Symphysis Pubis Dysfunction: Symptoms, Types, Causes and Treatment

Symphysis Pubis Dysfunction (SPD) is a condition that affects the pelvic joint at the front of the pelvis, causing pain, discomfort, and sometimes severe disability. It is most commonly associated with pregnancy but can also affect athletes and others due to trauma or overuse. This article provides an in-depth, evidence-based overview of SPD, exploring its symptoms, types, causes, and treatments to help individuals understand and manage this often misunderstood condition.

Symptoms of Symphysis Pubis Dysfunction

When SPD strikes, it can disrupt daily life in profound ways. People with SPD may experience pain ranging from mild discomfort to severe, debilitating agony. The pain often centers around the pubic bone but may also radiate into the groin, hips, lower back, or thighs. Everyday movements—walking, climbing stairs, turning over in bed—can become major challenges. Understanding these symptoms is vital for early recognition and appropriate intervention.

Symptom	Description	Impact on Daily Life	Source(s)
Pubic pain	Aching, stabbing, or burning pain at the front of the pelvis	Difficulty walking, standing, or moving	2 3 4 7
Groin radiation	Pain spreads to inner thighs, groin, hips, or lower abdomen	Reduced mobility, sleep disturbance	3 5 7
Clicking	Audible or palpable clicking sensation at the joint	Sensation of instability	5 4
Movement pain	Pain intensified by walking, stairs, turning in bed, or standing on one leg	Interference with daily activities	3 7 4
Tenderness	Localised tenderness over the symphysis pubis	Discomfort with palpation	5 4

Table 1: Key Symptoms of Symphysis Pubis Dysfunction

Common Symptoms and Their Impact

SPD manifests primarily as pain at the symphysis pubis—the joint at the front of the pelvis. This pain may be described as sharp, stabbing, aching, or burning. It often worsens with movement, especially activities that put stress on the pelvis:

• Walking: Many patients report a waddling gait due to pain, often making walking difficult or almost impossible during flare-ups.
• Turning over in bed: The act of rolling over can trigger intense pain, causing sleep disruption 3 7.
• Stairs and standing on one leg: Climbing stairs or tasks such as putting on pants (which require standing on one leg) can sharply increase discomfort 3.
• Clicking or grinding: Some individuals notice a clicking or grinding sensation at the pubic joint. This is a sign of joint instability 5.

Additional Effects on Daily Life

Beyond physical pain, SPD can have emotional and psychological impacts. Chronic pain often leads to frustration, anxiety, and even depression, particularly when it limits the ability to care for oneself or family, as is common among pregnant women 7. The condition can also strain relationships and challenge mental health due to its unpredictable nature and the lack of widespread understanding among healthcare professionals 7.

Types of Symphysis Pubis Dysfunction

SPD is not a one-size-fits-all diagnosis—it encompasses a spectrum of conditions affecting the pubic symphysis joint. Recognizing the different types helps in tailoring management strategies to individual needs.

Type	Description	Common Population	Source(s)
Pregnancy-related	Joint laxity and pain during/after pregnancy	Pregnant/postpartum women	2 3 4 7
Athletic/Traumatic	Microtears, osteitis pubis, instability	Athletes, especially soccer players	1 5 6
Inflammatory	Chronic inflammation (e.g., osteitis pubis)	Athletes, rare outside sport	5 6
Infectious/Metabolic	Infection or metabolic disease affecting joint	Rare, usually with other illness	6 8

Table 2: Types of Symphysis Pubis Dysfunction

Pregnancy-Related SPD

The most recognized form of SPD occurs during or after pregnancy. The physiological changes of pregnancy—especially hormonal shifts that increase pelvic ligament laxity—can make the symphysis pubis more mobile and susceptible to pain 2 3 4. This type typically develops gradually as pregnancy advances and may persist for weeks or months postpartum 2 7.

Athletic and Traumatic SPD

Athletes, particularly those involved in sports requiring rapid changes of direction (like soccer or football), can develop SPD due to repeated microtrauma or stress at the pubic joint 1 5. Two main subtypes exist in this group:

• Adductor dysfunction: Small tears at the muscle attachment points near the symphysis, often preceding other changes 1.
• Osteitis pubis: Inflammation of the pubic bone, sometimes coexisting with adductor injuries 1 5.

Inflammatory and Infectious SPD

Chronic inflammation or infection of the pubic symphysis is less common but can occur, especially in the context of systemic diseases or following pelvic surgery 6 8. Inflammatory conditions such as ankylosing spondylitis can cause fusion of the joint, while infections (pyogenic or tuberculous) lead to erosion or destruction 6 8.

Metabolic and Other Causes

Rarely, metabolic disorders (such as ochronosis or renal osteodystrophy) or congenital defects can affect the integrity of the symphysis pubis, leading to symptoms similar to SPD 6 8.

Causes of Symphysis Pubis Dysfunction

Understanding what triggers SPD is key to prevention and treatment. The causes are multifactorial, ranging from physiological changes in pregnancy to repetitive stress injuries in athletes.

