Hormonal changes during pregnancy lead to significant external and internal changes. Even young healthy women at this time often feel discomfort in the area of ​​the pubic articulation. Often, this pain is triggered by natural processes and does not pose a threat to the mother and fetus. However, there are other reasons that provoke soreness in this area.

Possible causes of pain during pregnancy

Gynecologists say that soreness in the pubic symphysis after 13 weeks of gestation is normal. This condition is due to physiological changes in the body in connection with the preparation for the upcoming birth. The hormone relaxin acts on the ligaments and bones, making them mobile and elastic. The pelvic and pubic bones gradually separate, providing the fetus with the necessary space for development and growth. This natural process ultimately makes labor easier and less painful.

In addition to normal changes in the physiology of the body, discomfort in the pubic area is often a harbinger of premature birth. Pain can be caused by the following:

• hormonal imbalance;
• narrow pelvic bones and their abnormal development;
• the size of the fetus, its location and the large volume of amniotic fluid;
• calcium deficiency and lack of vitamin D;
• lack of magnesium and phosphorus;
• old injuries;
• damage to the soft tissue around the pubic bone;
• a tendency to pathologies of joints and bones;
• infectious diseases of the genitourinary system;
• lack of the necessary mobility;
• being overweight.

If during pregnancy the pubic bone hurts when walking, this may be a sign of the development of symphysitis. Pathology is characterized by premature divergence of the pelvic bones and an increase in the distance between them by 8 mm or more. The disease is manifested by a change in gait and discomfort when climbing stairs. It is difficult for a pregnant woman to get up after a long sitting and roll over on her side.

Pubic pain after childbirth

After the baby is born, the pubic bone may continue to hurt for several weeks. If the cause of discomfort is symphysitis and increased production of relaxin, the painful sensations will gradually disappear on their own after the pelvic bones take their natural position and hormonal background will return to normal.

Pubic pain when carrying a baby can be hereditary. If maternal women have similar problems during pregnancy and childbirth, the likelihood of developing discomfort in this area increases. Expectant mothers who are pregnant with twins are also at risk.

If the pubic bone hurts after childbirth, this may be the result of a complication of labor or an injury received during the birth of the baby. Damage to the pubic bone, sprains of the ligaments require conservative treatment or surgery. If a pubic bone fracture is suspected, a woman is immediately admitted to the trauma department.

During an exacerbation of pain, the main goal of therapy is to relieve pain. Strict bed rest is complemented by the use of antibiotics and local anesthetics.

Alarming symptoms

Signs that a woman should definitely pay attention to:

• noticeable change in gait;
• difficulty raising straight legs while lying down;
• severe pain that interferes with normal movement;
• sharp pain in the pubis that increases when walking;
• pain arising from pressure on the pubis;
• temporary discomfort manifested when standing up, squatting, lifting and spreading the legs;
• a crunching, squeaking, or clicking sensation when you move your legs.

Such symptoms can disturb a woman from the very beginning, but most often pain in the pubic bone during pregnancy appears at a later date.

If a pain insignificant and short-term, this is a clear sign of the body's natural preparation for the process of childbirth, the expectant mother has no reason to worry.

Childbirth with pain in the perineum and pubic articulation

Only a doctor can decide how the delivery will take place with pain in the pubic bone: natural or by caesarean section. This conclusion is made no earlier than 32 weeks of pregnancy.

If the distance between the bones of the pubic articulation is less than 10 mm, childbirth will be carried out naturally, without the risk of harming the musculoskeletal system of the woman in labor.

If symphysitis of the second degree is diagnosed, it is possible to give birth on your own, without complications and unpleasant health consequences. Natural childbirth with such a diagnosis is allowed if the fetus is not too large, positioned correctly, and the woman in labor does not have a too narrow pelvis.

After the birth of a child, a woman will have to follow a pastel mode for about 3 days. In this case, the pelvis is tightly pulled with an elastic bandage. Further, for 3 months, it is recommended to wear an orthopedic corset, which provides fixation of the pelvic bones and prevents their further divergence.

If the distance between the pelvic bones is more than 1 cm, a planned cesarean section is prescribed so that during childbirth there is no rupture of the ligaments of the pubic articulation.

