Symphysitis is a condition in which there is a softening of the pubic joint and a divergence of the pubic bones. The disease often occurs during pregnancy. Progressive symphysitis interferes with the normal course of gestation, prevents spontaneous childbirth and may be an indication for caesarean section.

Excursion to anatomy

The female pelvis is a ring consisting of bones connected to each other: the pubic, pelvic, iliac, as well as the sacrum and coccyx. The pubic symphysis is the junction of two pubic bones. In this area there is a large amount of subcutaneous fat, nerve fibers pass through. Behind the symphysis is the bladder and urethra. This explains the appearance of disorders of the urinary system during the development of symphysitis.

Normally, the pubic symphysis is immobile. The bones are tightly connected to each other, the joints do not change their position. During pregnancy, due to the increased synthesis of the hormone relaxin, there is a gradual softening of the bones and ligaments of the pelvis. The cartilage connecting the pubic bones is stretched by 5-7 mm, becomes slightly mobile. This is a completely normal process, provided by nature for the safe passage of the child through the birth canal of the mother.

After the birth of a child, the process is reversed. The amount of relaxin decreases, the pelvic bones become strong again. The cartilage is compacted, the ligaments lose their extensibility. The size of the joint space decreases, and the symphysis again returns to its usual size.

Causes of symphysitis

The exact causes of symphysitis during pregnancy are not known. In some women, the divergence of the pubic symphysis remains within the normal range, while in others this physiological process leads to the development of pathology. There are two theories that can explain this problem:

1. Calcium deficiency (causes softening of the cartilage and divergence of the bones of the pubic symphysis).
2. Excess relaxin due to increased synthesis by the placenta and ovaries.

Symphysitis occurs already in the early stages of pregnancy and gradually progresses. Separately, symphysitis is isolated, which was formed before the conception of a child as a result of injuries or inflammatory processes in the pelvic bones.

Risk factors:

• hereditary pathology of the musculoskeletal system, leading to insufficient synthesis of collagen - a protein responsible for the strength of ligaments and cartilage;
• injuries of the pelvic bones before pregnancy or during gestation;
• inflammatory processes in the bones and joints;
• infectious diseases of the bladder and urethra;
• malnutrition and hypovitaminosis (lack of calcium, magnesium, phosphorus, vitamin D);
• sedentary lifestyle;
• excess weight;
• metabolic disorders;
• multiple pregnancy;
• polyhydramnios;
• large fruit.

The likelihood of developing symphysitis increases with the second and subsequent pregnancies (especially with a short interval between them).

Symptoms

Symphysitis, or symphysiopathy, occurs in the first trimester, but in the early stages the signs of the disease are not expressed. The first symptoms appear closer to the middle of pregnancy, when the weight of the woman increases and the load on the pelvic bones increases. With an increase in the gestation period, discomfort increases.

Signs of symphysitis:

• pain over the bosom;
• visible divergence of the pubic symphysis;
• change in gait.

Pain with symphysis is dull, aching. Unpleasant sensations are localized directly above the bosom. The pain intensifies in such situations:

• when pressing on the symphysis;
• while walking;
• when climbing stairs;
• with prolonged immobility (sitting or standing);
• when leaning forward.

A sudden change in body position also increases the pain. Occasionally, when moving, characteristic clicks in the womb area can be heard.

The gait of a woman changes with the development of symphysitis. The expectant mother rolls from foot to foot, waddle. The deflection in the lumbar spine increases. Movement slows down, walking hurts. In severe cases, a woman is practically unable to move independently, even for short distances.

The inability to raise straight legs in a prone position is another typical symptom of symphysitis. This symptom is one of the leading ones in the preliminary diagnosis of pathology.

Classification

Depending on the magnitude of the divergence of the pubic obliques, several stages of development of symphysitis are distinguished:

• 1 degree - from 5 to 9 mm;
• 2 degree - 10-19 mm;
• 3 degree - more than 20 mm.

The severity of the disease largely determines the prognosis and influences the choice of method of delivery.

Diagnostics

To identify symphysitis is shown:

Gynecological examination

On examination, the doctor pays attention to the condition of the pelvic bones and especially the pubic joint. With symphysitis, the divergence of the bones becomes quite pronounced. In stage III, when the cartilage is stretched up to 2 cm, the resulting space freely fits the pad of the finger. At the same time, a characteristic "duck gait" appears.

ultrasound

The final diagnosis is made after an ultrasound examination. With the help of ultrasound, the doctor can accurately measure the degree of divergence of the pubic bones and decide on further tactics.

X-ray examination

It is carried out only outside of pregnancy (for example, with symphysitis after childbirth). Radiography allows you to determine the distance between the pelvic bones, to identify signs of a previous injury and other comorbidities.

With symphysitis, a consultation with an orthopedist is mandatory.

Complications

Rupture of the symphysis is the most dangerous complication of symphysiopathy. A similar condition is noted after childbirth with their improper management and underestimation of the severity of the pathology. There is damage to the joint with a violation of its integrity and a divergence of the cartilage by more than 2 cm. Often this pathology is accompanied by rupture of the ligaments in the sacroiliac joints.

