Pregnancy brings many remarkable changes to a woman’s body as it prepares to nurture and deliver new life. While most of these changes are natural, some can lead to discomfort and functional difficulties. One such condition is Pubic Symphysis Dysfunction (PSD), which affects the joint at the front of the pelvis.

Pelvic girdle pain (PGP) is a common musculoskeletal complaint during pregnancy and may continue after childbirth. Research over the past two decades shows that PGP can affect between 7% and 65% of women during pregnancy, and up to 41% in the postpartum period. PSD is one specific type of pelvic girdle pain that causes discomfort in the pubic joint.¹

 Its knowledge, management during pregnancy and effective postpartum recovery plays an essential role in women’s health and quality of life.

 Pubic Symphysis Dysfunction in Pregnancy

Pubic Symphysis Dysfunction (PSD) is a condition where the joint at the front of the pelvis becomes painful and unstable during pregnancy. It occurs when the ligaments that support the uterus in the pelvis start to relax due to hormones like relaxin and progesterone. Combined with weight gain and a shifting center of gravity, these changes place additional strain on the pelvic joints. It is a frequent pregnancy related condition, which resolves after childbirth when well managed and rehabilitated adequately.²

Risk Factors and Symptoms of Pubic Symphysis Dysfunction

Pubic Symphysis Dysfunction occurs when the joint becomes unstable or strained. Risk factors include:

• Large babies
• Forceps delivery 
• Multiple pregnancies
• Previous pelvic trauma
• Rapid or difficult deliveries
• Pre-existing musculoskeletal problems

Dr. Pooja Bansal, BPT, Consultant Physiotherapist shared some commonly experienced symptoms by the patients.

Patients usually complain of pain, feeling of instability, clicking sounds on changing positions, difficulty with walking and doing mobility tasks to name a few. Symptoms vary from patient to patient and case to case.

                                                                               Dr. Pooja Bansal, BPT, Consultant Physiotherapist.

Symptoms include pain in the pubic area, groin, hips, lower back, or thighs. Many affected women develop a waddling gait. Women with Pubic Symphysis Dysfunction find walking, climbing stairs and turning in the bed painful and difficult.³

 

Diagnosis of Pubis Symphysis Dysfunction 

The diagnosis of Pubic Symphysis Dysfunction is based on clinical history and physical examination with or without imaging studies. Prompt diagnosis and treatment are necessary for symptomatic control and to avoid complications.

Medical History

The physician will start by inquiring into:

• Onset, nature of pain in the pubic area, groin, hips, thighs or lower back.
• Exacerbating pain triggers like walking, climbing stairs, turning in bed or standing on one leg.
• Effects on everyday activities such as limited movement and difficulty in sleeping.
• History of pelvic trauma or previous difficult pregnancy.

Clinical Examination

Physical examination helps to confirm Pubic Symphysis Dysfunction and rule out other causes of pelvic pain:

• Palpation: Palpation applied with mild pressure on the pubic symphysis to check for tenderness.

• Functional Tests:
  • Single Leg Stance Test: Standing on one leg becomes very painful.
  • Modified Trendelenburg Test: Assessing pelvic stability while weight bearing.
  • Pelvic Compression: To help evaluate joint mobility and pain.

• Gait Observation: Most women with Pubic Symphysis Dysfunction have a waddling or unsteady walk.

 Imaging Studies

Imaging is not mandatory but may be helpful in severe or uncertain cases:

• Ultrasound: Safe in pregnancy; useful in cases of joint widening.
• X-ray: Avoided during pregnancy due to radiation but may be done postpartum to measure separation.
• Magnetic Resonance Imaging (MRI): Provides detailed assessment without radiation, useful in cases of rupture or severe instability.

 Severity Grading

Pubic Symphysis Dysfunction can vary from mild discomfort to severe disability:

• Mild: Intermittent pain, manageable with activity modifications.
• Moderate: Persistent pain affecting walking and daily tasks.
• Severe: Inability to walk without aids, possible pubic symphysis separation.

 

Management of Pubic Symphysis Dysfunction

Pubic Symphysis Dysfunction is managed with a holistic approach to treat the pain, keep the pelvis stable, move without risk and rehabilitate gently. As symptoms manifest during pregnancy and persist into the postpartum period, ongoing care is essential in both the phases.

Dr. Pooja Bansal, also explained the role of physiotherapy and importance of the management of Pubic Symphysis Dysfunction.

“Pubic Symphysis Dysfunction can be managed by working on strengthening the core and pelvic muscles of the patient, stretching of the muscles around the pelvic area and teaching proper stabilisation and motor control. Other than that, belts can be prescribed to help with load bearing. For pain relief, ice, heat and electrical modalities can be given to the patient depending on their condition. Educating the patient about the precautions, activities to be avoided and how to manage their symptoms is very important”.

                                                                                                                Dr. Pooja Bansal, BPT, Consultant Physiotherapist

Lifestyle and Activity Modifications

Habit adjustments to relieve pelvis strain is the first step in coping with Pubic Symphysis Dysfunction. These are the basic changes that protect the pelvic joint and worsening of the symptoms.