Establishing diagnosis

Most diagnostic methods are contraindicated for pregnant women. Examination, palpation of the sore spot and patient survey, during which the specialist determines the nature of the pain, the intensity and frequency of manifestation, helps the doctor make a conclusion.

In addition to a visual examination, the doctor prescribes laboratory tests:

• general and clinical analysis blood and urine;
• biochemical blood test;
• analysis of hormone levels and more.

In addition to examining a gynecologist, a pregnant woman may need to consult a traumatologist, surgeon and neurologist.

The main method of instrumental examination of pregnant women is ultrasound, which allows to determine the degree of divergence of the pubic bones. In exceptional cases, MRI is used.

If the pain in the pubic bone does not go away for a long time after childbirth, standard methods for diagnosing pathologies of bones and joints are used - X-ray and CT.

The main methods of treatment

During pregnancy, women are not advised to self-medicate. Any use of medications must be coordinated with a doctor, who, after the necessary laboratory and instrumental studies, will prescribe an objective therapy.

The following recommendations will help ease the painful sensations of the expectant mother:

• be in a sitting position for no longer than an hour;
• if pain occurs while walking, you need to sit down, put a pillow, roller or bag under the lower back;
• if the pain bothers at night when changing posture, you need to turn correctly: first the shoulders, and then the whole body.

For pubic pain, the doctor first of all prescribes compliance correct regime nutrition. The diet must include fermented milk products, fatty sea ​​fish, beef liver, fresh fruits, vegetables and herbs.

• Relax all back muscles by getting on all fours. While in this position, bend your back and slowly lower your head down. Complete 10 sets. This exercise is suitable for women on early dates pregnancy or with a small belly.
• Lie on your back. Bend your legs at the knees, raise, then slowly lower your hips. Repeat the exercise 8-10 times.
• Remaining in a prone position with legs bent at the knees, place the heels as close to the buttocks as possible. Slowly spread and connect your legs. Repeat the exercise 5 times.

If diet and exercise at home do not relieve pain, your doctor will prescribe medications:

• NSAIDs and chondroprotectors that relieve inflammation and swelling of the pubic bone: Betalgon and Chondroxide;
• pain relieving ointments and gels approved for use during pregnancy;
• antispasmodics - No-shpu;
• Menovazine is a solution for rubbing a painful area with a strong analgesic effect;
• calcium preparations and complex multivitamins for micronutrient deficiencies;
• antibiotics in difficult cases.

In addition to drug treatment physiotherapy is used. UV treatments quickly stop inflammation. If the pain in the pubic bone is very severe, a pregnant woman can be hospitalized for individual treatment under the supervision of a medical staff in a hospital setting.

The use of traditional medicine

In the third trimester, the body begins intensive preparation for the birth process. This explains the condition when the pubic bone hurts during pregnancy at 32 weeks and later.

If the expectant mother is sure that physiological changes in the body are the cause of discomfort, you can use recipes to relieve pain traditional medicine... Compresses and lotions are popular:

• From black radish. The root crop must be peeled, grated and squeezed out. Lubricate the lumbar region vegetable oil and cover with gauze, on which the radish gruel is laid out. Leave such a compress for 15 minutes, wrapped in a blanket or woolen scarf. The procedure will be most effective if done before bedtime.
• From birch sap and plantain. Moisten fresh plantain leaves with birch sap and dry. Then attach to the lower back and wrap yourself in a blanket. The compress is removed after 15-20 minutes. After the procedure, it is advisable to remain in a horizontal position for a while, covered with a warm blanket.

In order not to harm your health and the health of the baby, it is imperative to consult a doctor before using traditional medicine recipes.

Prevention of pubic bone pain

Prenatal band reduces stress on the pelvic bones

Doctors' recommendations will help relieve pain in the pubic bone and prevent its appearance:

