Symphysitis: divergence of the symphysis pubischildbirth than dangerous, how to treat, causes and prevention

Update: October 2018

Pregnancy is a special condition of a woman in which all
organs and tissues undergo changes. No exception and
musculoskeletal system of the future mother. Very tangible changes
occur in the bones of the pelvis, which form the “channel” for birth
baby

How does the female pelvis?

The pelvis is a closed ring consisting of the pelvic bones, the sacrum
and coccyx. The pelvic bones, in turn, are composed of paws,
седалищных и подвздошных bones. Female pelvis, in addition to support
internal organs, has a very important function:
child birth AT связи с этим все связки и хрящи таза имеют
feature: they “soften”. The pubic articulation where
cartilage also becomes more mobile and softer under the action
special hormone – relaxin. it позволяет немного подстроить
размеры таза к окружности головки baby

What is symphysitis?

Literally, symphysitis in pregnancy is inflammation of the chest.
joints. It does not occur very often. AT период ожидания
baby is more correct to use the term “symphysiopathy”.

  • It means excessive softening of the cartilage, increasing the distance
    between bones more than 0.5 cm.
  • In a non-pregnant woman, the distance between the pubic bones
    is about 0.2 cm.
  • AT возрасте 18-20 лет оно может быть несколько увеличено (до
    0.6 cm), then gradually decreases.

If at the time of birth the bones still diverge, sometimes with
symphysis rupture, it is called symphysiolysis. Sometimes in their place
discrepancies begins the inflammatory process. These are
symphysitis

Symptoms of symphysitis during pregnancy

The process of excessive divergence of the pubic symphysis, and even more so –
symphysis inflammation, always find themselves following
symptoms:

  • Pain in the pubis of a shooting or pulling character
  • Increased pain during physical activity, especially during abduction
    hips to the side
  • Spreading pain to the back, hip or abdomen
  • Pain in the region of the symphysis with palpation
  • Pain during intercourse
  • Change of gait (“duck”, “waddling”)
  • Weakening or disappearance of pain at rest
  • ATозможны нарушения дефекации

It must be remembered that non-intense pain in pubic –
norm during pregnancy, it happens in 50% of women. Stretching
ligaments and softening of the symphysis cause some discomfort,
especially in the last weeks before birth. AT таких случаях будущим
Moms just need patience. Only the appearance of strong
unbearable pain, as well as loss of range of motion and sleep disturbance
considered symptoms of symphysitis during pregnancy.

Withчины симфизиопатии

Far from all pregnant women have pronounced changes in
лобковом симфизе и the pains. To this predispose certain
factors.

  • Heredity

It is believed that the risk of divergence of the symphysis is greater if the nearest
Relatives during pregnancy had similar problems

  • Connective tissue features

ATрожденная слабость связок и соединительной ткани в целом — это
quite a controversial issue in medicine. This condition is diagnosed
much more often than it actually is. In children with this feature
there are more dislocations and subluxations, there may be problems with valves
heart, prolapse of the kidneys and other organs, hypermobility of the joints.
With беременности женщины с дисплазией соединительной ткани могут
experiencing greater discomfort in the ligament area.

  • Calcium deficiency and vitamin D deficiency

Often, though not in all cases, it is precisely the lack of calcium.
leads to excessive softening of the symphysis. This factor may
indicate brittle hair, splitting nails, fractures in
pregnant women.

  • Kidney disease

It is believed that kidney disease (eg, pyelonephritis), lead to
enhanced excretion of protein and minerals from the body along with urine.
it способствует более интенсивному размягчению и расхождению
symphysis.

  • Pelvic injuries in the past
  • Multiple birth

Degrees of symphysiopathy

AT зависимости от расстояния, на которое разошлись лонные кости,
Symphysiopathies are of three degrees:

  • 1 degree – from 0.5 to 0.9 cm
  • 2 degree – from 1 to 2 cm
  • 3 degree – more than 2 cm

it расстояние определяют с помощью УЗИ. In addition, the doctor at
palpation can detect cartilage softening and instability
тазовых bones.

ATлияние симфизита на беременность и роды

Symphysiopathy in itself does not affect pregnancy. She is лишь
worsens future mom’s well-being. But излишнее растяжение лонного
joints during pregnancy can so thin him that in
in childbirth, cartilage rupture will occur (symphysiolysis).

it неприятная травма, которая приводит к потере
disability for several months. Joint Risk
increases if the woman’s pelvis is narrow, and the child is large (more than 4
kg). Therefore, doctors often recommend a cesarean section when
symphysiopathies of 2 and 3 degrees, as well as for severe pains and large
the fetus. it снижает травматизм матери в разы.