Risk factors:

• stormy rapid childbirth;
• anatomically or clinically narrow pelvis;
• large fruit;
• multiple pregnancy during natural childbirth.

The combination of these factors with grade III symphysitis can lead to a rupture of the symphysis and the appearance of such symptoms:

• sharp or gradually increasing pain in the area of ​​the womb;
• gait disturbance;
• impossibility of full movements.

In most cases, rupture of the ligaments during childbirth occurs gradually, and all the symptoms of the disease make themselves felt 2-3 days after the birth of the child. It is extremely rare that a woman in labor feels a sharp pain and hears the characteristic sound of torn ligaments directly at the time of childbirth.

With a rupture of the pubic symphysis, the puerperal woman is not able to roll over on her side on her own. A woman cannot take her legs off the bed (symptom of "stuck heel"), takes a forced position in which the pain subsides ("frog posture"). On palpation of the symphysis, there is a pronounced divergence of the bones and severe pain in this area.

To confirm the diagnosis, an X-ray examination of the pelvic bones is performed. The rupture of the symphysis is indicated by:

• divergence of bones up to 8 cm or more;
• vertical displacement of the pubic bone by 4 mm or more.

Rupture of the pubic symphysis is often accompanied by damage to the bladder and urethra. Dysuric disturbances join, outflow of urine is at a loss. Perhaps the development of the inflammatory process against the background of injury.

Treatment of rupture of the symphysis can be conservative and operative. Without special therapy, the cartilage will not heal or be replaced by dysfunctional connective tissue. In the future, refusal of treatment can lead to the formation of chronic pelvic pain and a significant change in gait.

Principles of treatment

The choice of method of therapy will depend on the severity of the process: the degree of divergence of the pubic bones and the presence of complications.

Conservative therapy

For the treatment of symphysitis during pregnancy, the following drugs are prescribed:

• Non-steroidal anti-inflammatory drugs to reduce pain (with caution in the I and III trimesters) - topically or orally.
• Calcium and magnesium preparations for strengthening bone tissue.
• Vitamin therapy (taking multivitamins for pregnant women or vitamin D3 separately is indicated).

The effect of drug therapy is enhanced by the physiotherapeutic effect on the affected area. Magnetotherapy has proven itself well.

1. Wearing a bandage before childbirth. A specially selected bandage supports the bones of the pelvis and thigh, prevents further divergence of the bones and the development of complications.
2. Limitation of physical activity. It is not recommended to walk for a long time, climb stairs, carry weights, bend over, throw one leg over the other.
3. Do not sleep on an excessively hard surface. In the supine position, a special pillow or roller should be placed under the legs. You can put a pillow under the buttocks, thereby raising the pelvis and reducing the load on the pubic joint.
4. It is not recommended to stay in one position for a long time (sitting or standing).
5. Therapeutic exercises: knee-elbow position, cat pose and other exercises recommended by the attending physician.

In most cases, treatment is carried out on an outpatient basis. In severe cases, hospitalization is indicated. Therapy is continued after the birth of the child.

Surgery

The operation is indicated for severe sprain or rupture of the pubic joint. To compare the pelvic bones, metal plates, implants are used, strong sutures are applied. Surgical treatment is carried out after the birth of the child.

Childbirth with symphysis

Natural childbirth is possible under the following conditions:

• symphysitis of the 1st degree (divergence of the pelvic bones up to 10 mm);
• normal size of the pelvis in the mother;
• one fruit;
• fruit weight no more than 4 kg.

In other situations, a caesarean section is indicated. Symphysitis II and III degree in childbirth threatens to rupture the pubic joint and cause serious health problems.

After the birth of a child with symphysitis II-III degree, it is shown:

1. Bed rest for 2-6 weeks.
2. Tight bandaging of the pelvic bones.
3. Physiotherapy.
4. Taking painkillers.

After the control x-ray examination, bed rest is canceled. Wearing a bandage, taking calcium and vitamins is recommended. Currently, special corsets are actively used to help keep the pelvic bones in place. Wearing a corset allows you to cancel bed rest already on the 5th day after childbirth. The corset should be worn for 3-6 months - until the symphysis is fully restored.

Prevention

To prevent symphysitis and its complications, it is recommended:

1. Balanced diet (eating foods rich in calcium, phosphorus, magnesium and vitamin D).
2. Taking multivitamins during pregnancy.
3. Yoga and gymnastics to strengthen the muscles of the back, abdomen, gluteal region.
4. Weight control.
5. Timely treatment of any emerging diseases.

Taking good care of your health is the key to good health. When the first signs of symphysitis appear, you should consult a doctor.

With the onset of pregnancy, a woman's body undergoes major changes. The hormonal and immune systems are rebuilt most strongly. But sometimes expectant mothers are faced with problems of the musculoskeletal system, which include the disease symphysitis.

