Diastasis Symphysis Pubis During Pregnancy: When Your Pelvis Splits

Separated pelvis pregnancy

Diastasis Symphysis Pubis is when your pelvis splits at your symphysis pubis (the cartilage holding your pelvis together).  That split pelvis can cause intense groin pain and takes a long time to heal.  There are treatments that can help though.  Can you pelvis split during pregnancy?  Yes, but often it is not that simple.

Separated pelvis pregnancy

Diastasis Symphysis Pubis

Diastasis basically means split (I also have a post on diastasis recti).

The Symphysis Pubis Joint is the line of cartilage at the front of your pelvis.  During pregnancy, it relaxes to let a baby through, but it can relax too much and can split, leaving your muscles trying to hold your body together.

This can be known by a few names included Pubic Symphysis Dysfucntion, pubic symphysis separation, pregnancy-related pelvic girdle pain, and Pubic Symphysis Diastasis. Some people just call it SPD. It is characterized by intense pain in the pelvic area — but it’s so much more, especially in pregnant women.

Hi, I’m Hilary — many people know me as The Pregnancy Nurse 👩‍⚕️. I have been a nurse since 1997 and I have 20 years of OB nursing experience, I am also the curly head behind this website Pulling Curls and The Online Prenatal Class for Couples. 🩺​ Besides my own pelvis splitting during pregnancy, I have seen hundreds of other patients who have a serious dysfunction that affects their lives. So, let’s talk about what you can do.

Oh, and if you’d ilke for me to follow you through your pregnancy, giving you helpful advice for the spot you’re at — join here:

If you’re looking for lots of information on your pelvis splitting — check out this podcast I did with a physical therapist on the subject (SO MUCH GOOD INFO!):

Split Pelvis during Pregnancy

At the age of 28 I had a nine pound baby. My previous one had been a pound and a half smaller than him. I thought I was going to have to push for the rest of my life to get him out. When he did come out, I noticed that things were “off” with my hips (and hips don’t lie).

My tailbone hurt like CRAZY when I was sitting.  Even after he was a few months old, I was having SO much pain while sitting.  It never even occurred to me that it was my pubis symphysis (at least not initially).

I kept thinking it would heal, but it didn’t seem to be healing at all.

Church was miserable.  For YEARS!

During that same time frame, I was trying to get pregnant — for about 4 years.

When I did —  the tailbone pain came back with a vengeance.  But, the further along in my pregnancy I noticed that things felt really “unstable” and that putting pants on was putting me to almost a 10 on the pain scale.  There were sometimes tears shed over that daily task.

I also have a whole post that talks about how to relieve pelvic pain. I also have a post if you’re 38 weeks and the pelvic pain makes it so you can’t walk.

Symptoms of Diastasis Symphysis Pubis or Dysfunctional Symphysis Pubis

I started to notice other things — there are a few symptoms of SPD

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  • A weird “electric” feeling pain in the middle of my pelvis (which I knew was my symphysis pubis).
  • A nerve pain that ran down the inner part of my thigh (I had always felt sciatic pain run down the back of my thigh, and this felt weird — more “electric”)
  • If I rotated my hips (like a hula hoop motion) things just started to feel more and more off in my pelvic region
  • Difficulty walking and putting pants on (lifting one leg)
  • Stairs were hard and pushing beds at work was getting more and more painful.
  • You can have tailbone, low back pain and also pelvic girdle pain — sometimes it would be categorized as “severe pain”

I talked to my doctor about it pretty frequently, and I actually finally stopped working at around 30 weeks of pregnancy, just because the pains were so bad.

Because the majority of the pain was in my tailbone area, I never really thought of it being my symphysis pubis — or really anything related to the pelvic bones.  In fact, I even visited a physical therapist (because I also had a weird pain on my rib — which she finally diagnosed as scoliosis related to pregnancy — although I think it may have been from the symphysis pubis) after I was off work.  In fact, no one ever mentioned it.

Pro Tip: Your tailbone extends from your sacroiliac joints — which is also where your pelvis can bend and flex during pregnancy — so, it makes sense that it could shift and be painful!

The other hard thing about this is that your provider will likely not find anything on physical examination. It is mostly the act of lifting one leg up that causes the pain (but no pain with pressure per se)

Not one.

After that baby was born I was MISERABLE.  The shooting pains on my pelvis got worse and worse.  I went back to work after 6 weeks (I split my maternity leave since my husband was off for the summer) and after my shifts, I was SO miserable.  Much worse than regular days — which didn’t really make sense.

I had a friend who worked for a chiropractor, and she gave me a pelvic girdle belt.  That started to help a lot at work (mainly because scrubs weren’t tight enough to keep my pelvis together).  I was finally not dying. It gives some external support to the pelvis (because my muscles weren’t ready). This was the first thing that gave me any significant improvement.

BTW, if you’re still pregnant check out some belly straps that might help.

BTW, I wish I’d just GONE to a chiropractor. One who is certified in the Webster method, like the one that came on my podcast.

My doctor sent me to a different physical therapist, who thought it was all due to my vagina and had me doing weird exercises and she was adjusting me in weird ways.  Finally, I just got grossed out enough, and things weren’t helping at all — I finally quit.

I saw a neurological pain doctor who gave me a steroid shot in my sacrum (which they do under fluoroscopy).  The first one worked pretty well, but the second one didn’t work at all — the pain was still there.

I then went to a chiropractor and did a bunch of session with him (dropping huge amounts of money) and that wasn’t helping at all either.

Finally — thanks to the internet, I realized that tailbone pain after pregnancy is VERY often caused by SPD.

