The load on the female body during the period of gestation significantly increases. Radical changes are taking place literally in all organs and systems, which, since conception, have been concentrated around the uterus. The reproductive organ itself, to some extent, depends on the pelvic bones and supporting muscles.
Physiological features
The uterus is located inside the pelvic ring, attaching itself to certain ligaments in a circle. In the body cavity, the muscles transform into uterine spirals, which can hurt with increased tone. This can occur in those women who have an anatomically twisted pelvis before pregnancy. Ligaments are not strained equally. As a result, one side is relaxed, and the other experiences excessive stress, which causes unpleasant sensations. Constant pulling pains are an occasion to see a doctor.
The pubic joint, or symphysis, is normally in a certain position and does not move. In some cases, the pubis becomes mobile and can swell, which is a pathology. With the onset of pregnancy, and especially as labor approaches, the cartilage tissue connecting the pubic bones softens under the influence of the hormone relaxin. This is necessary to ensure free passage to the baby’s head. At birth, these changes return to normal: the cartilage becomes denser, the width of the joint space decreases, and the ligaments acquire their former elasticity.
Causes of pelvic pain during pregnancy
Pain in the pelvis during the period of bearing a child can normally experience more than half of expectant mothers. Usually unpleasant sensations appear, starting from the middle of pregnancy, which is facilitated by completely natural causes. In some cases, the discrepancy of the pelvic bones during pregnancy is pathological in nature and is accompanied by many unpleasant symptoms that significantly worsen the woman’s quality of life, do not allow her to move normally and have a good rest.
According to most doctors, pain in the pelvis during pregnancy appears due to a deficiency of calcium in the body of the expectant mother. Inflammation in the bladder and urethra (cystitis, urethritis), chronic infection in the urogenital tract, magnesium deficiency in vitamin D hypovitaminosis can lead to the development of symphysitis. There is an opinion that the appearance of the pathology is affected by unfavorable heredity and certain problems with the musculoskeletal system (e.g., spinal curvature or osteochondrosis) before pregnancy.
Starting from the middle of gestation, the load on the muscles of the back increases intensively. The abdomen increases, as does weight gain, which can cause constant tension and pain in the pelvic girdle. It becomes difficult for a woman to walk during pregnancy. A growing uterus by itself helps to stretch all the ligaments, which can cause pain in the sacrum and pelvis. In this case, to avoid pain, it is enough to reduce the load and relax more in a horizontal position.
Symphysitis Risk Factors
Contribute to the development of a pathological condition (discrepancies in the pubic joints over the physiological norm), a sedentary lifestyle and a large weight gain during pregnancy, pelvic injuries in the past, large weight and size of the fetal head (more than 4 kg), numerous births, symphysitis during past pregnancies, significant burden on the body of the expectant mother (work related to physical stress, intensive activities in certain sports), hereditary diseases of the joints and bones, for example, a collagen defect, which leads to rezmernoy joint mobility.
Pathological bone discrepancy
Symphysitis (in ICD-10, pathology belongs to the class 000-099, block 020-029, group 026.7) in half of pregnant women appears as a variant of the norm and is manifested by minor unpleasant sensations. But if this condition significantly worsens the quality of life of the expectant mother, then we can talk about the pathological divergence of the pubic joint. The physiological norm is the discrepancy of bones up to 5-6 mm. Symphysitis of the first degree is diagnosed with a divergence of 6-8 mm, of the second degree - 8-10 mm, of the third degree - more than 10 mm.
The main symptoms of symphysitis
Most often, pain in the pelvis during pregnancy appears closer to the third trimester, when the effect of the hormone relaxin reaches its maximum, the weight of the baby is already more than 2 kg, in the total weight gain of a woman during the period of gestation, it approaches or exceeds 10 kg, which significantly increases the load on the supporting the motor apparatus of the expectant mother. Symphysitis is characterized by swelling in the pubic area, pain with pressure, independent pain in the groin, tailbone, perineum at rest and during movement, a characteristic overwhelming gait.
With a slight discrepancy in the pubic bones, the pain is periodic, they do not differ in intensity and can change localization. This symptom can be mistaken for manifestations of osteochondrosis or the threat of miscarriage. The pain appears with a long stay in one position, worse when walking or climbing stairs. With a significant degree of bone discrepancy, pain in the pelvis during pregnancy can occur at rest. Usually there is a pronounced soreness with a slight pressure on the pubic joint from both the vagina and the front.
A bone discrepancy becomes apparent if a fingertip is placed in it (more than 2 cm). Pain usually occurs in the second and third trimesters of pregnancy. In some cases, the bones diverge, but there is no pain until the birth. After childbirth, the abdominal muscles become flabby and the pubic bones can spread 2 cm or more. In this case, the woman simply cannot walk and intuitively takes a certain position, namely the “frog pose”. The pressure on the symphysis is reduced, which facilitates pain.
Necessary diagnostics
The diagnosis of symphysitis (in ICD-10 this pathology belongs to the class “Pregnancy, childbirth and the puerperium, code 000-099) is usually made only on the basis of complaints from the expectant mother. The doctor will definitely prescribe an ultrasound and tests to determine the width of the divergence of the pubic joint and the deficiency of substances in the blood, respectively. Biochemical analysis will confirm or refute the deficiency of trace elements, primarily calcium.