How does the symphysis break?

Symphysiolysis makes itself felt before giving birth, during childbirth or
right after them. Puerperal cannot lift legs alone
get out of bed (only sideways), climb the stairs, and
at times – generally move the limbs in the right amount. Any
physical activity hurts.

What is the danger of breaking the symphysis?

Symphysiopathy, although it gives a lot of inconvenience, does not threaten
health and life. But the rupture of the symphysis at birth is
already injury, pelvic fracture.

  • If the bones are 2 cm apart, then such a fracture is stable and rarely
    causes complications.
  • And if the distance between the edges of the bursting symphysis
    5 cm or more is a direct health hazard.

The edges of the bones can damage the urethra, urinary
bubble, clitoris. Hemorrhages may occur in the joints,
leading to arthritis later. Therefore, such breaks need
treat by surgery. Fortunately, similar
cases are very rare.

Withмер из практики: AT родильное отделение
A young woman (26 years old) received a multiple sexuality with complaints of
attempts From the anamnesis it is known that childbirth 2nd, in time, began about
5 hours ago. Waters moved an hour ago in an ambulance. With
conducting obstetric research revealed: the opening of the cervix
almost full, head pressed to the entrance to the pelvis, arrow-shaped
seam in the right oblique size, small spring on the left anteriorly. An hour later
born live, full-term boy without visible malformations. But
only the next day, my colleague and I, on a detour, found
puerperal duck gait and revealed complaints of pain in the pubic area.
After consulting the surgeon, the diagnosis was made: the discrepancy
joints. A child on the 5th day was discharged home under the supervision of his father
and grandmothers, and the woman is transferred to the gynecology department, where
spent 1.5 months in the supine state and bent and divorced in
knees with feet. It is difficult to say what led to such a state
with timely diagnosis (ultrasound) in case of discrepancy
junction shows a cesarean section and such effects could
to avoid. The puerperal was discharged with recovery after
X-ray examination (obstetrician-gynecologist)
Anna Sozinova).

Diagnostics

With появлении жалоб на боли и припухлость в области лобка, а
also movement difficulties, all pregnant women are shown
examination.

  • Ultrasound procedure

Ultrasonography of the symphysis joint allows to estimate the distance between
bones of the bosom, as well as see indirect signs of inflammation. But
often with a small discrepancy, a woman experiences intolerable
the pains. Conversely, with a large distance between the bones of the complaint
there are minimal. Thus, in the conclusion of the ultrasound will be indicated
only the magnitude of the divergence of the symphysis of the symphysis. And the final diagnosis
will also take into account the severity of symptoms.

  • Radiography of the pelvic bones

This method is most often used after childbirth for diagnosis.
symphysis rupture and treatment control. Pregnant women
X-ray digiometry (measurement of the pelvis) is performed less frequently. She is
allows you to further assess the compliance of the sizes of the fetal head
and pelvic circumferences.

  • CT and MRI

More accurate methods are used after childbirth. It helps
monitor the effectiveness of treatment, as well as identify other
pathology in the pelvic region.

Differential diagnosis

Often, pain, similar to the sensations of symphysitis, cause
completely different states. Therefore, it is imperative to inform your
gynecologist about the appearance of pain. The doctor will examine and prescribe
additional examinations. Other causes of pubic pain:

Sciatica (ischialgia)

This is pain in the sciatic nerve. Unpleasant
sensations can spread from the groin and tailbone to the leg to
lower leg This symptom may be a sign of diseases such as
arthritis, arthrosis, pelvic tumors and muscle damage.

Lumbago

This is an acute back pain associated with pathology.
spine (osteochondrosis, intervertebral hernia). Painful
sensations can be transmitted to the leg, groin, abdomen, often lead to
urination and defecation disorders.

Genital and urinary tract infections

This is another cause of pain in the pubic area. Cystitis caused by
E. coli or genital infections, often manifest
burning, cutting and tingling in the groin. Considering that during
pregnancy the tendency to cystitis increases when
such pains need to be screened for infections.

Osteomyelitis and other bone diseases (tuberculosis
lesions)

They are quite rare. But их нельзя сбрасывать со
accounts. Special attention should be given to women with a history of tuberculosis.
or suffered pelvic injuries.

To exclude or confirm the above diagnoses
it is enough to carry out ultrasound, x-rays, as well as donate smears and crops on
infections. Read more about osteomyelitis.

