Symphysitis

Symphysitis is considered a pathology of the pubic symphysis, the development of which is based on an inflammatory reaction in response to the impact of a damaging factor. Physiologically, the connection between the pubic bones of the pelvis is an immobile structure, but due to various conditions, its mobility may increase.

This process is caused by a change in the consistency of the ligaments, which acquire a softer form, as well as swelling of this area. As a result, the pubic bones gradually move away from each other, and their articulation acquires greater mobility.

Most often, such changes are observed during pregnancy or after childbirth. In the case of a small divergence of the bones, independent restoration of the anatomical position is possible. However, sometimes the distance between the bones exceeds 1 centimeter, which requires complex treatment.

During pregnancy, symphysitis may occur starting from the second half of the term. This is due to the rapid weight gain of the fetus and the increase in amniotic fluid. As a result, the pubic symphysis is constantly affected by a force that contributes to the divergence of the pubic bones.

If symphysitis is observed after childbirth, then this is most likely a consequence of trauma to the joint during labor as the fetus passes through the birth canal.

[ 1 ], [ 2 ], [ 3 ]

Causes of symphysitis

It is quite difficult to identify the exact cause of the development of the pathology, since several factors can simultaneously affect the occurrence of symphysitis. Thus, the causes of symphysitis can be excessive secretion of the hormone relaxin during pregnancy. As a result, the ligaments become softer and lose the ability to tightly hold the bones at the required distance.

This process occurs due to changes in hormonal levels and imbalance of its components. Also, the development of symphysitis can be facilitated by genetic factors that are hereditarily transmitted to a woman.

Causes of symphysitis such as insufficient levels of calcium and other microelements in the body of a pregnant woman can provoke the divergence of the pubic bones.

A high probability of developing symphysitis is observed in pregnant women with bone and joint pathology. One should also not forget about the course of pregnancy, since severe toxicosis, rapid weight gain, excessive physical activity and improper nutritional diet can lead to an increase in the distance between the pubic bones and excessive mobility of the pubic junction.

Pubic symphysitis

The hormonal system is one of the main regulating factors of the body's functioning. During pregnancy, it undergoes a restructuring, and the ratio of hormones changes. These processes are necessary to ensure all the necessary conditions for the growth and development of the fetus.

During hormonal changes, the production of certain active substances may predominate. Thus, with excessive synthesis of the hormone relaxin, pubic symphysitis is observed.

Its development is caused by the softening of the ligamentous apparatus, due to which the pubic pelvic bones are at a certain distance from each other. Thus, as the tone decreases, the pubic symphysis diverges and its mobility increases.

Pubic symphysitis is also possible with diseases of bones and joints, when a woman has a predisposition to developing symphysitis, especially if she has insufficient levels of calcium in the body.

Normally, the distance between the pubic bones increases slightly. This is necessary to ensure passage for the fetus through the birth canal. In addition, the method of delivery depends on the degree of divergence of the pubic symphysis, since natural childbirth with a large distance between the bones can lead to such a complication as ligament rupture.

Symptoms of symphysitis

The beginning of softening of the ligaments between the pubic bones can be observed already from the 6th-7th month, since it is during this period that the appearance of clinical signs of pathology is noted. Symptoms of symphysitis under certain unfavorable circumstances can bother already from the 4th-5th month.

At the initial stage, the pregnant woman feels aching periodic pain in the perineum and pubic area. They bother her during intensive walking or climbing stairs. Then the pain syndrome intensifies due to the fact that the mobility between the pubic bones increases.

The pain becomes constant and is observed not only during physical activity, but also at rest or when changing body position. In addition, discomfort is felt in the area of the pubic symphysis. Later, the pregnant woman acquires a "duck" gait. It helps her to use the pubic symphysis less when walking, thereby reducing pain impulses.

Symptoms of symphysitis become more pronounced in the last months of pregnancy, when the force acting on the pubic bones is maximum. Pain can spread to the femoral, lumbar, groin and buttock area.

Symphysitis of pregnancy

The process of bearing a fetus is a serious burden on the woman's body. During this period, the hormonal system is restructured, as a result of which an exacerbation of the existing concomitant pathology of the endocrine system is possible.

In addition, the pregnant woman's body is subjected to stress from the fetus, as an additional circle of blood circulation appears; as the fetus grows, the uterus gradually rises and in the last stages reaches the diaphragm, as a result of which it becomes increasingly difficult for the woman to breathe (the respiratory volume of the lungs decreases).

The enlarged uterus also prevents the normal outflow of venous blood from the lower extremities, affecting the blood vessels. In general, the body undergoes serious changes and do not be surprised if a small failure is possible somewhere.

Thus, symphysitis of pregnant women is a fairly common pathology, the development of which is based on the relaxation of the ligamentous apparatus connecting the pubic pelvic bones. The diagnosis is made using symptoms and the results of additional instrumental studies.

Postpartum symphysitis

During pregnancy, the ligamentous apparatus between the pubic bones of the pelvis is affected by many factors, as a result of which it loses its tone and the ability to hold them at a certain distance.