What is symphysis

The pubic articulation of a woman (or symphysis) in the normal state is motionless. But during pregnancy, the body produces the hormone relaxin, which prepares the body for childbirth: it relaxes the pelvic bones to form the birth canal. In some cases, the symphysis becomes excessively mobile, becomes inflamed, and the pubic bones diverge greatly. Then they make a diagnosis of symphysitis (or symphysiopathy). To date, doctors cannot say with certainty why inflammation and stretching of the symphysis occurs. Most experts agree that the main reason is the lack of calcium. Some also note the role of the hereditary factor and the presence in the anamnesis of a pregnant woman of injuries of the musculoskeletal system before conception. Not the last role is played by the excess weight of the expectant mother or his quick set during the period of bearing the baby.

The relationship between the manifestations of symphysitis and age has not been established.

Symptoms of symphysitis during pregnancy

Many women experience brief pubic pain in the third trimester. This is considered normal, as the pelvic bones are preparing for the birth process: they expand, and the fetal head drops lower. The following symptoms should alert you:

• frequent pain in the pubic area (pulling or sharp when trying to get out of bed, turn to one side);
• a soft crunch, accompanied by pain when pressing on the pubic bone;
• pain when walking or other physical exertion;
• change in gait (it becomes a “duck”, unhurried, neat, which helps to avoid shooting pain in the pubic part of the pelvis);
• swelling in the pubic area;
• pain during intercourse;
• inability to raise one or both legs from a lying position.

With symphysitis, the pubic bones soften and become too mobile.

Can symphysitis appear in early pregnancy

Inflammation and stretching of the symphysis can occur in any trimester and even after childbirth. Most often, such a diagnosis is made starting at 25 weeks. If a woman had symphysitis in a previous pregnancy, the likelihood of recurrence of symptoms is high. More often in such cases, pain and divergence of the pubic bones appear earlier.

Despite the enormous inconvenience and severe pain that symphysitis causes, the disease does not affect the development of the fetus and its health.

How to determine symphysitis during pregnancy: history taking, consultations of narrow specialists, ultrasound

At the slightest sign of symphysitis, a woman needs to contact a gynecologist, and, on his recommendation, an orthopedist-traumatologist. The most reliable method of diagnosis is x-ray. However, it is contraindicated during pregnancy. Therefore, first of all, the doctor relies on the results of the examination and anamnesis. After that, an ultrasound examination (ultrasound) is performed, during which the degree of divergence of the frontal bones is studied:

• the first - 5–9 mm;
• the second - 10–19 mm;
• the third - 20 mm and more.

How to give birth with an established diagnosis

Symphysitis affects the process of delivery. Most often, with a disease, a planned caesarean section is prescribed. Doctors sometimes hear the disagreement of a pregnant woman with a ban on natural childbirth, although the risk is high: when a child passes through the birth canal, the symphysis may break, and this can cause complications:

• severe pain;
• damage to the edges of the bones of the urinary canal and bladder;
• hemorrhage in the joints, which in the future threatens to develop into arthritis;
• the need for strict bed rest for several weeks.

Natural childbirth is allowed only with the simultaneous presence of the following factors:

• the divergence of the bones is not more than 10 mm;
• the fruit is not large (less than 4000 g);
• the woman's pelvis is of normal size.

Treatment of the disease

Unfortunately, it is impossible to completely eliminate symphysitis. The goal of treatment is to relieve pain and prevent an increase in sprain. The first degree is easier to treat than others. In some cases, it is enough to adhere to the following recommendations:

• reduce physical activity and get more rest;
• change body position more often (pain in the pubic area increases if you stand or sit for a long time);
• if possible, sleep on an orthopedic mattress;
• take vitamins and calcium as prescribed by the doctor;
• do special exercises to strengthen the pubic joint;
• eat right, avoiding an increase in body weight above normal.

In the second and third degrees of the disease, the following are added to the intake of vitamins and a balanced diet:

• strict bed rest;
• wearing a special bandage;
• taking anti-inflammatory and pain medications (most often such treatment takes place in a hospital).

During treatment in a hospital, the main emphasis is on physiotherapy - magnetotherapy and special massage.

Medications for the treatment of symphysitis

The main function of drugs prescribed during this period is to relieve pain and compensate for the lack of calcium and vitamin D in the body. Among them:

• Nurofen in children's dosage;

Drugs prescribed in the treatment of symphysitis of the second and third degrees - photo gallery

The use of Aquadetrim (vitamin D) must be supervised by a doctor: its excess can harm the fetus
Nurofen for children can be used as a pain reliever, but only in the first and second trimesters of pregnancy. Calcemin is prescribed to strengthen the bones of a woman Panadol is used to relieve symptomatic pain

Physical exercise

The need to perform exercises and their complex are determined by the doctor. Physical activity is aimed at strengthening the muscles of the pelvic floor, reducing pain and preventing further divergence of the pubic bones:

• "Cat" - take the original knee-elbow position (kneel and elbow, straighten your back and shoulders in one line). Gently arch your back in an arc, lowering your head down and at the same time straining your stomach. After five seconds, return to the starting position;
• “Striving up” - lie on your back, put your hands along the body, bend your legs at the knees. Focusing on the hands, slowly raise the pelvis up. Hold in this position for three seconds, then lower the pelvis;
• Kegel exercises - training the muscles of the vagina by squeezing them. In addition to being useful for symphysitis, this technique helps prepare the body for childbirth.

