Pubic Symphysis Diastasis

Anatomy and Pathophysiology of Pubic Symphysis

The pelvis is a spatially closed structure formed by the pelvic bones and sacrum. The posterior part of the ring is formed by the posterior parts of the hip bones, sacroiliac joints, and sacral bone. The anterior part of the ring includes the pubic bones and the pubic symphysis. The pubic symphysis is a synchondrosis made of a fibrous cartilage disc between the two surfaces of the pubic bones covered by hyaline cartilage, which slowly decreases in thickness with age. It is strengthened by ligaments: upper pubic, lower pubic (arcuate, subpubic), posterior pubic, and anterior pubic. The posterior pubic ligament, as thin as the membrane, passes into the periosteum of the pubic bones, while the anterior pubic ligament is a thick structure containing both transverse and diagonal fibers. It also includes fibers from the aponeurosis of the abdominal muscles (rectus abdominis and oblique external muscle), gracilis muscle, and adductor longus muscle, which significantly increases effectiveness of locking the sacroiliac joints [7]. The connection of the anterior pubic ligament with the ischiocavernosus muscles and corpora cavernosa has also been described. The greatest stability of symphysis is provided by strong and thick upper pubic ligaments and lower arches. Additionally, minimal mobility is ensured by a small rotation of 1 to 3° [7].

The pubic symphysis disc is made of fibrous cartilage, in which apart from regularly arranged, thick, type I collagen fibers, chondrocytes are deployed. An additional feature of this tissue is the low content of glycosaminoglycans (2% dry weight). The arrangement of collagen fibers reflects the forces acting on the disc. Unlike the vitreous cartilage, the interpubic disc does not have perichondrium. The width of the pubic symphysis changes with age. In a newborn, it is 9–10 mm, gradually decreasing with age. A normal width of the pubic symphysis in adults is 3–6 mm, and is larger in the anterior part than the posterior [7].

Shear forces act on the joint while bending, standing, and while standing with the leg raised, known as tensile and frictional (sliding) forces, which have different values and vectors. While walking, pubic symphysis absorbs shock from the pelvic ring. Under physiological conditions, the pubic symphysis may become loose in the range of 1–2 mm (during lower limb abduction) and may also be rotated by 1°.

During pregnancy, especially in the first trimester and during childbirth, relaxation of the structures of the pubic symphysis can be observed as a result of hormone activity [2,4,8]. The perinatal dilation of the symphysis by 3–5 mm is physiological, and returns to its original size within 5 months [7]. With soft tissue relaxation comes: anterior pelvic tilt, accentuated low-back curvature, hyperextension of the upper back, forward tilting of the neck, and backward extension of the neck [8].

Pubic symphysis diastasis is a medical condition where the pubic symphysis, the joint that connects the left and right sides of your pelvis, becomes too wide. This can happen due to trauma, pregnancy, or other factors. When the joint separates, it can lead to pain, difficulty moving, and in some cases, long-term discomfort.

This condition is common in pregnancy but can also occur after accidents, injuries, or even during heavy lifting.

Pathophysiology (Structure, Blood, Nerve Supply)

The pubic symphysis is a cartilage joint located at the front of the pelvis. It’s normally held together by ligaments and supports weight during walking, running, and other activities. The blood supply to this joint comes from the obturator and external iliac arteries. The nerve supply is primarily from the pelvic splanchnic nerves, which help control sensation and movement in the pelvis.

Types of Pubic Symphysis Diastasis

There are two main types:

1. Traumatic Diastasis: Caused by external forces such as an accident or heavy lifting.
2. Obstetric Diastasis: Common in women during or after childbirth, particularly when there is excess pressure on the pelvis.

 Causes of Pubic Symphysis Diastasis

1. Pregnancy: Increased pressure on the pelvis during labor and delivery.
2. Childbirth: The passage of the baby can strain the joint.
3. Car accidents: Sudden trauma can cause the joint to separate.
4. Heavy lifting: Overexerting the body can stretch or injure the pubic symphysis.
5. Fall or direct impact to the pelvis: Injuries can damage the joint.
6. Obesity: Extra weight can strain the pelvic joint.
7. Sacroiliac joint instability: Poor alignment of other pelvic joints.
8. Pelvic fractures: Broken bones in the pelvis can affect the pubic symphysis.
9. Pelvic inflammatory disease: Infections can lead to joint dysfunction.
10. Spinal misalignment: Poor posture or spinal issues affecting pelvic alignment.
11. Chronic stress: Constant strain on the pelvis can lead to joint separation.
12. Overuse of pelvic muscles: Excessive physical activity without proper recovery.
13. Hormonal changes: In pregnancy, hormones like relaxin soften ligaments, which can lead to diastasis.
14. Multiple pregnancies: Having more than one pregnancy can increase risk.
15. Poor posture: Misalignment of the pelvis due to poor posture.
16. Age: Older adults may be more prone to joint issues.
17. Genetics: Some people may have a predisposition to pelvic instability.
18. Sedentary lifestyle: Weak muscles around the pelvis may lead to instability.
19. Muscle imbalance: Uneven strength in pelvic muscles can cause strain.
20. Previous pelvic surgery: Scar tissue or weakened joints can result from prior surgeries.