• Avoid tasks that make the pain worse like climbing stairs often, standing on one leg or carrying heavy objects.
• When dressing, sit down to prevent putting pressure on one leg.
• Getting in or out of bed or cars should be done with the knees close together. 
• Utilize pillows for support between the knees and under the abdomen during sleep.
• Take lots of rest breaks and avoid prolonging house tasks.

 

Use of Supportive Devices

Supportive external aids can help to stabilize the pelvis and minimise pain.

• Pelvic Support Belt: Helps to stabilize the pelvic bones and decrease joint motion.
• Crutches or Walking Aids: Helps pregnant women experiencing severe pain or instability.
• Postpartum abdominal Binders: Beneficial in supporting the pelvis region and areas around hips and stomach while the muscles recover.

Pain Management

Pain relief is essential for preservation of mobility and quality of life.

• Cold or Heat Therapy: Applying ice or hot packs on the pubic area can relieve pain.
• Safe Medication: Paracetamol (acetaminophen) is safe during pregnancy, but prior doctor consultation is necessary.
• Relaxation Exercises: Deep breathing, meditation or gentle stretching helps to reduce tension and pain perception.

 Physiotherapy and Exercise

Physiotherapy is the basis for Pubic Symphysis Dysfunction treatment, during and after pregnancy. An experienced physiotherapist trains the patient with exercises that tone and support the pelvis. Regular physiotherapy brings relief from the pain, but also the possibility of future joint instability.

During Pregnancy

• Pelvic Floor Exercises (Kegels): Strengthen the floor muscles that support the bladder and uterus.
• Hydrotherapy: Working out in warm water relieves strain on your joints and eases pain.
• Postural Training: Educating how to sit, stand, and walk properly to promote even distribution of body weight.

After Childbirth

• Gradual Strengthening: Concentrate on building up core, pelvic floor and back muscles to regain balance and stability.
• Postural Retraining: Addressing postural changes that occur with pregnancy can halt the pain.
• Manual Therapy: A skilled physiotherapist can execute light massage or alignment techniques to relieve stiffness and pain.4

 

Management of Severe or Complicated Cases

In rare cases, the pubic symphysis may separate excessively known as pubic symphysis diastasis.

• These patients require bed rest, physiotherapy, or even surgical intervention to realign the joint.
• Medical supervision is essential, and women need mobility aids until complete healing occurs.
• With proper treatment, even severe cases can recover well over time

Conclusion

Pubic Symphysis Dysfunction is a painful condition and can be very frustrating, but it can also be managed with care. Gentle exercise, mobilizing aids, physiotherapy and lifestyle changes are important in pregnancy and postpartum recovery. Through patience, persistent professional care and guidance, most women regain full mobility and return to their normal daily activities without lasting discomfort.

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Related Initiative

Within the broader scope of maternal health, this article contributes to SHAKTI — HealthOdysseyHub’s postpartum care initiative dedicated to evidence-based education and collaborative practice in maternal recovery.

Learn more about SHAKTI here: https://healthodysseyhub.com/shakti-postpartum-care-healthodysseyhub/

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References 

1. Albert, Hanne, Godskesen, Mona PT, Westergaard, Jes G. Incidence of Four Syndromes of Pregnancy-Related Pelvic Joint Pain. Spine 27(24):p 2831-2834, December 15, 2002. https://journals.lww.com/spinejournal/abstract/2002/12150/incidence_of_four_syndromes_of_pregnancy_related.20.aspx
2. Stolarczyk A, Stępiński P, Sasinowski Ł, Czarnocki T, Dębiński M, Maciąg B. Peripartum Pubic Symphysis Diastasis-Practical Guidelines. J Clin Med. 2021;10(11):2443. Published 2021 May 31. doi:10.3390/jcm10112443
3. Shnaekel KL, Magann EF, Ahmadi S. Pubic symphysis rupture and separation during pregnancy. Obstetrical & gynecological survey. 2015 Nov 1;70(11):713-8. DOI: 10.1097/OGX.0000000000000247
4. Jain S, Eedarapalli P, Jamjute P, Sawdy R. Symphysis pubis dysfunction: a practical approach to management. The Obstetrician & Gynaecologist. 2006 Jul;8(3):153-8. https://doi.org/10.1576/toag.8.3.153.27250
5. Norvilaite K, Kezeviciute M, Ramasauskaite D, Arlauskiene A, Bartkeviciene D, Uvarovas V. Postpartum pubic symphysis diastasis-conservative and surgical treatment methods, incidence of complications: Two case reports and a review of the literature. World J Clin Cases. 2020;8(1):110-119. doi:10.12998/wjcc.v8.i1.110

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About the author

Dr. Hansini Bhaskaran

Aesthetic Dentist | Medical Writer | Health Communication

Dr. Hansini Bhaskaran is an aesthetic dentist with hands-on clinical and management experience in facial aesthetics. She is also a passionate storyteller with a growing interest in medical writing and health communication.

Areas of Interest - Aesthetic Dentistry | Skincare | Health Communication

Skills - Medical Writing | Clinical Insight | Content Development

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