It is dangerous to perform physical exercises with symphysitis without first consulting a doctor.

Exercises for pregnant women - video

Wearing a bandage

Wearing a bandage is one of the mandatory measures in the treatment of symphysitis. It is prescribed during pregnancy and after childbirth, so that the pubic bones quickly fall into place. When choosing a bandage, you need to know certain rules:

• such a design is selected individually depending on the degree of the disease;
• before buying a bandage, you need to measure it in order to understand how comfortable it is;
• put it on only lying down, tightening it tightly. In a standing position, a woman should feel tight support of the pelvic bones;
• the bandage is not worn all the time, but is used only when you need to walk a lot.

Home remedies for pubic bone divergence

Home treatments for symphysitis include certain foods that are rich in calcium:

• cheese, preferably goat (it can be added to fresh vegetable salads, put on sandwiches or eaten as a separate dish);
• fish (steamed or baked);
• cottage cheese (casseroles, mousses, cakes are prepared from it or consumed fresh);
• almonds, if there is no allergy to this nut;
• prunes.

Unripe almonds can be dangerous, as they can cause severe poisoning, and bitter nuts contain a substance that, when ingested, turns into potassium cyanide - the strongest poison.

Sesame with honey

Small sesame seeds are saturated with calcium, so you can make a simple, tasty and healthy dish out of them. You need to mix 100 grams of sesame seeds with a small amount of unsweetened honey (to taste). This mixture can be eaten during the day or left overnight in the refrigerator, after spreading it into molds. The honey will harden and you will get sesame gozinaki.

Prevention of the onset and development of the disease

It is impossible to prevent the appearance of symphysitis. This is due to the fact that the exact causes of the divergence of the pubic bones are unknown. However, it is possible to strengthen the muscles of the pelvic floor, reduce pain, and prevent rupture of the symphysis. To do this, doctors advise:

• plan a pregnancy (before conception, undergo a complete examination, take tests for latent infections, check the functioning of the thyroid gland, tell the gynecologist about how previous pregnancies went and whether there were signs of symphysitis before);
• at the planning stage and during gestation, ensure a sufficient supply of vitamins to the body (on the recommendation of a doctor), eat a balanced and nutritious diet;
• undergo all recommended ultrasound examinations;
• regularly visit an obstetrician-gynecologist, and if signs of the disease appear, immediately inform him about it;
• with a confirmed diagnosis, follow all medical recommendations.

Pain in the pubis, its swelling, difficulty walking may indicate symphysitis during pregnancy. This is inflammation at the junction of the pubic bones, which is called the symphysis. There is dense connective tissue here, in other words, cartilage, which stretches and softens during inflammation, causing increased bone mobility.

What is symphysis and symphysis?

The term "symphysis" doctors call the pubic articulation of the bones, which we in ordinary life call the pubis. During pregnancy, the joint becomes mobile, as it begins to naturally stretch. This is quite normal for a subsequent delivery. In this case, such a development of events is also possible that the stretching process will not proceed correctly. The result will be excessive softening and hypermobility, while the expectant mother will feel this fact on herself according to the following signs: swelling of the pubis, discomfort, soreness. This set of symptoms is called symphysitis.

When a woman is not pregnant, the pubis is absolutely motionless, but when pregnancy occurs, under the influence of the hormone, the symphysis tissues gradually stretch. The closer the birth of a child, the more supple the pubis becomes, because the main task is the free passage of the baby during childbirth. With normal indicators, the pubis expands by 5-6 mm (maximum 10 mm) down and up. As a result, the width of the pubic articulation is 15 mm. These metamorphoses disappear in the postpartum period: the cartilages are placed denser, the ligaments are more elastic, and the joint space is narrower.

Photo of symphysitis during pregnancy:

Symphysitis is called an increased divergence of the pubic bones, that is, when the indicators are more than 6 mm. Symphysitis during pregnancy has several degrees:

• 1 - discrepancy from 6 to 8 mm;
• 2 - from 8 to 10 mm;
• 3 - from 10 mm.

Causes

Symphysitis during pregnancy is accompanied by the following symptoms, which should be reported to the doctor:

1. Painful sensations in the pubis with pressure, movement;
2. Swelling of tissues on the pubis;
3. Clicking, crunching when moving;
4. Duck gait, lameness.

Pain can occur when walking, trying to raise the leg up from a prone position, turning the hip, turning over on the bed, squatting, getting up. They become especially strong at night.

In general, symphysitis is understood as a number of pathological changes in the symphysis, which can occur not only during pregnancy. This joint can soften, swell, stretch, diverge, tear, become inflamed after a pelvic injury, strenuous running.

Symphysitis during pregnancy has no prerequisites for its development. But there are two significant assumptions that explain the excessive divergence of the pubic bones and the formation of inflammation in the pubic symphysis:

• Deficiency of calcium (the main element of bones). A girl in position is required to receive almost 1,000 mg of calcium per day.
• Exceeding the norm of the production of the hormone relaxin, produced by the placenta and ovaries, it helps to relax the pelvic ligaments.