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I also noticed that when I did yoga (especially down dog — stretching out my glutes) that the tailbone pain stopped for a bit.  Also, during all of this my plantar fasciitis was horrible.  in the mornings I could barely walk (don’t miss my full post on ankle pain in pregnancy).

After a long time of stretching and working on my plantar fasciitis, the tailbone pain started to resolve.  About the time that P turned 2 we moved to Arizona, and I was FINALLY able to sit in the car for long periods without crying.

However, she’s turning 8 next month and I still have it flare up every now and then, especially around my period I’ll get that extra boost of relaxin in my bloodstream and I’ll feel the twinges.

Symphysis Pubis Dysfunction is when your pelvis relaxes a lot (so hasn’t split entirely) — which is what I think I had.

But, even though my pelvis didn’t entirely split, it was still extremely painful.

If you’re looking for ways to understand pregnancy, and communicate with your healthcare team better, I recommend The Online Prenatal Class for Couples. You’re guaranteed to understand more about your pregnancy journey, and be more prepared for delivery!

I also have a full post on if you’re experiencing hip pain early in pregnancy and one on just general hip pain during preganancy.

Groin Pain in Pregnancy

It is easier to pull a groin muscle when you’re pregnant because of your changing center of balance and “loose” hips.

However, it can also be your groin muscles & pelvic ligaments trying to hold your pelvis together — which it was in my case.  It feels different than a pull (although still very painful).  So, it’s something to keep an eye on.  Usually, a pelvic support belt helps that groin pain a lot (vs if you pulled a muscle, the belt won’t help). Some people may even find the pain extends into their upper thighs as well.

FAQ’s about Groin/Pubic Pain in Pregnancy

How do you relieve pregnancy groin pain:

  • You can use LIGHT heat (nothing much more than “warm” as the baby is very close to your pelvis) >> I have a whole post on heating pads in pregnancy.
  • Use a pillow between your legs when you’re laying on your side.
  • Use a pelvic girdle after discussing it with your doctor.

What Causes Symphysis Pubis Dysfunction:

Pregnancy seems to be the main thing that causes it — but there are other risk factors:

  • Overweight (my 3rd pregnancy found me lighter than I was during my 2nd) or heavy weight gain.
  • If your baby is super low (called a low station) — and my baby was HIGH, so these aren’t always true.

The two sides of your pelvis are held together by a small band of cartilage — during pregnancy, your body releases a hormone called Relaxin that helps that tissue relax (and can also help your baby come out more easily).

The pelvic joints do have some flex normally, but during pregnancy it allows it to stretch a lot more.

It’s like a separation of the joint without a fracture. It’s a fairly rare complication (although I think it’s not reported and most doctors ignore it as regular postpartum pain).

It helped me to think of it more as a dislocation of that joint — it allows extra movement in those areas. It sometimes causes pain in your lower back and sides (as your body tries to keep it together).

Symphysis Pubis Dysfunction Treatment

  • Go to a physical therapist that can give you exercises unique to your situation. This isn’t something that most obstetricians are trained to help in (which is good, we all need to know our specialties).
  • Talk to your doctor — they might recommend a lower pelvic support.
  • Doing Kegels and pelvic tilts will help to strengthen your pelvic girdle — the muscles surrounding your pelvis.
  • You can’t actually strengthen the tissues that hold your pelvis together.  That is what it is (but you can strengthen the muscles surrounding the tissues).
  • If some women have it bad enough, they’ll do a cesarean section, rather than have women push and possibly have the head bump it and hurt it further.
  • Bed rest and trying to not spread your legs as much as possible.
  • Put on your birth plan that you’d like to watch your pelvic joint and only pull your knees apart if very necessary (like for a shoulder dystocia).

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Exstrophy of the Bladder

Along with your pelvis having issues, it sometimes doesn’t support your abdominal walls and you can have issues with your bladder. This can lead to incontinence.

Pubis Symphysis After delivery

A lot of women heal pretty quickly after delivery because that hormone isn’t being secreted any longer.

There is no reason to muscle through the pain — you aren’t strengthening anything.  Some women even find a walker very helpful.

If you’re still hurting after a few weeks, definitely talk to your doctor. In fact, if it’s still hurting at your check-up with your provider, I’d ask for a PT consult — to discuss treatment options and to help strengthen your pelvic floor muscles.

Continue to wear your pelvic girdle (although, you are also going to have to strengthen your own muscles — so you can’t rely on that forever) — also, tight pants often took the place of the girdle.

Ask to see a physical therapist.

Sometimes there are people who specialize in this, so definitely ask around.

When I asked around, most doctors just said it would take a lot of time to heal.

And it sure did. It could have taken MUCH less time if I had seen a physical therapist who was trained in how to help.

Some doctors will order an MRI scan, although it may show you what degree the bones are separated, the symptoms are much more conclusive than that test.

I just wish that I had known more about it when I was pregnant.  Not a single doctor mentioned it — and I work in labor and delivery! Early diagnosis would have made it SO much easier to treat and cope with.

The good news is that there are a LOT of trained professionals that can help!

**IF you are in extreme pain find someone that can help you. Keep pushing until you find that person.

I have a list of 5 things you can do to help your pelvic pain.  I hope they help you!  It’s certainly not fun!

NOW is the time to get prepared for your upcoming birth. Check-out this online prenatal class for couples that can get you prepared in just a few hours!

And, if you’re looking for more information on SPD, here are a few other smart articles I found about it:

Alright, now that you’ve figured that out — let me help you have your confident birth!

References

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