• Carefully monitor your diet. The diet must include foods rich in calcium, magnesium, iron and phosphorus. It is better to give up spicy, fatty and fried foods and give preference to dishes cooked in a steam bath. Pregnancy involves an increase in total body weight, but every extra pound should be treated with caution. Being overweight puts more stress on the lower limbs, joints, spine and pelvis.
• Get more rest. Women in position should definitely rest during the day. It is recommended to purchase a mattress or a special orthopedic pillow for pregnant women, which will allow you to take a comfortable position at night while sleeping and have a good rest.
• Delegate some of the responsibilities to loved ones. Do not hesitate to ask your family for help. Excessive physical exercise and overwork is often one of the causes of pain.
• Sit less often. During rest, it is preferable to take a horizontal position, and it is better to position the legs so that they are above the level of the body. This position avoids undue stress on the pubic bone. You cannot sit on a very soft surface for a long time. In this case, the knees should not be above the level of the hips. Cross-legged with pubic pain is also not recommended.
• Monitor your gait and wear comfortable shoes. Do not walk too fast during pregnancy. The step width should be small. The height of the heel should not exceed 5 cm.
• Reduce the activity of life and avoid sudden movements. Pregnant women shouldn't lead too much active image life. At the first manifestations of pain and other alarming symptoms, you need to temporarily stop playing sports and give up doing everyday household chores.
• Do special gymnastics. For each stage of pregnancy, separate sets of exercises have been developed that help the expectant mother stay in good physical shape, maintain the elasticity of muscles and ligaments.
• Massage. Massaging movements will allow the woman to relax and relieve stress from the pelvic bones. However, it is important to remember that the procedure should be performed by a specialist experienced in working with pregnant women. Wrong actions of the massage therapist and exposure to dangerous points can provoke premature birth.

To reduce the stress on the spine and pelvis, a special prenatal support bandage will help. The device will relieve the ligaments and evenly distribute the weight of the enlarged abdomen, preventing further divergence of the pubic articulation. Popular gymnastic balls - fitballs, which also relieve pain in the lower back, pubis and hips during pregnancy.

If, while carrying a baby, your pubic bone hurts, this does not necessarily indicate any disturbances in the functioning of the body.

Briefly about the pubic bone

The pubic bone is one of the three bones that form the hip bone. The pubic bone itself consists of two pubic bones.

These two bones create the pubic articulation, which forms the anterior pelvic wall.

The main causes of pubic pain

In the late stages of pregnancy, the woman's body prepares in every possible way for the birth of a baby and tries to simplify this process as much as possible for both the baby and the mother.

One of the stages of this preparation is the softening of the pelvic bones. The body begins to secrete a hormone relaxin which makes the bones softer and the ligaments and cartilage between the bones more elastic. Thus, during childbirth, when the baby moves along the birth canal, the pelvic bones will be able to expand as much as possible, giving the baby more space.

Actually, due to the softening process, the pubic bone experiences an unusual load during pregnancy, so pain may occur.

This may also be facilitated by the lack of calcium in the body of the expectant mother.

If the pain is periodic, not very severe, does not bring much concern, you should not worry. But if the pain is sharp enough, becomes more intense when walking or a sharp change in body position, then its cause may be symphysitis- the divergence of the bones of the pubic articulation.

Syphysitis occurs due to an excessive amount of relaxin in the body, calcium deficiency, hereditary predisposition, diseases of the musculoskeletal system.

What to do if pubic pain is present?

Firstly, you can not worry about the baby - pain in the pubis, both physiological and caused by the separation of bones, does not pose any danger to the baby.

To relieve pain, pregnant women often begin to walk "duck gait" - waddling from side to side, thus reducing the load.

If you are diagnosed with symphysitis, a bandage should be worn until the end of labor to prevent further separation of the bones.

In addition, it is worth adjusting the diet by adding foods containing calcium, which is generally beneficial during pregnancy.

In addition, it is necessary to reduce physical activity. It is also forbidden to be in a sitting position for a long time.

What can be the threat of pain in the pubic bone?

If the pain in the pubic bone is caused by the separation of the bones, this threatens a cesarean section, since natural childbirth will be contraindicated for you.

With symphysitis, natural childbirth can significantly injure the pelvis, after which a woman may completely lose the ability to walk in the future.

Which doctor should i see for pubic bone pain?

If you are very worried about pubic bone pain, you need to get tested by several specialists. Namely, you will have to visit a gynecologist, surgeon, traumatologist, and you will also need to do an ultrasound of the pelvic bones.

During pregnancy, a woman's body undergoes great changes that contribute to the normal development of the child and pregnancy in general. Sometimes these changes are not only beneficial but also harmful. On the forums of expectant mothers, there are often questions about pubic pain. How to determine if this is a norm or a deviation and, in general, why do these pains occur?

