Pubic Bone Pain in Pregnancy (SPD): What Helps

Pubic bone pain in pregnancy is usually symphysis pubis dysfunction (SPD), which many providers now call pelvic girdle pain. It’s pain in the joint at the front of your pelvis, where the two pubic bones meet. It tends to flare when you stand on one leg, climb stairs, roll over in bed or get out of a car. The NHS says it “is not harmful to your baby, but it can be painful and make it hard to get around.” What helps is mostly keeping your knees together, sitting down for one-legged jobs, and telling your OB or midwife early so they can refer you for physical therapy.

Where this post stops

I’m pregnant with my second, and this time I felt it as a bruised ache dead center whenever I put on pants standing up. I’m not a doctor, a midwife or a physical therapist. This post describes what SPD feels like and repeats the everyday adjustments two health sources list. It doesn’t diagnose anything, and it doesn’t name a pain reliever or anything else you swallow. “Ask your OB what you can take” is as far as it goes.

What it is

Cleveland Clinic’s page on symphysis pubis dysfunction explains the joint. Your pubic symphysis sits “at the front and bottom of your pelvis” and connects the left and right pubic bones. Ligaments normally hold it steady. In pregnancy a hormone called relaxin loosens those ligaments, which Cleveland Clinic says can begin “as early as 10 weeks”. The loosening is useful, because it lets your pelvis widen for the birth. The cost is that the joint can move more than is comfortable, with the weight of the baby pressing on it.

On the name: Cleveland Clinic says SPD “is sometimes called pelvic girdle pain”, the newer term, because it “more accurately describes how you feel pain across your entire pelvis”. The NHS page on pelvic pain in pregnancy uses PGP and SPD together.

It’s common. Cleveland Clinic says SPD and pelvic girdle pain “affect about 1 in 4 people during pregnancy.” The NHS estimate is “up to 1 in 5 pregnant women to some degree.”

What it feels like

The NHS lists where you might feel it:

• “over the pubic bone at the front in the centre, roughly level with your hips”
• “across 1 or both sides of your lower back”
• “in the area between your vagina and anus (perineum)”

Cleveland Clinic describes a range, from “mild discomfort that tends to stay in the front of your pelvis” to “sudden shooting pain” or pain that spreads into your lower abdomen, back, groin and thighs. Both sources mention that you might feel or hear “a clicking or grinding” in your pelvis.

The movements that set it off are a list of ordinary life. Cleveland Clinic’s version: walking, stairs, turning over in bed, getting out of bed, getting in and out of the car, standing on one leg, getting up from a chair, and spreading your legs apart. It adds that the pain often gets “more intense the closer you are to delivery”, as the baby gets heavier.

How it differs from the other pelvic pains

• Round ligament pain is a quick twinge at the side of the bump or into the groin when you move suddenly, and it passes in seconds to minutes. It has its own post: round ligament pain.
• Lightning crotch is a split-second electric zap, usually late in pregnancy. See lightning crotch, explained.
• SPD is in the joint. It’s tied to weight-bearing and to moving your legs apart, and it lingers as an ache.

That list is to help you describe it on the phone. Working out which one you have is your provider’s job.

What helps

The NHS and Cleveland Clinic lists overlap almost completely. Combined:

• Keep your knees together getting in and out of the car. Sit down first, then swing both legs in as one. Cleveland Clinic’s wording is “squeezing your legs together”.
• Sit down to get dressed. The NHS says to “sit down when getting dressed or undressed”. This was the fix for my pants problem.
• Stand evenly. “Put equal weight on each leg when standing.”
• Sleep with a pillow between your knees. Both sources say this. Cleveland Clinic specifies side sleeping “with a pillow between your knees and lower legs”. A full-length pillow like the Momcozy U-shaped pregnancy pillow keeps your knees and ankles level all night. The rest of the nighttime setup is in how to sleep when pregnant.
• Stay active, within limits. The NHS: “keep active but avoid doing things that make the pain worse.” Cleveland Clinic says the benefits of walking “typically outweigh the risks”, though you may need to change how far or how often you go.
• Try an ice pack. Cleveland Clinic lists “placing an ice pack on your pelvic area”. Wrap it in a cloth.

Both lists also say what to cut back on. The NHS names “sitting or standing for long periods”, “going up and down stairs too often” and “lifting heavy objects”. Cleveland Clinic adds twisting motions and squats. If you have a toddler, the lifting one is the hardest. This is a good week to teach them to climb into the car seat themselves.

Physical therapy and support belts: ask for the referral

Home adjustments only go so far. The NHS says “getting diagnosed as early as possible can help keep pain to a minimum and avoid long-term discomfort”, and that you “may be referred to a physiotherapy service that specialises in obstetric pelvic joint problems.” That can mean exercises for your pelvic floor, stomach, back and hip muscles, and “equipment, if necessary, such as crutches or pelvic support belts.”

Cleveland Clinic also lists a pregnancy support belt and physical therapy among the options a provider can help with. I’d let them choose the belt and show you how to wear it, since they’ve examined your pelvis and can see how you move. So the step here is the referral. Ask your OB or midwife about one at your next visit, or sooner if things are getting worse.

Will it go away?

Usually it does, after the birth. Cleveland Clinic says most people find the pain “subsides within a few months of giving birth”, once relaxin stops and the ligaments tighten again. The NHS is frank that these problems “tend not to get completely better until the baby is born”, but that treatment “can improve the symptoms during pregnancy.” Cleveland Clinic is also clear that SPD “shouldn’t require bed rest.”

It isn’t a sign that labor is close, either. Cleveland Clinic says so directly: SPD and pelvic girdle pain “don’t mean your labor is near or progressing.”

When to call your OB or midwife

The NHS says to call your midwife or doctor if you have pelvic pain and:

• “it’s hard for you to move around”
• “it hurts to get out of a car or turn over in bed”
• “it’s painful going up or down stairs”

Cleveland Clinic adds two more reasons:

• It’s interfering with daily life. “Let your healthcare provider know if your pelvic pain interferes with your daily life.”
• It’s getting you down. The pain “can take a toll on your mental health”, and Cleveland Clinic says to talk to your provider if you have symptoms of depression. The NHS says the same if the pain “is causing you considerable distress”.

Cleveland Clinic also lists trouble peeing or pooping as a symptom that can show up alongside the pain. Mention that if it happens.

FAQ

Is pubic bone pain in pregnancy normal?

It’s common. The sources put it at roughly 1 in 4 or 1 in 5 pregnancies. Cleveland Clinic says not to just put up with it, though: being in real pain and unable to do your usual activities “isn’t something you should accept.” Tell your provider.

Does SPD hurt the baby?

The NHS says PGP “is not harmful to your baby.”

Is walking bad for SPD?

Cleveland Clinic says the benefits of walking usually outweigh the risks. If walking causes extreme pain or makes things worse, change how often, how far or in what shoes you walk, and ask about physical therapy.