Symptoms of Pubic Symphysis Diastasis

1. Pain in the pelvic area: Discomfort at the front of the pelvis.
2. Pain when walking: Difficulty moving due to joint separation.
3. Difficulty standing up: Pain when transitioning from sitting to standing.
4. Swelling: Inflammation around the pubic area.
5. Tenderness: Sensitivity to touch around the pubic joint.
6. Pain during intercourse: Discomfort while engaging in sexual activity.
7. Limited mobility: Reduced ability to perform daily tasks.
8. Groin pain: Pain radiating into the groin area.
9. Lower back pain: Discomfort in the lower back due to pelvic misalignment.
10. Difficulty climbing stairs: Pain when stepping up.
11. Leg pain: Discomfort in the thighs or legs, especially during movement.
12. Pelvic instability: A feeling of unsteadiness in the pelvis.
13. Pain when rolling over in bed: Increased discomfort during sleep movements.
14. Numbness: Loss of sensation in the pelvic area or legs.
15. Muscle spasms: Cramping or spasms in the pelvic region.
16. Pain with lifting: Difficulty lifting objects due to pelvic pain.
17. Sharp pains: Sudden, intense pain in the pelvic area.
18. Painful stretching: Discomfort during certain exercises or stretches.
19. Difficulty walking long distances: Exhaustion due to pain.
20. Instability in the pelvis: A sensation that the pelvis is “moving” or “shifting.”

Diagnostic Tests for Pubic Symphysis Diastasis

1. Physical examination: A doctor will check for pain, tenderness, and instability.
2. X-ray: Used to see bone structure and detect any abnormalities in the pelvic joint.
3. MRI scan: Provides detailed images of soft tissues around the pubic symphysis.
4. Ultrasound: Helps visualize the pelvic area and identify issues with soft tissue.
5. CT scan: Provides a 3D image of the pelvis to check for fractures or joint separation.
6. Pelvic examination: Manual examination to test for tenderness and mobility.
7. Blood tests: To rule out infections or inflammation.
8. Bone scan: Used to check for signs of injury or stress fractures.
9. Intra-articular injection: A diagnostic test where a dye is injected into the joint to check for separation.
10. Posture assessment: To identify any misalignments in the pelvis.
11. Gait analysis: Assessing the way you walk to see if pain affects movement.
12. MRI arthrogram: An advanced MRI test with contrast dye for more detailed images.
13. Stress test: To check how much pressure the pubic joint can withstand.
14. Electromyography (EMG): Tests the electrical activity of muscles around the pelvis.
15. Functional mobility tests: Assessing how well you can move with the condition.
16. Palpation test: A doctor presses on the pelvis to check for painful spots or instability.
17. Dynamic ultrasound: Used to assess the movement of soft tissues in the pelvic region.
18. Pelvic radiography: Specific X-rays focused on the pelvic joint.
19. Postural sway test: To evaluate balance and coordination affected by the pelvis.
20. Stress X-ray: To view the pubic joint under different levels of strain.

Non-Pharmacological Treatments

1. Physical therapy: Exercises to strengthen the pelvic floor and surrounding muscles.
2. Rest: Giving the body time to heal without further strain.
3. Ice packs: Reducing inflammation and pain with cold therapy.
4. Heat therapy: Applying heat to relax tight muscles and improve circulation.
5. Pelvic support belts: Wearing a support belt to reduce strain on the pelvis.
6. Posture correction: Improving posture to relieve pressure on the pubic symphysis.
7. Stretching exercises: Gently stretching the muscles around the pelvis.
8. Breathing exercises: Techniques to reduce stress and improve muscle function.
9. Acupuncture: Inserting needles into specific areas to alleviate pain.
10. Massage therapy: Relieving muscle tension around the pelvis and lower back.
11. Yoga: Relaxing and strengthening exercises to improve flexibility.
12. Swimming: Low-impact exercise to reduce pressure on the pelvis.
13. Chiropractic adjustments: Manipulating the spine and pelvis for better alignment.
14. TENS (Transcutaneous Electrical Nerve Stimulation): Using electrical impulses to reduce pain.
15. Cognitive behavioral therapy (CBT): Helping to manage pain through mental techniques.
16. Orthotic supports: Wearing shoe inserts to improve alignment and comfort.
17. Avoiding heavy lifting: Reducing stress on the pubic joint.
18. Gentle walking: Walking at a moderate pace to improve joint function without overstraining.
19. Dietary changes: Eating anti-inflammatory foods to reduce swelling.
20. Hydrotherapy: Therapeutic use of water for rehabilitation.
21. Pilates: Strengthening core muscles to stabilize the pelvis.
22. Ergonomic adjustments: Modifying daily environments to avoid unnecessary strain.
23. Mindfulness and relaxation: Techniques to reduce stress and manage pain.
24. Sleep support: Using supportive pillows and sleep positions to avoid joint pressure.
25. Body mechanics education: Learning proper body movements to avoid further strain.
26. Kinesiology taping: Using specialized tape to support the pelvis and reduce discomfort.
27. Cryotherapy: Using ice or cold treatment to reduce swelling.
28. Epsom salt baths: Soaking in warm water with Epsom salts to relieve muscle tension.
29. Weight management: Maintaining a healthy weight to reduce stress on the pelvic joints.
30. Pelvic floor exercises: Strengthening muscles around the pelvis to support joint health.

