Pregnancy & Baby 

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History of pubic symphysis separation

Pubic symphysis separation is a recognised complication of pregnancy with estimates of incidences ranging from one in 300 to one in 30,000. Characteristic symptoms of symphyseal separation include suprapubic pain and tenderness with radiation to the back of legs, difficulty in walking and, occasionally, bladder dysfunction. An x-ray and ultrasound are frequently used to confirm the diagnosis.

Trauma or obstetric interventions such as the use of force to move the thighs or the use of forceps may also trigger separation.

Postpartum clues might be: urinary incontinence when changing position from supine or prone to upright, pain in the hips or lower back when walking or use of a waddling gait when walking. The change in gait and the pain when walking may not be noticed until 24 hours or more after delivery.

We really don't understand why this occurs in some women, but there may be a genetic predisposition to this. Scandinavian countries report a high incidence. Associations with multiparity, large babies, pathology of the joint (causing loosening) and increased force placed on the pelvic ring have been suggested as possible explanations.

Treatment is usually conservative, including bed rest, pelvic binders, the use of walkers and mild analgesics, which usually result in a complete recovery within four to six weeks.

The occurrence of a symphyseal separation should not significantly alter the management of subsequent pregnancies, and the same types of conservative therapy are recommended for any recurrence of symptoms. Recurrent separation of the symphysis pubis could occur during subsequent deliveries, but generally is no worse than the first occurrence.

I would try to get a referral to a good physiotherapist who is experienced in this condition. Use of a binder or light-weight maternity girdle may help as well.

Avoid postures where you need to separate the thighs by more than a normal stride width. During the birth, you should pick the position for birth; don't let your midwife force your legs back. Giving birth on your side may be most comfortable.

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