Symphysitis during pregnancy is formed for a number of reasons:

1. Diseases of the musculoskeletal system, inherited, causing excessive joint mobility and other disorders;
2. Multiple births;
3. Injury to the pelvic bones;
4. Large fetus (weighing more than 4 kg.)
5. Inert, immobile way of life;
6. The presence of symphysitis during previous pregnancies.

How will childbirth go with symphysis?

Symphysitis during pregnancy can cause artificial delivery, that is, with the help of a caesarean section, it all depends on the severity of the disease.

A large fetus, a voluminous head of a child and a narrowing of the pelvis - these signs indicate that with such a picture, a discrepancy of 10 mm is critical. Natural childbirth is possible only with a discrepancy of up to 10 mm, a medium-sized child and a normal pelvis.

Symphysitis during delivery can cause a rupture of the pubic joint. Basically, at the birth of a baby, the symphysis creeps slowly, because complaints of women in labor about pain in the pubic region occur during movement and a few hours or days after the birth of the child.

It also happens that a young mother feels a sharp pain during childbirth in the pubic area, and there may also be a sound from the ligaments that are torn. As a result, even the voluminous head of the crumbs easily passes and falls through the bone ring.

Rupture of the symphysis may be accompanied by injuries of the bladder, the appearance of hematomas on the pubis and labia, which are manifested by the accumulation of clotted or liquid blood.

Even a light touch on the pubis can then become a source of severe pain, while the articulation bones have a high level of mobility, and the symphysis area may have a step or depression at the site of tissue divergence. To eliminate damage to the symphysis, operational measures will be required using metal structures.

Treatment of symphysitis during pregnancy

It will not be possible to completely eliminate symphysitis during pregnancy, so you have to wait until the baby is born. In the postpartum period, the hormonal background stabilizes and everything will fall into place. At the same time, you can improve the situation with proper nutrition, taking vitamin and mineral complexes, and courses of therapeutic measures that your doctor will prescribe. In the presence of infections, you will also have to undergo treatment.

Symphysitis during pregnancy in the first stage can be stabilized in several ways:

• Decreased physical activity, more rest;
• Sleep on an orthopedic mattress;
• Taking drugs based on easily digestible calcium;
• Taking B vitamins and eating foods that contain them;
• Ultraviolet procedures;
• Taking painkillers approved by your doctor;
• Strengthening exercises.

At 2 and 3 degrees, you will have to resort to holding the pubic bones in a position close to each other. The expectant mother will:

1. Observe bed rest in strict order;
2. Wear a bandage in the form of a skirt or apply tight bandaging;
3. Eat a diet rich in calcium and drink calcium supplements.

To date, there is also a special bandage for symphysitis, which helps to fix the bones in the correct position. Such a bandage makes it possible to move more, which is of particular importance for women in labor, because they need to take care of their babies.

Treatment of symphysitis can take place with an osteopathic doctor who specializes in diseases of the musculoskeletal system and will be able to choose the most effective means and physiotherapy methods to eliminate the problem. Massage, as well as special gymnastics, will be relevant for women who have given birth.

Severe pain can be a reason for treatment in a medical facility. At the hospital, the woman will be prescribed physical therapy, as well as anti-inflammatory and pain medications to relieve symptoms and speed up recovery. Hormonal preparations are not used.

Symphysitis must be treated with special exercises. At the same time, gymnastics should be started already when the first signs of the disease appear during the period of bearing a child.

• In the prone position, the expectant mother should bend her legs, and pull her feet up to her buttocks. Next, the knees slowly spread apart and linger in this position for 30 seconds. Then the knees are brought back. Repeat this exercise 6 times.
• An equally popular exercise for dealing with symphysitis is the well-known “kitty”. It got its name due to the fact that when performed, a woman resembles a stretching cat. To perform this exercise, the expectant mother should kneel and rest her hands on the floor. The back should be relaxed and the spine in a straight position. The head should neither fall nor rise. Then the woman begins to arch her back, raise her head, simultaneously tensing the muscles of the abdomen and hips. "Kitty" must be performed three times.

To achieve the result, the exercises are performed at least three times a day.

Complications with symphysis

The future baby will not in any way experience complications from symphysitis. Ultrasound will demonstrate the normal development of the crumbs in the absence of other pathological conditions.

The main complications can arise from damage to the pubic ligaments during delivery. After that, it will take a long time to fully recover. Sometimes surgery may be needed if the risk of rupture is high. But basically, symphysitis during pregnancy goes away after the birth of a child by itself. If you want to avoid the consequences of grade 2-3 symphysitis, you will have to agree to a cesarean delivery. Main indications:

1. divergence of bones by 10-15 mm or more;
2. severe pain syndrome;
3. the weight of the baby is more than 4 kg;
4. anatomically narrow pelvis.

