Pelvic pain is one of the most common complaints during pregnancy. Many women experience it as a sudden twinge in their crotch, a dull ache that radiates down their thighs, or a stiffness in their hips that makes it difficult to walk. It has a name: symphysis pain, or pelvic locking, and it's something that can be treated.
This guide explains what symphysis pubis pain is, when it occurs, how it differs from other pregnancy pains, and what actually helps besides simply waiting for the pregnancy to end.
What is symphysis pain?
The symphysis is the joint at the front of the pelvis that connects the two pelvic bones. During pregnancy, the body produces the hormone relaxin, which softens ligaments and joints throughout the body in preparation for birth. This is necessary, but it can mean that the symphysis becomes too mobile and unstable, which causes pain.
The condition is medically called symphysiolysis or symphysis pubis dysfunction, and it is a subtype of the broader term pelvic locking, which also includes pain in the two sacroiliac joints at the back of the pelvis.
Where is symphysis pain located?
Symphysis pain is typically located:
- at the front of the pelvis, directly above the crotch
- radiating down the inner thighs
- the groin region on one or both sides
- combined with pain in the lower back or buttocks, if the sacroiliac joint is also affected
- A characteristic description is a cutting or burning sensation during activities that require the legs to be moved apart, such as getting out of a car, walking up stairs, turning in bed, or taking a step to the side.
When does symphysis pain start during pregnancy?
Symphysis pubis pain can occur at any time during pregnancy, but it is most common in the second and third trimesters, when the uterus grows and changes the load on the pelvis. However, many women experience symptoms earlier.
Symphyseal pain in early pregnancy
It is possible to experience symphysis pain as early as the first trimester. Relaxin is released early in pregnancy and can cause pelvic instability in some women before the belly is visible. Early pain is often confused with regular pregnancy cramps or round ligament pain, but the symptoms are typically more localized and worsen specifically with movement.
When is pelvic pain a sign of labor?
Towards the end of pregnancy, increased pressure in the pelvis can be caused by the baby getting stuck in the pelvis. This typically causes a feeling of heaviness and increased downward pressure and differs from symphysis pain in that it is not sharp pain with movement. Regular, wave-like pelvic pain that intensifies can be a sign of labor and should always be evaluated by the midwife.
Pelvic locking and pelvic release: what's the difference?
The two terms are often used interchangeably in everyday speech, but there is a difference:
Pelvic loosening is the physiological process where the ligaments in the pelvis loosen during pregnancy. It happens to all pregnant women and is normal.
Pelvic locking is when this solution causes instability and pain that affects everyday life. It is therefore not a diagnosis in itself, but a description of the consequences of the symptoms.
Symphyseal pain is pain specifically from the symphysis joint at the front of the pelvis and is the most common form of pelvic locking during pregnancy.
Symptoms of symphysis pain and pelvic locking
Symptoms vary in intensity from woman to woman. What they have in common is that they are typically worsened by:
- walking, especially over longer distances
- stairs and slopes
- to stand on one leg, e.g. when getting dressed
- tossing and turning in bed at night
- to get in and out of cars
- sexual activity
- activities that spread the legs apart
In severe cases, symphysis pain can make it difficult to walk at all, and the pain can significantly disrupt sleep. Many women find that the pain is most intense in the morning after a night where the pelvis has rested in inappropriate positions.
Symphysis pain without pregnancy
Although symphysis pain is most common during pregnancy, it can also occur outside of pregnancy.
Causes include:
- previous pregnancy-related instability that has not fully healed after birth
- trauma to the pelvis, e.g. from falls or traffic accidents
- overload from sports with high pelvic load
- hormonal changes related to the menstrual cycle
Postpartum pubic symphysis pain is a special area. Many women expect the pain to go away immediately after giving birth, but for some it continues for weeks or months, especially if microscopic damage to the pubic symphysis occurred during birth or if the pelvis does not recover properly.
What helps with symphysis pain during pregnancy?
Osteopathy and Physiotherapy
At OsteoMedica, we regularly see pregnant women women with symphysis pain and pelvic lockingThe treatment aims to restore balance in the pelvis, reduce instability and relieve the symphysis joint by working with the surrounding muscles, joints and connective tissue.