Cause	Mechanism	Affected Group	Source(s)
Hormonal changes	Pregnancy hormones relax pelvic ligaments	Pregnant women	2 3 4
Mechanical overload	Repetitive microtrauma, overuse	Athletes	1 5 6
Joint instability	Excessive movement of pelvic bones	Athletes, pregnancy	1 5 6
Inflammation	Chronic irritation of the joint	Athletes, rare outside sport	5 6
Infection	Bacterial or tuberculous infection	Rare, post-surgical	6 8
Metabolic disorders	Disease alters bone/joint structure	Rare, systemic illness	6 8

Table 3: Causes of Symphysis Pubis Dysfunction

Hormonal and Physiological Factors

Pregnancy is the most common context for SPD, driven by the surge in hormones such as relaxin and progesterone. These hormones prepare the body for childbirth by softening and loosening the ligaments of the pelvis, including those stabilizing the symphysis pubis 2 3 4. However, for some women, this physiological change leads to excessive joint mobility, causing pain and instability.

• Notably, the degree of joint relaxation does not always correlate with the severity of symptoms—some women may have significant pain with only minimal separation 2.

Mechanical and Overuse Injuries

In athletes, repeated mechanical stress on the pubic symphysis—through running, kicking, or abrupt movements—can lead to microtears at muscle attachments (enthesis) and inflammation of the pubic bones (osteitis pubis) 1 5. Chronic overuse leads to instability, which may further exacerbate pain and dysfunction 5 6.

Joint Instability and Trauma

Direct trauma, pelvic fractures, or severe stretching of the joint can cause SPD. Instability or diastasis (widening) of the joint may follow, particularly in cases of difficult childbirth or pelvic injury 4 6.

Inflammatory, Infectious, and Metabolic Causes

Although less common, chronic inflammatory diseases (e.g., ankylosing spondylitis), infections (e.g., osteomyelitis), and metabolic disorders can all affect the symphysis pubis, resulting in pain, joint widening, and sometimes destruction 6 8.

Treatment of Symphysis Pubis Dysfunction

SPD can be life-altering, but a variety of treatments exist, tailored to the underlying cause and severity of symptoms. Most cases resolve with conservative management, though persistent or severe cases may require more intensive interventions.

Treatment	Approach/Method	Effectiveness/Outcome	Source(s)
Conservative	Rest, activity modification, pain relief	Most cases resolve; delivery curative in pregnancy	2 5 10 13
Physical therapy	Exercises to strengthen pelvis, advice	Improves function, reduces pain	10 13
Pelvic support belts	External stabilization	Reduces movement, some symptom relief	10
Injections	Corticosteroids, anesthetics	Temporary relief for inflammation	9
Surgery	Curettage, resection, stabilization	For refractory cases, good outcomes	11 12
Antibiotics	For infectious causes	Resolves infection, prevents damage	9

Table 4: Treatments for Symphysis Pubis Dysfunction

Conservative Management

The cornerstone of SPD treatment is conservative care, which includes:

• Rest and Activity Modification: Avoiding activities that exacerbate symptoms, such as standing on one leg, heavy lifting, or excessive walking, allows the joint to recover 2 5 13. In pregnancy, symptoms usually resolve within six months after delivery 2.
• Pain Relief: Non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are commonly used for pain control 5.
• Physical Therapy: Targeted exercises to strengthen pelvic and core muscles, along with advice on posture and movement, are effective in reducing pain and improving function 10 13.

Physical Therapy and Pelvic Support

Supervised physical therapy is highly recommended. Therapists can teach:

• Pelvic stabilization exercises
• Safe movement strategies for daily activities
• Use of aids (e.g., crutches, pillows for sleeping)

Pelvic support belts (rigid or non-rigid) may be used to provide external stabilization, though research suggests they do not significantly outperform exercise and advice alone 10.

Injections and Surgical Options

For persistent inflammation (such as osteitis pubis), corticosteroid or local anesthetic injections can provide temporary relief 9. When conservative measures fail, surgical interventions may be considered:

• Curettage: Surgical scraping of the inflamed symphysis pubis for refractory osteitis pubis; most athletes return to full activity within months 12.
• Wedge Resection: Removal of part of the joint in chronic, severe cases yields good long-term outcomes, though some risk of instability remains 11.
• Stabilization Procedures: Rarely, surgical stabilization or mesh placement is used for severe instability 9 11.

Management of Infectious and Metabolic Causes

If SPD is caused by infection, prompt antibiotic therapy is essential to resolve the infection and prevent further joint destruction 9. Management of metabolic or inflammatory diseases requires addressing the underlying condition alongside SPD-specific interventions 6 8.

Conclusion

Symphysis Pubis Dysfunction is a multifaceted condition that can significantly impact quality of life, especially for pregnant women and athletes. Early recognition and tailored management are key to minimizing symptoms and promoting recovery.

Key Points:

• SPD presents with pain at the front of the pelvis, often radiating to the groin and aggravated by movement 2 3 4 5 7.
• Types include pregnancy-related, athletic/traumatic, inflammatory, infectious, and metabolic SPD 1 2 3 4 5 6 7 8.
• Causes range from hormonal changes and mechanical overload to joint instability and, rarely, infection or metabolic disorders 1 2 3 4 5 6 8.
• Most cases respond to conservative treatments such as rest, physical therapy, and pain relief, with surgery reserved for severe or resistant cases 2 5 10 11 12 13.

With improved awareness and multidisciplinary care, individuals affected by SPD can achieve meaningful pain relief and restore their quality of life.