If the bones are separated by no more than 1 centimeter, the birth can be carried out through natural channels. Sometimes it happens that the distance between the pubic bones increases after childbirth.

Postpartum symphysitis occurs as a result of the influence of factors from both the fetus and the pregnant woman. Excessive stretching of the ligaments is facilitated by a large fetus, a narrow pelvis of the woman, severe toxicosis, previous pathology of the joints and bones, as well as many other factors.

If the divergence is several centimeters, then with the help of special exercises and a bandage you can quickly get rid of the symptoms of symphysitis or even the symphysitis itself.

Postpartum symphysitis, caused by a significant distance between the pubic bones, requires complex treatment, which includes drug therapy, physiotherapy, wearing a bandage and exercise.

Complications of symphysitis

The divergence of the pubic bones can have different degrees, the most serious complications of symphysitis are observed when the distance between the bones exceeds 1 centimeter. Starting from the first stage, the appearance of pain syndrome is noted, which bothers periodically and has a nagging character.

At this stage, the pregnant woman can fight the pain with the help of special physical exercises and painkillers. However, as the process progresses and the distance between the pubic bones increases, the pain syndrome becomes constant, regardless of the woman's activity.

Since pain is observed even at rest, the pregnant woman's psycho-emotional state is disturbed, she becomes irritable and tearful. In addition, the nervous system is affected by hormonal levels, which change significantly during pregnancy.

Such complications of symphysitis as excessive divergence of the pubic bones up to rupture are serious consequences of ligament pathology. As a result, the pubic symphysis loses the connection between its structures, which leads to the inability to walk, stand or lift the legs.

[ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ]

Diagnosis of symphysitis

The process of diagnosis includes a thorough questioning of the woman about her complaints, the duration of the disease, as well as identifying the provoking factors that caused the development of symphysitis.

Symphysitis diagnostics consists of additional instrumental methods of examination, which are used depending on the woman's condition. That is, if a woman is pregnant, then some examinations are not allowed, for example, X-ray, computer or magnetic resonance imaging. In this case, she is recommended to undergo only ultrasound diagnostics.

In case of development of pathology after childbirth, then diagnostics of symphysitis can use all methods that are necessary for diagnosis. With their help, not only the divergence of the pubic joint bones is determined, but also the distance between them is estimated.

As a result, after conducting the research, further therapeutic tactics are determined. Based on the ultrasound diagnostics of the pregnant woman, the method of delivery is determined based on the degree of divergence of the pubic bones.

Ultrasound for symphysitis

During pregnancy, it is necessary to exclude all factors that may have a negative impact on the fetus. Thus, it is allowed to use only ultrasound diagnostics for various purposes (to monitor the condition of the fetus and amniotic fluid, as well as to determine pathology on the part of the pregnant woman).

Ultrasound for symphysitis is the only method that is allowed to be used without harming either the fetus or the future mother. This method is used to determine the degree of divergence of the pubic bones and measure the distance between them.

Thus, with the help of ultrasound, in case of symphysitis, it is possible to detect the first degree of divergence, which is characterized by a divergence of the pubic bones of no more than 5-9 millimeters. In the second stage, a distance of 1 centimeter is observed, and in the third - more than 2 centimeters.

With symphysitis of the third degree, a woman cannot walk, sit or lift her legs, as all these actions cause severe pain. Based on the data obtained after conducting an ultrasound examination, further tactics for managing the woman, as well as treatment directions, are determined.

Treatment of symphysitis

Depending on the degree of divergence of the pubic bones and the clinical manifestations of the pathology, treatment of symphysitis may include various methods of assistance.

A mandatory condition of therapy is the performance of specially developed physical exercises that reduce the intensity of the pain syndrome, strengthen the gluteal, perineal, femoral and lumbar muscles. Thanks to them, the pelvic structures restore their physiological position.

Treatment of symphysitis involves following certain recommendations. Among them, it is necessary to highlight: reducing physical activity, in particular, climbing stairs and fast walking, not sitting in one position for a long time (more than 1 hour), not placing one leg on the other when sitting, and also, when standing, evenly distributing the load on both legs.

In addition, you need to monitor your diet and eat more foods containing calcium - dairy products. Calcium can also be taken in tablet form. It is necessary to control your weight, since excess weight predisposes to the appearance of severe pain syndrome.

Among the medications, it is worth noting anti-inflammatory drugs and complexes of vitamins and microelements.

Bandage for symphysitis

The treatment tactics are determined individually in each case, taking into account the degree of divergence of the pubic pelvic bones and the severity of clinical manifestations of symphysitis. Despite the distance between the bones of the pubic symphysis, there are some therapeutic methods that must be used.

A special set of physical exercises and a bandage are the mandatory components of the treatment complex. A bandage for symphysitis is used to maintain the pelvic structures in a physiological position and prevent further divergence of the pubic pelvic bones.

A symphysitis bandage is a bandage made of dense material that can hold the pelvic bones in a certain position.

However, there are some peculiarities. Thus, the bandage must be selected individually for each pregnant woman or woman in labor, during which she needs to try it on and determine how comfortable it is.

Firstly, the bandage should be put on in a lying position, fastened quite tightly, leaving room for the palm to enter. Secondly, when rising, it is necessary to assess how tightly it fits and supports the pelvic structures.