Each specific situation should be discussed with the doctor who leads the pregnancy, as well as with the doctor who will take care of the birth. Quite often these are two completely different people. If the expectant mother has doubts, it is better for her to consult an osteopath, as well as other gynecologists.

If the diagnosis revealed 2-3 degrees of symphysitis, then doctors recommend giving birth by caesarean section. It is really better for a pregnant woman to listen in order to avoid breaks and, subsequently, a long period of treatment and recovery. After all, the gap is complicated by the presence of inflammation. It also entails limited motor activity, and elementary things cause difficulties, for example, getting out of bed.

Bed rest is a prerequisite for the treatment of ruptures of the symphysis. Naturally, this leaves its mark, since the care of a newborn should take place almost continuously. Moreover, a large tear may require surgery followed by staples and a cast.

But if the problem is detected in a timely manner, then the likelihood of maintaining health is much higher. Numerous reviews of women who have been diagnosed with symphysitis during pregnancy claim that even with this problem, a significant discrepancy can be avoided and a child can be born with minimal complications. The keys to success are a balanced diet, as well as gymnastics. By the way, some women were able to completely overcome this disease.

Prevention of symphysitis

In order to prevent symphysitis during pregnancy, active prevention of the disease is needed. This will allow you not to resort to treatment completely. But there is one caveat: the exact causes of the disease have not yet been established. Although recommendations for expectant mothers can achieve good results.

• Pregnancy planning, that is, the maximum preparation for conception, helps to identify many diseases even before a new life appears in the womb of a woman. A complete examination and effective treatment are important here.
• Timeliness in registration. The expectant mother should visit the doctor no later than 12 weeks after conception. And it is even better to do it as early as possible, especially if there are certain indications.
• Regular scheduled check-ups with doctors.
• Normalization of the diet - the exclusion of fried, fatty, flour and sweet. Focus on protein foods: meat, beans, milk, dairy products.
• Take vitamin and mineral complexes, which include calcium.
• The use of a prophylactic bandage.
• Performing gymnastic exercises that are allowed during pregnancy.
• Refusal of excessive physical exertion: long walking, standing or sitting.
• Exclusion of psycho-emotional stress. If you can't keep calm, ask your doctor to prescribe sedatives.
• Objectively and rationally approach the assessment of the situation and the need for a caesarean section.

Diet for the prevention of symphysitis

Symphysitis during pregnancy can be prevented if you follow a diet enriched with minerals that are involved in the formation of bone tissue: zinc, magnesium, calcium, phosphorus, manganese. Also, to enhance the effect, you will need vitamin D. This means that the diet of a pregnant woman should include not only milk and dairy products, but also fish, eggs, seafood, mushrooms, nuts, legumes, greens. At the same time, it is necessary to exclude food that contributes to the active set of extra pounds, because weight gain is an additional burden on the spine and joints.

Outdoor walks are suitable for expectant mothers, especially in sunny weather, as the sun's rays contribute to the production of vitamin D, which positively affects the health and skeletal system. In addition, moderate physical activity strengthens the muscles of the abdomen, back and buttocks, and also stretches the pelvic muscles.

The expectant mother should be attentive to her health in order to prevent possible complications and facilitate the course of pregnancy.

Folk recipes

Alternative methods will help relieve symphysitis during pregnancy. But the main thing that needs to be done is to consult a doctor first so that the use of improvised means does not turn into an unpleasant experiment with your health and the health of your baby.

A mixture of honey and sesame seeds is quite effective and useful. Sesame seeds are enriched with calcium, so eating them will have a positive effect on health. To prepare the mixture you will need:

1. 100 gr. sesame;
2. honey to taste.

The components are mixed, cooked must be consumed during the day. The course of admission lasts until the soreness passes.

• goat cheese;
• fish;
• almond;
• prunes.

These products can be used alone or in combination with other products. Health is determined primarily by the diet, therefore it is necessary to continue the diet aimed at the prevention and treatment of symphysitis even with complete recovery and the disappearance of pain.

Among other folk methods that help alleviate the condition are Corvalol drops. To do this, you need to lubricate the pubis with medicine, rubbing a little. You can repeat the procedure several times a day.

Pregnancy is a happy period in a woman's life. But sometimes it happens that it is overshadowed by concomitant diseases that complicate the birth process. Sudden hormonal changes and an increased load on internal organs are natural factors that affect the condition of the expectant mother. One of the frequent disorders encountered at this time is symphysitis.

What is symphysis

During childbirth, the fetus passes through the woman's hip joint, which imitates a ring. In front, it consists of two bones that form the pubis (or pubic symphysis). During pregnancy, the body of the expectant mother produces the hormone relaxin, which is responsible for softening the joints of the joints. This is a physiological necessity and is necessary for the safe passage of the fetus through the birth canal.

Under the influence of some factors, a failure may occur: the joint softens too much. As a result, it stretches excessively and becomes more mobile than is acceptable. In this case, pregnancy is accompanied by pain in the pubic area, which can turn into swelling in this area. This phenomenon is called symphysitis.

According to statistics, symphysitis occurs in every second expectant mother. This condition does not pose any threat to the development of the fetus, but it causes a lot of discomfort in the process of bearing a child and can be dangerous complications during childbirth.