Physiology of the pelvic bones.

In the second trimester of pregnancy, the weight of the fetus begins to increase faster, the mother's body is gradually preparing for childbirth. During a natural delivery, the baby goes through the birth canal. They consist of not only soft but also hard tissues. The pelvic bone is formed by 3 fused bones, but the pubic bones are interconnected by fibrous-cartilaginous tissue. Under the influence of the hormone relaxin, the fibers of the cartilage swell and loosen so that the pelvic bone can "disperse" a little and facilitate the process of childbirth.

When is pubic pain the norm?

During pregnancy, a woman may feel a little soreness in the area of ​​the pubic joint. But the pain will be minor and short in time, it will not interfere with the woman's daily activities.

Pathological pain in the symphysis area.

The cause of symphysitis (a strong divergence of the pubic bones) is a violation of phosphorus-calcium metabolism. Calcium prevents excessive discrepancy of the pubic cartilage, but with poor nutrition, diseases of the intestines or parathyroid gland, it becomes deficient. Also, a decrease in calcium occurs with a lack of vitamin D, which contributes to the normal absorption of calcium.

Symphysitis symptoms.

Normally, the distance between the pubic bones is up to 0.5 mm

The first degree of symphysitis is 0.5-0.9 cm.

The second is 1-2 cm.

The third is more than 3 centimeters.

At the first degree, the symptoms will be mild, or may be absent altogether. If the disease continues to progress, there are:

Swelling in the pubic area;

On palpation, the mobility of the pubic bones is easily felt;

There are sharp pains when walking, abduction and adduction of the legs, climbing stairs;

A duck gait appears;

The pain radiates to the lower abdomen, thigh, sacrum, tailbone;

Pains are especially characteristic when changing the position of the body during sleep and after waking up. A sharp pain is caused by an attempt to raise the legs while lying on the back.

Diagnostics.

The doctor listens to the complaints of the pregnant woman, examines and palpates the pubic region. When revealing swelling of the pubic joint, pain with pressure, the obstetrician-gynecologist prescribes an ultrasound of the pubic joint, with the help of which the degree of divergence of the pubic bones is determined. Symphysitis can also be detected radiographically, but this method applies only as a last resort.

The divergence of the pubic articulation causes adverse consequences only for the mother, for the child it is not dangerous.

1. As a rule, the doctor prescribes vitamins with a high calcium content. But in late pregnancy, they should not be taken, as premature ossification of the child's skull and skeleton may occur.

2. Wearing a bandage. It is better to buy a universal bandage, the size of which is easily adjustable. It is recommended to wear it not only as a support for the abdomen, but also to tighten the pelvic bones with it (at least a few hours a day); for this purpose, you can purchase a special orthopedic bandage for the pelvic bones.

3. A set of special physical exercises.

You also need to ensure yourself physical peace, evenly distribute the load on both legs, and try not to gain excess weight.

How will the birth take place?

Symphysitis does not always entail a caesarean section. With a divergence of the pubic articulation up to 1 cm, childbirth takes place naturally. If the discrepancy is no more than 1.5 cm, natural delivery is also possible (with a medium-sized fetus and a wide pelvis). To resolve this issue, a consultation with a surgeon or orthopedist is additionally appointed.

After childbirth, it is necessary to limit physical activity, change the position of the body gradually. For 2 weeks after giving birth, you need to continue to wear the bandage to reduce the distance between the pubic bones.

Pregnancy brings many changes: it changes appearance future mother, there are changes in her life, worldview, sensations.

Mostly - these are all pleasant moments, however, sometimes the state of pregnancy can bring some complications in the form of pains of a different nature.

Some of them become just a physiological reaction of the body to your new position, but it also happens that painful sensations signal you about more serious problems or complications. So, pain in the pubic bone is one of the most common complaints of pregnant women.

Your body's pelvic bone is formed by the fusion of three bones, and one of them is the pubic bone. By itself, this bone is paired, since it consists of two pubic bones that form the pubic articulation. They also form the anterior wall of the pelvis.

In addition, it is worth noting that the bone looks like a roller, in its shape, and in thickness it is comparable to the thumb.

When a woman is carrying a child, her entire body prepares for the upcoming birth.

