9 cm;
IIIdegree: distance between pubic bones greater than 2.0 cm.

Symphysitis symptoms

The main manifestation of the disease is pain syndrome that occurs in the second half of the gestational period or after childbirth. The pain is usually felt as superficial and localized in the pubic area. Soreness with symphysitis intensifies at night, during sex, when trying to abduct the thigh (spread the legs apart), pressing the hand on the bosom. Often there are pulling or aching pain in the hip joints and lower back. The patient experiences significant difficulties in performing some movements - raising straightened legs up from a supine position, walking up the stairs.

With pronounced symphysitis, lameness is possible, the nature of the gait changes noticeably, which becomes waddling (“duck”). When walking or palpation of the womb, crackling, clicking, “grinding” are sometimes heard or felt. To reduce pain, the patient can take a characteristic "frog posture": lying on her back, slightly bend her knees, turn outward and spread her hips. The probable calcium deficiency, as the cause of the disease, is evidenced by fatigue, brittle nails, tooth decay, night cramps of the leg muscles, impaired sensitivity, and the occurrence of paresthesia. Very rarely, when the symphysis diverges, a slight subfebrile condition occurs with an increase in temperature to 37.3-37.4 ° C.

Complications

The most formidable consequence of symphysitis is symphiolysis - a rupture of the pubic joint with complete damage to the ligaments that stabilize the pubic symphysis, the inability to walk, raise legs and even stand on them. Severe pain syndrome and movement disorders limit a woman's ability to take care of herself, a child, and housekeeping. A significant decrease in the quality of life can lead to emotional disorders - from depression and tearfulness to deep hypochondria and postpartum depression. In 68-85% of patients, symphysiopathy occurs in subsequent pregnancies and childbirth.

Diagnostics

Usually a typical clinical picture and the occurrence of the disease in connection with gestation allow a quick diagnosis to be made. To confirm symphysitis, physical and instrumental studies are used to confirm the divergence of the pubic bones and clarify the degree of the disorder. The most informative in terms of diagnostics are:

Gynecological examination. During vaginal examination, a woman feels pain from the inside of the pubic symphysis. A significant discrepancy is detected by palpation in the form of a depression felt by a finger at the junction of the pubic bones.
Ultrasound of the pubic joint. Non-invasive sonographic examination provides anatomically accurate visualization of the pubic area. Determining the degree of stretching of the symphysis is an important criterion for choosing a method of delivery.
Radiography of the pelvic bones. It is carried out in the postpartum period. According to the x-ray, the distance between the bones of the pubis is easily specified, their possible displacements to the side and up / down relative to each other are revealed.
Biochemical blood test. Since one of the likely causes of the disease is a violation of calcium metabolism, blood tests for calcium and magnesium levels are recommended. With symphysitis, their content is reduced by almost 2 times.

In doubtful cases, the disorder has to be differentiated from acute cystitis, pubic osteitis and osteomyelitis, bone form of tuberculosis, other osteopathies of the pelvic bones, lumbago, sciatica, femoral vein thrombosis, ankylosing spondylitis. Usually the patient is examined by an orthopedic traumatologist. If necessary, consultations of a phthisiatrician, neuropathologist, urologist, phlebologist are prescribed.

Symphysitis treatment

Identification of the pathology of the pubic symphysis in a woman is the basis for correcting the pregnancy management plan and a more thorough approach to choosing the method of delivery. To alleviate the patient's condition, a complex drug therapy is recommended, aimed at various links of pathogenesis, which is supplemented with physiotherapeutic and other non-drug methods. Usually, a pregnant woman or a woman in labor is prescribed:

Calcium preparations. Since hypocalcemia is considered one of the most likely causes of symphysitis and is detected in most patients with such a diagnosis, the use of vitamin-mineral complexes containing calcium is justified. Magnesium preparations and vitamin D contribute to better absorption of the mineral.
Non-steroidal anti-inflammatory drugs. In the tissues of the symphysis, pathophysiological changes characteristic of the inflammation process are observed. The use of NSAIDs can reduce the production and activity of inflammatory mediators, as well as increase the pain threshold of receptors.

Of the physiotherapeutic methods of treating symphysitis, magnetotherapy of the pubic area is the most effective. To reduce the load on the pelvic ring, a woman is recommended to wear a bandage, strengthen the muscles of the pelvis, lower back, and hips with the help of a special set of gymnastic exercises, exercise sufficient physical activity, observe sleep and rest.

With symphysitis of the 1st degree, which is diagnosed most often, natural childbirth is possible. The divergence of the symphysis by 1 cm or more is an indication for a caesarean section. Operative delivery is also recommended for severe pain, bearing a large fetus, anatomically narrow pelvis. After childbirth, women with symphysitis of II-III degree are recommended 2-6 weeks of bed rest with tight bandaging of the pelvis and subsequent wearing of a bandage. Thanks to the use of special corsets to hold the pelvic bones in a certain position, strict bed rest can be reduced to 3-5 days. These corsets are recommended to be worn for 3-6 months.

Forecast and prevention

The prognosis for symphysitis depends on the degree of its severity and the timeliness of the correction. Clinical manifestations almost completely disappear by 4-6 months of the postpartum period, although some soreness in the pubic region may persist for up to 1 year. As a preventive measure, a diet with a sufficient content of calcium-rich foods (milk, sour cream, cottage cheese, hard cheese, buckwheat, legumes, leafy greens, nuts), vitamin and mineral supplements, sufficient insolation and physical activity, and exercises to strengthen the pelvic muscles are recommended. .