Despite complications, with diagnosed symphysitis, natural childbirth is possible - it depends on the degree of divergence of the pubic bones.

Diagnosis of symphysitis and the causes of its occurrence

The exact causes of the disease have not been established by medicine. Among the theories explaining the excessive softening of the symphysis during pregnancy, there are 2 main ones:

• lack of calcium, which is the main component in the construction of bone joints (its lack makes the joint more mobile, as a result of which, due to the increased load on the hip joint, the bones diverge too widely);
• excessive production of relaxin.

Diagnosis of symphysitis is difficult because X-ray, which gives the most accurate picture, is contraindicated in the perinatal period. As a rule, doctors primarily rely on symptomatic indicators, and then prescribe an additional examination.

How to determine symphysitis during pregnancy: dangerous symptoms

More often, symphysitis occurs in the third trimester, but already from the middle of pregnancy, it is important for the expectant mother to observe her feelings in the pubic area. If one of the following signs of the disease appears, you should consult an obstetrician-gynecologist:

• difficulty climbing stairs
• feeling as if something clicks in the pelvis while walking;
• pain in the pubic area, which increases if you try to take your leg to the side;
• the appearance of lameness and waddle gait (although this may be due to a large load on the lumbar region);
• pain in the hip joint and lumbar (more often they occur at night and are accompanied by the inability to move freely);
• inability to raise legs up from a lying state;
• swelling in the pubic area, especially if it is single.

If symphysitis is suspected, the doctor determines the degree of risk of its occurrence based on the anamnesis (surgery, previous births, hip joint injuries), lifestyle, and dietary habits.

To confirm the diagnosis, an ultrasound examination is prescribed, which shows the presence of bone divergence and its degree. On the recommendation of a gynecologist, it is possible to consult a physiotherapist and an orthopedist.

Degrees of the disease

Depending on the degree of divergence of the pubic bones, various complications are possible. The most severe of these may be a rupture of the articulation. This is a very severe injury that requires long-term treatment, including bed rest.

Depending on the width of the discrepancy, three degrees of symphysitis are distinguished:

• 0.5–0.9 centimeters (first degree);
• 1–1.9 centimeters (second degree);
• more than 2 centimeters (third degree).

With diagnosed symphysitis of the first degree, natural childbirth is assumed (subject to all medical recommendations and the absence of disease progression). But even in this case, there is a minimal risk of rupture of the pubic joint. The second and third degree are an indication for a caesarean section.

Symphysitis treatment

All treatment of symphysitis during pregnancy is aimed at alleviating the physical condition of the woman and preventing the disease from progressing. If the divergence of the articulation arose while waiting for the child, it goes away on its own after childbirth and the restoration of the hormonal background.

Wearing a bandage

To alleviate pain, the expectant mother is recommended to wear a special bandage, which helps relieve swelling and, due to additional support for the lower abdomen, prevents the discrepancy from increasing in size.

Trying on the bandage before buying should take place in the prone position. When lifting, it is estimated how tightly it supports the hip joint.

Supplementation with calcium and vitamins as an early aid

With symphysitis, the doctor may prescribe an additional intake of calcium. However, this decision should be balanced, since an excess of the mineral in the later stages can reduce the mobility of the baby's skull bones and make it difficult for the head to pass through the birth canal. In addition to calcium, special vitamin and mineral complexes for pregnant women are most often recommended.

Vitamin-mineral complexes for expectant mothers, which can be prescribed by a doctor for diagnosed symphysitis - photo gallery

Vitrum Calcium is prescribed if it is necessary to replenish calcium and vitamin D3 Calcium is often prescribed in conjunction with vitamin D, which allows the mineral to be absorbed in the maximum amount
Elevit Pronatal Complex contains 3600 IU of retinol palmitate
Alphabet Mom's health tablet contains 40% of the daily intake of beta-carotene Vitrum Prenatal improves a woman's well-being and improves immunity

Pain Reduction: Exercise, Physical Therapy, Home Remedies

To prepare for natural childbirth and reduce the pain caused by symphysitis, gymnastics that strengthens the joints helps. A set of exercises must be approved by a doctor. A great addition to the treatment of symphysitis will be special courses for pregnant women (for example, yoga).

As a physiotherapeutic effect, magnetotherapy is prescribed on the area of ​​​​the pubic symphysis (this is the effect of a magnetic field with a low frequency). Of the folk remedies that help with symphysitis, one can distinguish nutrition with the obligatory use of foods high in calcium (hard cheese, sardine, sesame, almonds, milk, white cabbage).

The occurrence of symphysitis is possible during childbirth. This happens if the fetus is large or with a narrow hip joint. Severe postpartum bone dehiscence requires complex treatment that includes medications (including calcium and anti-inflammatory drugs).

Prevention of symphysitis

The best way to prevent the onset of a disease is to prevent it. Pregnancy planning makes it possible to be examined in advance and identify risk factors for the occurrence of symphysitis.