The changing hormonal background contributes to these changes, in particular, the hormone relaxin has a softening effect directly on the pubic bone, so that by the time you start labor, it becomes more mobile and pliable.

It is not only the pubic bone that is subject to softening, but also other cartilages, ligaments, and places of fusion of the pubic articulation. This was provided by wise nature so that you could give birth more easily, and the baby managed to go through the birth canal.

As you understand, with discomfort in the pubic bone, you simply feel pain from the fact that the ligaments are strongly stretched. However, if the manifestations of pain are very strong and frequent, then you should immediately consult with your doctor, as this may indicate the presence of more serious problems that are not caused by the physiological preparation of the body for childbirth.

Possible symptoms and risk factors

However, it is worth reassuring expectant mothers: symphysitis is, of course, an unpleasant diagnosis, but it does not pose any threat to your baby, although it will cause you a lot of discomfort.

Among the reasons that can lead to symphysitis or become triggers for its appearance, doctors distinguish the main ones:

• An excess of relaxin in the body of a pregnant woman, as well as its increased effect.
• The second reason is often a severe deficiency or acute lack of calcium.

This can negatively affect the child, because his growth and development depend on an adequate supply of all the necessary nutrients and nutrients, and a lack of calcium can lead to improper skeletal formation).

In addition, doctors believe that symphysitis is manifested due to hereditary or individual characteristics the body (possibly if a woman had problems with the musculoskeletal system before pregnancy, with fractures or injuries of the pubic bone, with some pathologies of the body structure, such as a saber-shaped pubis, etc.).

As a rule, the following symptoms help to recognize symphysitis:

• it hurts to lift your legs straight (from a prone position);
• the pubic bones are very sore when walking;
• there are strong and sharp painful sensations if you press on the pubic bone;
• when you make any sudden movement, walk a lot or climb stairs, step over the threshold, even roll over from side to side - the pain increases significantly;
• pain syndrome grows and manifests itself more and more often (not only in the pubic region, but also in the pelvis and coccyx);
• the gait changes, becoming waddling, like a duck.

How is the problem diagnosed in pregnant women?

If you experience or worsen pain, consult a doctor immediately. In addition to your gynecologist, other specialists - a traumatologist and a surgeon - will have to confirm the diagnosis.

Also, most likely, you will be referred for an ultrasound examination of the pubis, sometimes, if urgently needed, an X-ray may also be prescribed if the gestational age is not more than 16 weeks.

In a normal state, the distance between the two pubic bones is approximately four to five millimeters.

Having made an allowance for the divergence of bones during pregnancy, you need to add another two to three millimeters. That is, if the bones of the pubic articulation are already apart by ten or more millimeters, you will be diagnosed with symphysitis (symphysiopathy or dysfunction of the pubic symphysis).

Depending on the degree of discrepancy and the presence of inflammation, they are isolated (the first is the safest and needs simple observation, and the second and third require careful monitoring of the condition of the pregnant woman and exclude natural childbirth).

The main methods of treatment and prevention of pain in the pubic bone

If pubic pain in your case is caused by the fact that the presenting part of the fetus simply presses on the pelvic bones, and the distance of divergence is within the normal range, then you will not be prescribed any special treatment.

• it is better to sit on something soft (it can be a chair or a chair, however, it is worth staying in a sitting position as little as possible). If you still have to sit for a long time, watch yourself: try not to cross your legs, avoid asymmetric body positions, and your feet should be on the floor at the same time;
• when lying down and want to roll over, try to make a U-turn first top body and only then change the position of the pelvis;
• you are strictly prohibited from any load on the hip joint, therefore, even while lying in bed, it is better to put a blanket, roller or pillows rolled into a roll under your feet and butt;
• try to follow, because extra pounds will not only prevent you from getting in shape faster after childbirth, but also are a serious load on all muscles and bones, including the pubic one;
• if you need to take a step to the side, it is recommended that you first just turn around, and then step forward or backward, depending on where you need to go;
• exclude heavy physical exertion, do not make sudden movements, and when walking, move slowly and calmly.

Your daily nutrition should be complete and balanced, so that the body receives trace elements and nutrients it needs for full functioning.

In this case, you may need to add more foods to the menu that are rich in calcium and magnesium (all dairy products, nuts and dried fruits, legumes, cereals, dark green leafy vegetables).