And finally, thirdly, the bandage should not be used around the clock, but only if you have to stand or walk for a long time. The bandage must be removed at night to avoid excessive compression of the internal organs.

[ 10 ], [ 11 ], [ 12 ]

Exercises for symphysitis

Excessive physical activity is strictly prohibited, as it contributes to an even greater divergence of the pubic pelvic bones and an increase in pain.

On the other hand, specially selected exercises for symphysitis allow not only to reduce the severity of pain, but also to strengthen the ligaments and increase the tone of the muscles of the perineum, buttocks, thighs and lower back.

Exercises for symphysitis should be performed several times a day, especially with severe pain. The complex includes several exercises that can help in the fight against symphysitis.

First, you need to lie down and place your feet as close to your buttocks as possible. Then you should slowly move your knees apart, hold them in the maximum permissible position and close them again. You can repeat 5 to 10 times, gradually increasing the number of exercises.

Next, move your feet slightly away from your buttocks so that your shin forms a right angle with the floor, and lift your pelvis until you get a straight line with your body. However, you need to control the height of the lift to avoid discomfort. Repeat 6-10 times.

The third exercise is known to everyone as the "cat". It involves doing it on your knees and leaning on your palms, arching your back upwards, lowering your neck and head. The abdominal muscles should be tense. Hold for 5 seconds and repeat 3 times.

Treatment of symphysitis with folk remedies

The pathology of the divergence of the pubic pelvic bones is based on the influence of pathogenic factors that contribute to an increase in the distance between the bone structures.

To combat symphysitis, folk remedies are used rather than medications, especially at the first stage. Treatment of symphysitis with folk remedies includes performing a set of specially selected physical exercises, following a proper diet, and using a bandage.

The effectiveness of these methods depends directly on the woman and the seriousness of the approach to treatment. Thus, by regularly performing exercises, she will soon strengthen the muscles of the buttocks, perineum, lower back and hips, which is necessary to restore the physiological position of the pelvic structures.

In addition, daily exercises, the frequency of which reaches 3-4 times a day, help reduce the intensity of pain.

Also, the treatment of symphysitis with folk remedies involves the use of foods that contain a high percentage of calcium. As for the bandage, it is an integral part of the treatment and is necessary to maintain the pubic bones of the pelvis in a normal position, gradually bringing them closer to each other.

Prevention of symphysitis

Identifying the main factor influencing the development of symphysitis is a rather problematic task. In this regard, prevention of symphysitis also cannot be clearly defined.

By following certain rules and recommendations, it becomes possible to reduce the risk of pathology. So, to begin with, you need to reduce the amount of stress and perform special physical exercises. Such a course should be selected by a specialist individually for each woman, taking into account her concomitant pathology and contraindications.

In addition, prevention of symphysitis consists of maintaining a proper diet and lifestyle. It is necessary to eat foods with calcium and spend enough time in the fresh air.

As for pregnant women, they are advised to register in a timely manner, visit a doctor regularly, adhere to a dietary diet and avoid exposure to stress factors.

In addition, pregnant women should wear a bandage to maintain the physiological position of bone structures and internal organs, and also not neglect to perform special exercises.

Symphysitis prognosis

The divergence of the pubic pelvic bones is observed in almost 50% of all pregnancies. It was noted that each subsequent pregnancy increasingly predisposes to the development of symphysitis. Thus, if during the first pregnancy softening of the ligamentous apparatus was already detected, then subsequent pregnancies will also be accompanied by this process.

The prognosis of symphysitis depends on the degree of divergence of the pubic bones and the clinical manifestations that bother the woman. If measures are taken in time to solve this problem, the prognosis of symphysitis is quite favorable.

In addition, during pregnancy, the woman is under constant supervision of a doctor who monitors the development of symphysitis and decides on the choice of the method of delivery. The pathology does not have a negative impact on the woman's health, provided that the symphysitis is controlled.

After childbirth, hormonal levels stabilize, swelling of the pubic symphysis decreases, and the severity of pain decreases.

Symphysitis is observed in half of all pregnancies, but with due attention to the pathology and selection of effective treatment, a woman may not remember about symphysitis within a few months after giving birth.

Symphysitis and sex

As already mentioned, symphysitis develops as a result of exposure to various provoking factors, which leads to softening of the ligamentous apparatus between the pubic and pelvic bones.

The divergence of the bones is accompanied by pain syndrome, which makes symphysitis and sex mutually exclusive processes. Pain prevents a woman from relaxing and receiving pleasure, which leads to greater nervous tension and irritability.

Even if symphysitis is in the first stage of development and no painful sensations arise during sexual activity, there is still a high probability of their appearance after sex.

As for the second and higher stages of pathology, here sex will contribute to the intensification of the pain syndrome, which is always accompanying the woman. This is especially true for active sex and intense movements.

Of course, with symphysitis, physical activity is necessary, only in the form of special exercises aimed at gradually strengthening the ligamentous apparatus and muscles. They are performed slowly and do not cause painful sensations to the woman, but, on the contrary, help to reduce their severity.