Symphysitis treatment

Symphysiopathy (softening of the symphysis pubis) is a phenomenon
characteristic only for pregnancy. Therefore, after 4-6 months
after childbirth, all symptoms usually disappear. Sometimes pain in the area
pubes can last up to 1 year. Medical assistance in such
situations not required. If there was a symphysiolysis
symphysis), the treatment will depend on his degree.

Treatment of symphysiopathy during pregnancy

To alleviate the symptoms of divergence of the symphysis can, adhering to
simple recommendations:

  • Limiting the duration of walking, sitting in one place and
    climbing stairs
  • Uniform weight distribution with a fixed posture (standing,
    sitting)
  • Eating foods rich in calcium. In some
    In cases, the doctor may prescribe calcium supplements. Withем добавок
    must be supervised by a specialist, since the excess of this
    trace element can harm the fetus, especially in the 3 trimester. AT
    Calcium administration is not recommended during the last weeks before birth.
  • Control body weight. Excess weight increases the load on the joints and
    ligaments, causing pain.
  • Butшение дородового бандажа с 25-28 недели беременности.
    Special support for the abdomen reduces pressure on the symphysis, reduces
    pain.

Symphysitis treatment при беременности контролируется
obstetrician-gynecologist and orthopedic traumatologist. Often needed
consultation of a physiotherapist and a neurologist.

Pain relief exercises:

Поза кошки –  стоя на коленях и локтях, нужно выпрямить
back and shoulders. Then kick back the arc, simultaneously lowering
head down, straining your abdominal muscles. Repeat these steps.
repeatedly.

Raising the pelvis – in the supine position you need to bend the legs in
lap. Then slowly raise the pelvis, fix at the top
and lower. Повторить упражнение repeatedly.

Kegel exercises are exercises that imitate delay and
the release of a stream of urine, strengthen the muscles of the pelvic floor. It may
somewhat reduce pelvic instability and relieve stress from the pelvic
bones.

ATсе физические упражнения можно выполнять, если они не вызывают
increased pain, and if there are no medical contraindications.

Treatment of symphysiolysis after birth

  • Anesthesia

Usually to relieve pain syndrome use substances from
группы нестероидных противовоспалительных средств (НПATС). It’s all
known paracetamol, ibuprofen and other painkillers.
Withменять их нужно только в случае сильных болей, так как
бесконтрольный и длительный прием НПATС ведет к образованию язв
stomach and abnormal liver function. Also required
consultation of the doctor at feeding by a breast of the child. Not everyone
painkillers are safe for the baby.

  • Gentle mode

With несильном расхождении костей порой достаточно снижения
physical activity using reeds and other special
means.

  • Bandages

Butшение бандажа, захватывающего вертелы бедренных костей,
reduces pain and reduces the risk of further discrepancies.
This speeds up the symphysis accretion.

  • Physiotherapy

Some types of physiotherapy (for example, magnetic therapy) apply
to accelerate the overgrowth of the symphysis. This method only helps in
совокупности с постельным режимом и фиксацией тазовых bones.

  • Bed rest

With тяжелой степени расхождения и разрыве симфиза показан
strict bed rest. To accelerate accretion, they use
special hammock with weight hanging crosswise. it
the device brings the bones together.

  • Pelvic Belt Treatment

To enhance the effect of the hammock use a special pelvic girdle.
It has several belts, which are clings to the weights. With their
the tension of one or another part of the belt is adjusted using
promotes rapid accretion of the gap.

  • Surgical treatment of chronic tears

If for some reason the treatment of the symphysitis was not carried out, but
a long-standing break reminds oneself of pain and limitation of movements,
then resort to surgery. AT ходе хирургического вмешательства
use rods and plastic materials to recover
pelvic integrity.

Symphysitis prevention

Symphysiopathy cannot be prevented because there is no exact
established causes of this condition. But при выполнении следующих
recommendations can reduce the risk of symphysis rupture and avoid
long treatment.

  • Careful pregnancy planning (screening for infection,
    pathology of the thyroid gland)
  • Good nutrition during the planning period and throughout
    pregnancy and lactation
  • Withем дополнительных препаратов при необходимости (кальций,
    iron, iodine preparations)
  • Ultrasound of the fetus in the 3rd trimester to determine the intended
    child weights
  • Control of glucose levels in diabetes mellitus (since it is
    the disease is accompanied by the birth of large children with a mass more
    4.5 kg)
  • You must report all injuries, fractures and
    problems with previous birth
  • Appeal to a specialist in case of pain in the pubic area,
    swelling and restriction of movement
  • Consultation with a specialist in the method of delivery (in
    some situations a cesarean section avoids heavy
    pelvic injuries).

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