Also, additional preparations containing calcium and substances that help it to be better absorbed in the body - vitamins D and C can be prescribed. For this purpose, it is recommended to take the drug "Calcium D-3 Nycomed" (maybe "Calcemin" or others).

In addition, it may be advisable to start taking a special multivitamin complex for pregnant women ("Pregnavit", "Elevit", "Teravit-pregna", etc.).

However, you cannot prescribe any drugs yourself. Even useful vitamins can lead to serious complications if taken incorrectly or overdose: for example, if calcium becomes in excess in your body, the baby's skull bones will begin to harden prematurely, and the placenta may also age early.

To relieve pain a little, it is allowed to take. If the inflammatory process or trauma gives pubic edema, then ointments or gels for rubbing ("Betalgon", "Chondroxide") can also be prescribed.

After childbirth, in some cases, antibiotics are prescribed, as well as other medications and procedures are used to relieve the inflammatory process and help the body to return to normal.

Under certain indications, doctors also prescribe the wearing of a bandage. Its function will be to anchor and support the pelvic ring, preventing the pubic bones from moving further. It is about a special orthopedic pelvic bandage.

There is also a whole range of gymnastic exercises, by performing which, you can help your ligaments become stronger and stronger, as well as increase the tone of the pelvic muscles, which will significantly reduce pain. Here are some of the most effective and simple ones:

• familiar to all "Cat".

Get on your knees and rest on your hands, while relaxing your back muscles. Make sure that the spine, neck and head are at the same level. Bending your back up as you exhale, lower your head down and contract your abdominal and hip muscles.

• Exercise that is very important for pubic pain.

Lie gently on the floor and bend your knees at a thirty-degree angle. Then slowly and carefully try to raise your pelvis (you don't need to lift it very high, watch your sensations) and stay in this position for a few seconds. Get down to the floor and start all over again.

• Lying on your back, bend your knees and pull them towards you so that your heels rest on your buttocks. Slowly spread your knees to the sides and bring them back.

Please note that exercises can be done only with the permission and under the supervision of a doctor, since with progressive symphysitis physical activity is already contraindicated, and the woman is advised to lie more in order to prevent the problem from aggravating. Sometimes doctors even insist on inpatient observation and treatment.

The decision about the method of the upcoming delivery will be made based on several factors. To be allowed to give birth naturally, you need the following:

• the child should not be too big;
• yours is normal, not;
• the bones were no more than ten millimeters apart.

Conclusion

Pubic pain is normal for pregnancy as your body needs to prepare for childbirth. However, with constant discomfort and severe pain, it is better to undergo an examination in advance and consult a doctor. This will not only help alleviate your condition, but will also prevent the situation from getting worse and also save you from unnecessary complications.

During pregnancy, many physiological changes occur in the pelvic region that explain this symptom:

• an increase in the mechanical effect on the pelvis due to an increase in the mother's body weight;
• relaxation of ligaments and fibro-cartilaginous joints as a result of hormonal changes;
• posture change in late pregnancy.

The pain is different in strength and sometimes it is so severe and debilitating that it causes problems with the load on the legs and walking. Plays an important role early diagnosis causes of pain in the pubic bone, with timely intervention, a decrease in the incidence associated with the underlying pathology is observed. Due to the limited use of imaging techniques and their potential adverse effects on the fetus during pregnancy, it is difficult to diagnose musculoskeletal diseases.

Classification of causes of pain in the pubic bone during pregnancy

Musculoskeletal Disorders

Diseases affecting the pubic bones and pubic symphysis

• dysfunction of the pubic symphysis
• osteomyelitis of the pubic bone
• osteitis of the pubic bone
• pregnancy-induced osteomalacia

Reflected pain

• short-term osteoporosis of pregnancy affecting the hip joint
• mechanical back pain and sciatica

Other diseases

Urinary tract infection

Musculoskeletal Disorders

Diseases affecting the branches of the pubic bone and / or the pubic symphysis:

• mechanical (dysfunction of the pubic symphysis);
• idiopathic (pubic osteitis);
• inflammatory (osteomyelitis);
• metabolic (osteomalacia).

Dysfunction of the pubic symphysis is most common during pregnancy.

