Monday, June 18, 2012

Pregnancy: Symphysis pubis dysfunction

i have diagnosed myself for having this problem...
cos, since baby turned his head down, i have been feeling a 'pressure' below... i thought that was normal and eventually it will go (or at least it'll come & go)... but this time the pain was concentrated at my symphysis pubis only @-@.. worsen at night or after i had my long day...

it was really difficult for me to roll over in bed, to swing my legs down fr bed etc...

and it was really bad last wednesday when i really cried in pain.... T_T

i googled and found this... Symphysis Pubis Dysfunction (SPD) or symphysis pubis instability or also known as Pelvic Girdle Pain (PGP).


What is symphysis pubis dysfunction?

The two halves of your pelvis are connected at the front by a stiff joint called the symphysis pubis. This joint is strengthened by a dense network of tough, flexible tissues, called ligaments. To help your baby pass through your pelvis as easily as possible, your body produces a hormone called relaxin, which softens the ligaments.

As a result, these joints move more during and just after pregnancy, causing inflammation and pain, known as symphysis pubis dysfunction or SPD.

A related condition is diastasis symphysis pubis (DSP), in which the gap in the pubic joint widens too far. The average gap between the bones in a non-pregnant woman is between 4mm and 5mm, and during pregnancy it's normal for this gap to widen by 2mm or 3mm. If the gap is 10mm or more, DSP is diagnosed. It's rare, and can only be identified by X-ray.

What causes SPD?

We are not sure exactly what causes SPD, but it's thought to be caused by a combination of hormones that you produce during pregnancy and the way your body moves. It is thought that if one side of the pelvis moves more than the other when you walk or move your legs, the area around the symphysis pubis becomes tender.

Although the condition is thought to be related to excess movement in the pelvic joints, the amount of discomfort isn't related to any gap in the joint. Many women with a normal-sized gap feel a lot of pain.

If you have hypermobility syndrome, stated your periods before you were 11, or are overweight, then you may be more likely to develop SPD during your pregnancy.

When does it happen?

SPD can occur at any time during your pregnancy or after giving birth. Many women notice it for the first time around the middle of their pregnancy. If you have SPD in one pregnancy, it is more likely that you'll have it again next time you get pregnant.

The symptoms may also come on earlier and progress faster, so it is important to seek help promptly. It can help if you allow the symptoms from one pregnancy to settle before trying to get pregnant again.

What are the symptoms?

Pain in the pubic area and groin are the most common symptoms. But you may also have the following signs:

 •Back pain, pelvic girdle pain or hip pain. --> i dont have the backpain or hip pain. 

•A grinding or clicking sensation in your pubic area.

•Pain down the inside of your thighs or between your legs. It can be made worse by parting your legs, walking, going up or down stairs or moving around in bed. --> it is worse when parting my legs! and moving around in bed is 'killing' me!!

•Worse pain at night. It can stop you sleeping well and getting up to go to the toilet in the middle of the night can be especially painful. --> definitely worse in the evening/at night! *cry*

How is it diagnosed?

SPD is becoming more widely understood by doctors, physiotherapists and midwives. Your doctor or midwife should refer you to a specialist women’s health physiotherapist who will have experience in treating it.

Your physiotherapist will diagnose SDP by listening to your description of your symptoms and by testing the stability, movement and pain in your pelvic joints and muscles.

How is it treated?

SPD is often managed in the same way as pelvic girdle pain, and treatment will include:

•Exercises, especially for the tummy and pelvic floor muscles, to improve the stability of your pelvis and back. You may need gentle, hands-on treatment of your hip, back or pelvis to correct stiffness or imbalance. Exercise in water can sometimes be useful.

•You should also be given advice on how to make daily activities less painful and on how to make the birth of your baby easier. Your midwife should help you to write a birth plan which takes into account your SPD symptoms.

•Acupuncture may help and has been shown to be safe during pregnancy, but make sure your practitioner is trained and experienced in working with pregnant women.

•Osteopathy and chiropractic may help, but again, make sure you see registered practitioner who is experienced in treating pregnant women.

•A pelvic support belt will give quick relief. --> i'm wearing the maternity belt which i assume partly help easing my backpain... phewhh...


 Are there any self-help tips I can follow?

There are things you can do yourself to ease your pain:

•Regular pelvic floor and tummy exercises can ease the strain on your pelvis. Get down onto your hands and knees and level your back so that it is roughly flat. Breathe in and then as you breathe out, squeeze in your pelvic floor muscles and at the same time pull your belly button in and up. Hold this contraction for between five and 10 seconds without holding your breath and without moving your back. Relax the muscles slowly at the end of the exercise.

•Avoid moving your legs apart when your back is slumped or you are lying down. Take care when getting in and out of the car, bed or bath. If you are lying down, pulling your knees up as far as you can stops your pelvis from moving and makes it easier to part your legs. If you are sitting, try arching your back and sticking your chest out before parting or moving your legs, as this also helps to stop your pelvis from moving. --> since i know this 'diagnosis', these movements really help me to not exacerbate the pain!

•Avoid pushing through any pain. If something hurts, if possible don't do it. If the pain is allowed to flare up, it can take a long time to settle down again. --> i also suffering from constipation last week, so that might explained why it gotten worse @_@ 

•Move little and often. You may not feel the effects of what you are doing until later in the day or after you have gone to bed. --> oh yes... too much sitting down or lying down may exacerbate the pain... but too much walking will definitely make it worse.. i hate being home-bound over the weekend huhuhu...

•Rest regularly by sitting on an exercise or birth ball or by getting down on your hands and knees. This takes the weight of your baby off your pelvis and holds it in a stable position. --> thanks to my friend's gymball, it really helps! I would sit on the ball as much as possible.. 

•Avoid heavy lifting or pushing. Supermarket trolleys can often make your pain worse, so shop online or ask someone to shop for you. --> i havent been to Tesco since the last 2 weeks. Last week we went, but i just sat having my coffee latte and let my dear hubby did the shopping... sakit la mau jalan banyak esp lepas keje huhu...

•When climbing stairs, go up them one step at a time. Step up onto one step with your best leg and then bring your other leg to meet it. Repeat with each step. Only use stairs when you have to. --> errr this only done when i remember... lambat la melangkah satu persatu hehehe.. Ayish lagi laju naik tangga dari mummy kalo gitu LOL

•Avoid swimming breaststroke and take care with other strokes. You may feel swimming is helping your pain while you are in the water, but it could make you feel worse when you get out. --> tarak swimming!

•When getting dressed, sit down to pull on your knickers or trousers. --> oh ni memang... tak boleh nak angkat kaki tinggi dari buku lali... esp petang/malam.. pagi ok lagi.. T_T

How soon after I've had my baby will I recover from SPD?

Most women find that their symptoms improve after their baby is born, although some still have pain when their babies are a year old. Carry on with physiotherapy after the birth and get help with looking after your baby during the early weeks if you can. --> i hope my symptoms will be gone after baby is born... *praying*

 Some ex-sufferers find the pain recurs every month just before their period is due. This is caused by hormones which have a similar effect to the pregnancy hormone relaxin.

There are few exercises to help to ease the pain -- here.

And this condition is well-diagnosed in overseas i think, but here, when i asked my OBG, she only said 'pressure from baby's head' ;(

You could read some of the mamas' experiences in the circleofmoms forum

well, every pregnancies are different... so, i'm not complaining.. syukur pada Allah, maybe nanti bersalin and postnatal akan dipermudah kan ameeennn....

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