Treatment of symphysitis during pregnancy
Symphysiopathy during pregnancy does not have any effect on the development of the fetus. After birth, the problem usually disappears on its own. Prior to this, pathology can be dangerous at the time of delivery. There is a risk of significant discrepancy between the pubic bones, which in the future will require a long recovery. Natural birth in most cases is possible, but the supervising obstetrician-gynecologist will finally decide this question.
To alleviate the condition of a woman before childbirth in case of symphysiopathy during pregnancy, the doctor will give certain recommendations. As a rule, the use of special anti-inflammatory drugs, multivitamin complexes with calcium or individual drugs is indicated. It is necessary to adjust the diet, normalize weight and control weight gain, reduce physical activity, do gymnastics and be sure to wear a bandage.
Exercise with symphysitis
With severe pain, a restriction of physical activity will be required. Expectant mother can not walk a lot on stairs, sit or lie on a hard surface, in a standing position you need to distribute weight on both legs. In the prone position, you can put a stiff pillow under the buttocks, lifting the pelvis, and several pillows under the legs. This will reduce fetal pressure on the pelvic area. With minor pain, the elbow-elbow pose will help. If there is a history of diseases of the musculoskeletal system, a woman must definitely consult a trauma surgeon or osteopath for pain.
Antenatal bandage: how to wear
The brace supports the stomach and prevents excessive sprain. A wide support belt made of elastic fabric can be worn from 20-24 weeks. In some cases, this is advisable sooner or much later. A bandage is especially relevant for women who lead a fairly active lifestyle during the period of gestation, are on their feet for several hours in a row, have diseases of the musculoskeletal system or experience pain in the pelvis. Wearing a bandage is indicated for the appearance of stretch marks, multiple pregnancy, varicose veins, some obstetric pathologies, the threat of premature birth, osteochondrosis.
How to wear an antenatal bandage? The belt must not be worn continuously. A break of 30-40 minutes is recommended every three hours of wearing. The bandage should not squeeze the stomach and deliver any discomfort. It is advisable to wear a support belt until the very end of pregnancy, if it brings relief to the woman, but there are no contraindications. With proper use of the bandage, it poses no danger to either the child or the woman herself.
Vitamin and mineral complexes
Calcium preparations are usually prohibited in the third trimester of pregnancy, when the body is actively preparing for childbirth. This can lead to some complications. Some doctors even recommend excluding calcium-containing foods from the diet, because strengthening bone tissue will greatly complicate the birth process. The baby's skull will become stronger and harder, which is extremely undesirable before his birth.
What is better calcium for pregnant women in the second trimester, when the use of such a mineral is acceptable? One of the most common drugs is calcium gluconate, but it is the worst perceived by the body (due to the lack of vitamin D). The combination remedy is Calcium D 3 & raquo; (Complivit, Nycomed). Such vitamins fill up the deficiency of nutrients much more effectively. When choosing a drug, it is important to remember that only a doctor can choose the best vitamins for pregnant women (in the first trimester and throughout the rest of the term).
Drug therapy
In some cases, inpatient treatment may be required. In a hospital, physiotherapeutic procedures are carried out, anti-inflammatory drugs and painkillers are administered under the supervision of doctors. Used medical bandaging. Ultraviolet irradiation of the pubic area, antibacterial therapy can be used.
Natural birth or cop?
With a significant discrepancy in the pubic bones during pregnancy, there may be indications for delivery by cesarean section. With a narrowing of the pelvis and a large size of the fetus (more than 3.5 kg), a critical distance of divergence is 10 mm. The issue is resolved individually. Delivery in a natural way is possible, but only if the bones do not expand more than 10 mm, the pelvis of a woman is of normal size, and the fetus is not very large.
With symphysitis in childbirth, a pubic joint rupture is possible . In this case, the woman in labor suddenly feels intense pain, sometimes a characteristic click is heard when the ligaments are broken. After that, even a large head of the child freely passes between the bones. Sometimes the rupture is accompanied by a wound to the internal organs (primarily the bladder and canal), the formation of extensive hematomas in the labia and pubis. For recovery requires surgical treatment with the imposition of special metal structures.
Symphysitis prophylaxis
For the prevention of pain in the pelvis during pregnancy, a diet is recommended, enriched with all the necessary trace elements and trace elements involved in bone formation, and vitamin D. These nutrients are found in cheese, eggs, meat and fish, milk and milk products, nuts. It is better to avoid foods that contribute to active weight gain, because extra pounds greatly increase the load on the musculoskeletal system.
A woman is recommended walking in the fresh air, sunbathing and air baths, moderate physical activity. A good influence on the body is fitness or yoga for pregnant women, water aerobics or swimming. In addition, it is advisable to take suitable vitamin-mineral complexes, you need to monitor your posture. You may need to take painkillers. In this case, you need to adhere to the doctor’s recommendations and abandon self-medication, because during pregnancy you can not drink all the drugs.