Dysfunction of the pubic symphysis

Dysfunction of the pubic symphysis (symphysiopathy) occurs as a result of instability of the pelvic girdle due to relaxation and diastasis of the bones of the pubic symphysis. In the UK, due to a lack of objective and subjective diagnostic criteria, the reported incidence of symphysis pubis dysfunction varies geographically widely and ranges from 1:36 to 1: 300 pregnancies. In the Scandinavian countries, most women have pubic symphysis dysfunction in the first trimester of pregnancy, while in the UK it usually occurs in the second half of pregnancy. The recurrence rate in subsequent pregnancies is 85%.

Symptoms are pain in the pubic bone when walking, turning in bed, climbing stairs, standing on one leg, and raising or spreading the legs. Abduction of the hip is not possible due to pain. Although pain is usually localized to the pubic symphysis, it can radiate to the lower abdomen, groin, perineum, thigh, leg, and lower back. The pain is described as sharp, burning, boring.

Sometimes a duck gait appears. The most common clinical symptom- Soreness in the pubic symphysis or sacroiliac joints. Active elevation of the straightened leg is usually limited due to pain and can cause palpable displacement of the symphysis pubis. Hip movements, especially abduction and lateral rotation, are also limited by pain.

Clinical examinations / physical examinations are usually performed by midwifery physiotherapists. The objective signs are as follows.

• Trendelenburg symptom. When standing on one leg, the lowering of the opposite buttock is noted (normally it rises). Palpation of the anterior surface of the pubic symphysis causes pain that persists for more than 5 seconds after the end of palpation.
• Patrick-Faber symptom. In the supine position, while fixing the anterior upper spines of the iliac bones, the researcher flexes the hip and places the foot in the area of ​​the opposite knee joint, while the leg passively hangs outward. With a positive result, pain occurs in the area of ​​the sacroiliac joint.

On the plain radiographs of the pelvis in the anteroposterior projection, the expansion of the pubic symphysis with displacement is revealed when the image is taken in the position on one leg.

Osteomyelitis of the pubic articulation

Pubic osteomyelitis is a sluggish infection of the pubic bone, a rare disease that usually occurs 2 weeks to 3 months after urogenital interventions, gynecological operations, or surgical delivery. Less commonly, it occurs in intravenous drug users due to the spread of bacteria from the injection site. Common symptoms are soreness in the area of ​​the pubic symphysis or branches of the pubic bones, pain limiting the movement of the hips, especially abduction, pain with lateral compression of the pelvis, and related common manifestations- subfebrile body temperature. In the blood, normochromic anemia, leukocytosis, an increase in inflammatory markers (C-reactive protein and ESR) are detected. Blood and urine cultures are positive in about 50% of cases, Staphylococcus aureus and Enterobacter and Pseudomonas bacteria. On the X-ray of the pelvis, the divergence and erosion of the bones of the pubic symphysis is determined. Radioisotope scanning of bones reveals increased absorption, but this method is not used during pregnancy.

Osteitis of the pubic bone

Osteitis of the pubic bone is a painful inflammation with a symmetrical lesion of all structures in the area of ​​the pubic symphysis. It usually occurs idiopathically, but is sometimes associated with pregnancy, seronegative spondyloarthritis, urogenital manipulation, and trauma.

Symptoms are pubic pain radiating to the groin, thigh and lower abdomen. The pain is worse when climbing stairs, raising your legs, lying on one side and turning on one leg, coughing and sneezing. Palpation of the pubic symphysis and bilateral simultaneous pressing of the greater trochanters causes pain. Decreased hip abduction results in a duck gait. In addition, weakness of the hip flexors appears.

Typical radiological signs are erosion, cystic changes and rarefaction of the medial edges of the branches of the pubic bones. X-ray examination of the pelvis reveals diastasis of the bones of the pubic symphysis, with their displacement in the position of the patient on one leg. A later manifestation of the disease is sclerosis of the edges of the pubic bones. An increase in the number of leukocytes and the level of inflammatory markers is usually not noted. Bone scans may be negative.