Drugs for Pubic Symphysis Diastasis

1. NSAIDs (Nonsteroidal Anti-Inflammatory Drugs): For pain relief and reducing inflammation (e.g., ibuprofen, naproxen).
2. Acetaminophen: Pain relief without inflammation reduction.
3. Opioids: Stronger pain relief (e.g., hydrocodone, oxycodone) for short-term use.
4. Muscle relaxants: To relieve muscle spasms around the pelvis (e.g., cyclobenzaprine).
5. Steroid injections: To reduce inflammation directly in the affected area.
6. Topical pain creams: Creams that are applied directly to the skin for pain relief (e.g., lidocaine patches).
7. Antibiotics: If there is an infection causing joint inflammation.
8. Corticosteroids: For reducing severe inflammation in chronic cases.
9. Anticonvulsants: For nerve-related pain (e.g., gabapentin).
10. Tricyclic antidepressants: Used to treat chronic pain and improve sleep (e.g., amitriptyline).
11. Bisphosphonates: For bone health in case of fractures or bone loss.
12. Calcium and vitamin D supplements: For supporting bone health.
13. Proton pump inhibitors: For stomach protection during long-term NSAID use.
14. Topical menthol creams: For localized pain relief.
15. Hyaluronic acid injections: To lubricate the joint and reduce friction.
16. Antioxidants: Supplements like vitamin C to reduce inflammation.
17. Antihistamines: If allergic reactions are contributing to inflammation.
18. Diuretics: To reduce fluid retention and swelling.
19. Prostaglandin inhibitors: For pain management.
20. Bone growth stimulators: Used in some cases for faster healing of bone injuries.

Surgeries for Pubic Symphysis Diastasis

1. Pubic symphysis fusion: Fusing the bones of the pelvis together.
2. Pelvic fixation surgery: Using screws and plates to stabilize the pelvis.
3. Osteotomy: Cutting and reshaping bones to improve alignment.
4. Arthroplasty: Replacing the pubic symphysis joint with a prosthesis.
5. Laparoscopic surgery: Minimally invasive surgery to address internal joint issues.
6. Tendon repair surgery: Repairing ligaments or tendons around the pubic symphysis.
7. Pelvic ligament reconstruction: Rebuilding the ligaments that support the pelvis.
8. Hip replacement surgery: In some severe cases, a hip replacement might be necessary.
9. Spinal alignment surgery: Fixing spinal misalignment that contributes to pelvic instability.
10. Bone grafting: Adding bone tissue to support the pelvis if there is significant bone loss.

Preventive Measures

1. Avoid excessive strain on the pelvis: Practice proper body mechanics.
2. Strengthen pelvic muscles: Regular pelvic floor exercises.
3. Maintain a healthy weight: Reducing pressure on the pelvic region.
4. Stay active: Regular physical activity keeps the muscles and joints flexible.
5. Supportive footwear: Wearing shoes with proper arch support.
6. Proper posture: Maintaining good posture throughout the day.
7. Avoid heavy lifting: When lifting, use correct techniques to prevent injury.
8. Hydrate well: Proper hydration for joint health.
9. Use a pelvic support belt during pregnancy: Helps stabilize the pelvis during delivery.
10. Stretch regularly: Keeping muscles flexible can prevent injuries.

When to See a Doctor

• If you experience severe pelvic pain that doesn’t improve with rest or over-the-counter treatments.
• If symptoms interfere with daily activities or mobility.
• If you have difficulty walking or standing.
• If you experience numbness, weakness, or tingling in the legs.
• If you have a history of pelvic trauma or surgery and are experiencing discomfort.

This outline provides a detailed, easy-to-read guide on pubic symphysis diastasis. By focusing on clear, simple explanations, it becomes more accessible to the reader. The content includes multiple sections, helping it rank well on search engines while providing helpful insights for anyone looking for information on this condition.

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