Osteopathic treatment during pregnancy is gentle and adapted to the body's condition. We work with soft tissue techniques, joint movement and specific muscle activation rather than manipulation. Many women notice noticeable improvement after just one to two treatments.
We also offer physiotherapy bækkenbundsvurdering, as the function of the pelvic floor directly affects the stability of the symphysis and sacroiliac joints.
Symphysis pain exercises
Exercises can reduce the pain experience by strengthening the muscles that stabilize the pelvis, especially the pelvic floor, hip flexors and the internal abdominal muscles. Important principles:
- avoid exercises that spread the legs symmetrically, e.g. squats with a wide stance
- Keep your legs close together when getting in and out of bed.
- The side plank is a good stabilization exercise that does not strain the symphysis.
- Water gymnastics effectively relieves the pelvis and is widely recommended for pregnant women with pelvic pain.
- yoga and stretching are beneficial, but avoid positions that open the pelvis wide
Exercises can reduce the pain experience by strengthening the muscles that stabilize the pelvis, especially the pelvic floor, hip flexors and the internal abdominal muscles. Important principles:
Pelvic belt and support cushion
A pelvic belt can provide temporary relief by compressing and stabilizing the symphysis during walking and standing activities. It is not a treatment in itself, but an aid. It should be used under supervision, as incorrect placement and overtightening can worsen symptoms.
A pregnancy pillow at night, placed between the knees and under the stomach, can reduce pelvic rotation and provide better sleep.
Everyday tips that make a difference
- Sit down when putting on clothes and shoes.
- swing both legs together out of the bed and the car rather than one leg at a time
- avoid standing on one leg
- take shorter trips more frequently rather than longer trips less frequently
- avoid stairs and hills when possible during periods of intense pain
- A warm shower or heating pad against the pubic symphysis may provide short-term relief.
What pelvic pain should you be aware of when pregnant?
Most pelvic pain during pregnancy is harmless, albeit annoying. However, there are symptoms that require immediate medical attention:
- sudden, very intense pain in the pelvis that does not subside
- bleeding associated with pelvic pain
- pain combined with fever
- pain that resembles regular contractions and intensifies
- loss of feeling in the legs or problems with bladder control
These symptoms are not typical of symphysis pain and should be investigated immediately.
Frequently asked questions about symphysis pain
What does symphysis pain feel like?
Symphyseal pain is often described as a cutting, burning, or stabbing pain in the front of the pelvis above the crotch. It can radiate into the thighs and is significantly worsened by movement, especially activities that spread the legs.
Can symphysis pain harm the child?
No. Symphysis pain is pain in the mother's joints and muscles and does not directly affect the baby. However, it can limit movement and activity level, which can affect the well-being and sleep of the pregnant woman.
Does pubic symphysis pain go away after childbirth?
For many women, pain subsides quickly after birth as relaxin levels decrease and the pelvis recovers. However, for some, pain persists for weeks or months. Early postpartum treatment, including postnatal osteopathy, can speed recovery and prevent chronic pain.
Can you give birth naturally with symphysis pain?
Yes, in the vast majority of cases. It is important to inform your midwife about your pain before birth so that birthing positions can be adjusted. Positions that avoid widening of the legs are preferable. Talk to your obstetrician and your physiotherapist about a birthing plan.
When should I seek treatment for symphysis pain?
Seek treatment if the pain affects your ability to walk, sleep, or perform daily activities, or if it does not improve within one to two weeks. The sooner treatment is started, the easier it is to restore balance in the pelvis.
Treatment of symphysis pain and pelvic pain in Copenhagen
OsteoMedica has clinics in Nørrebro and Amager and specializes in treating pregnant women with pelvic pain and symphysis pain. We combine osteopathic treatment with physiotherapy and offer an individually tailored course that takes into account where you are in your pregnancy.
You don't have to accept pelvic pain as an inevitable part of pregnancy. Book an appointment directly or contact us if you are unsure what is right for you.
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