Pregnancy-induced osteomalacia

It is a metabolic bone disease resulting from vitamin D deficiency. Vitamin D requirements increase during pregnancy and, if left untreated, osteomalacia occurs. Vegetarians are at particular risk of this disease. The symptoms of the disease are vague, so a misdiagnosis is often made. Usually there is pain in the bones of the axial skeleton. Localized pubic pain occurs due to pseudofractures (Loser's zone). On the roentgenogram, a thin translucent strip about 2 mm wide is visible, which runs perpendicular to the surface of the bone from the cortex into the bone. Duck gait due to proximal myopathy. Soreness of the pubic bones, spine, ribs and sternum is determined.

Diagnosis is based on biochemical examination of low or normal serum calcium levels and increased level alkaline phosphatase in almost all patients. The diagnosis is confirmed by low serum vitamin D levels. The X-ray shows Loser's zones in the pubic and ischial bones. With oral vitamin D replacement therapy, biochemical parameters usually return to normal. Otherwise, it is necessary to exclude malabsorption.

A brief description of these diseases and differential diagnosis are presented in the table below. It illustrates the similarity of clinical manifestations. X-rays are rarely used during pregnancy, therefore diagnostic difficulties arise, and the prevalence of any of these diseases during pregnancy remains hypothetical.

Characteristics of musculoskeletal diseases of the pubic bone during pregnancy

	Pubic joint dysfunction	Osteitis of the pubic articulation	Osteomyelitis	Osteomalacia
Pain above the pubis	Yes	Yes	Yes	Yes
Loss of abduction in the hip joint	Yes	Yes	Yes	Yes
High erythrocyte sedimentation rate (ESR)	Not	Not	Yes	Not
Pathological results of biochemical studies	Not	Not	Not	Yes
Common Symptoms	Not	Not	Yes	Yes
Pubic diastasis	Yes	Yes	Not	Not
Displacement of the pubic articulation	Yes	Yes	Not	Not
Erosion	Not	Yes	Not	Yes
Cysts / rarefaction	Not	Not	Not	Yes
Lozere zones	Not	Not	Yes	Not

Reflected pain

Musculoskeletal disorders of the spine and hip joints sometimes manifest as pain in the pubic bone. For any joint problems, attention should be paid to the possible problems of the adjacent joints (above and below). However, as a rule, other symptoms distinguish them from diseases of the pubic bone itself and the pubic symphysis. These diseases are described below.

Short-term osteoporosis of pregnancy with damage to the hip joints

This is a rare but well-known condition. In pregnant women, the left hip is usually affected, although the right hip and other joints may be affected.

Symptoms are hip pain that is localized in the groin or radiates to the front of the knee, especially when the legs are loaded. The white blood cell count and the level of inflammatory markers are elevated slightly or within the normal pregnancy range.

X-ray shows localized osteopenia in the femoral head and acetabulum. On ultrasound, effusion in hip joint. Differential diagnosis this disease from other lesions of the pubic bone is carried out in the absence of localized pain on palpation of the pubic symphysis.

Mechanical back pain and sciatica

In the later stages of pregnancy, lumbar lordosis and reversal of the lumbosacral junction are increased. By the end of pregnancy, up to 50% of women complain of lower back pain. The pain radiates to the buttocks and sometimes to the legs and pubic region. It can be so strong that it interferes with sleep. The pain increases during labor and disappears soon after delivery.

Gait usually does not change, myopathy is absent. Lower back movements provoke pain. With prolapse of the disc, the elevation of the straight leg is impaired and local neurological symptoms are observed. Local pain in the area of ​​the pubic symphysis is usually absent. The diagnosis is usually made on the basis of clinical examination and X-ray of the lumbosacral spine, which is performed while the pain persists and intensifies.

Other diseases

Lower urinary tract infections usually present with dysuria, urinary frequency and urgency, but these symptoms are less severe during pregnancy. Women complain of pain behind the pubic symphysis.

Urinary tract infection

A urinary tract infection can present with pain behind the pubic bone, which is confused with diseases that directly affect the pubic bone. In the third trimester, urination is more frequent, therefore, the diagnosis is usually made on the basis of a urine test with an indicator strip, which reveals proteinuria. In this case, the number of colonies of microorganisms per 1 ml of urine equal to 105 (when inoculating the middle portion of urine) confirms the diagnosis of urinary tract infection.

On clinical examination, soreness over the pubis is usually absent. Gait is not disturbed, hip abduction is normal. With adequate antibiotic therapy, there is a rapid symptomatic improvement.