Registration for pregnancy for up to 12 weeks and regular visits to the gynecologist will allow you to notice the disease at an early stage and prevent its development. Proper nutrition, which excludes a large amount of carbohydrates, but implies the use of food rich in proteins and calcium, will help the body to function normally. And the prophylactic wearing of a bandage, starting from the middle of the second trimester, even in the absence of symphysitis, will ease the load on the lower back and hip joint.

A set of exercises and yoga for pregnant women will help strengthen the muscles of the buttocks, hips, back, due to which the load on the joints will decrease, and childbirth will be less painful.

Divergence of the pubic joint - video

Not a single pregnant woman is insured from symphysitis. This painful and dangerous condition can significantly complicate the last months of bearing a baby. In this material we will tell you how to recognize and how to treat symphysitis during pregnancy.

What it is?

In both women and men, the pubic bones are connected by a small vertical symphysis. This connection runs right in the center, behind the symphysis is the bladder, and below - the external genitalia. Normally, this connection is quite mobile, representing a fibrocartilaginous disk with a slit-like liquid cavity inside.

The pelvic bones manage to be firmly held due to the ligaments growing into the disc. The strongest of them are the upper and lower. The anterior and posterior ligaments are somewhat weaker. The pubic articulation (pubic symphysis) ensures the stability of the pubic bones of the pelvis.

During pregnancy, the load on all the anatomical components of the pelvic zone increases tenfold. Ligaments, muscles, bones undergo changes, including the symphysis. Nature so conceived that the pelvic bones, which form a visual ring, should miss the head of the baby during childbirth. To make this possible, the symphysis softens and the pubic bones become more mobile. Sometimes during this process inflammation occurs, the pelvic bones begin to diverge. It is this phenomenon that has received the name symphysitis in medicine.

To some extent, new, not always pleasant sensations in the pubic bone area visit all pregnant women in the later stages. But not every expectant mother is diagnosed with symphysitis by doctors.

We are talking about the disease when the divergence of the bones reaches certain values ​​and is accompanied by inflammation.

Causes

As already mentioned, softening of the pubic symphysis is a natural process and necessary for the normal course of childbirth. The expansion of the pelvis is the preparation of the female body for the upcoming important event - the birth of a new person. The main question is why in some women this process proceeds without any special features, within the framework of the program laid down by nature, while in others it turns into a painful and dangerous condition.

The true causes that lead to symphysitis, science and medicine are not known for certain today. But there are several versions that are still considered as probable prerequisites:

1. First, it is a lack of calcium. In pregnant women, this mineral mainly goes to the structure of the bones of the child; many expectant mothers, especially in the second half of pregnancy, experience a pronounced calcium deficiency.
2. The second likely cause is excessive production of relaxin. This hormone, as the name implies, is designed to soften the bones, ligaments of the pelvis before childbirth. It is produced by the placenta, and also in some quantities by the ovaries of the expectant mother. If for a number of reasons the hormone is produced more than necessary, then the joints, ligaments and cartilage soften to a greater extent, which, combined with the load on the pelvis caused by bearing a baby that has already become large, gives such an unpleasant effect.

In the first half of pregnancy, the fetus is small, it does not exert much pressure on the pelvic bones. However, the closer to childbirth, the greater its weight. The closer the date of birth, the stronger the baby is pressed by the head to the exit from the small pelvis, therefore pressure on the pubic joint increases.

Risk group

A woman can be warned in advance about the likelihood of developing symphysitis. And all because most often the divergence of the pelvic bones with painful inflammation occurs in certain categories of pregnant women.

Long years of observation of expectant mothers allowed doctors to get an idea of ​​the risk group. It included:

• Women with diseases of the musculoskeletal system. This includes both acquired diseases and hereditary pathologies - congenital weakness of bone tissue, increased bone fragility, collagen deficiency.
• Women who gave birth more than 2 times. The more births in history, the higher the likelihood of instability of the symphysis. Especially dangerous are situations in which the period between births is short - no more than three years.
• Women who have suffered pelvic trauma. Any fractures, dislocations, cracks in the pelvic area, if they have taken place in the past, increase the chances of developing symphysitis. Often such injuries are inherent in ladies who are professionally involved in athletics (running).
• Women who have suffered from symphysitis in the past. If during a previous pregnancy a woman developed a similar pathology, the probability of recurrence is almost 100%.
• Pregnant women leading a sedentary lifestyle. If the expectant mother does not physically load herself and tries to lie or sit more, avoids walking, does not do gymnastics, then symphysitis in the later stages is very likely.
• Expectant mothers carrying a large or giant fetus. A large child is considered to have an estimated birth weight of more than 4 kilograms. A giant is a baby who, according to preliminary estimates, at birth will weigh more than 5 kilograms.

If a woman is at risk, this does not mean that symphysitis will definitely begin. You need a coincidence of risk factors, for example, bearing a large fetus against a background of calcium deficiency or a pelvic injury in the past against a background of increased production of relaxin.

Symptoms and signs

Symphysitis is manifested by rather characteristic sensations, which are not difficult to determine. It usually starts with severe pain. The further, the stronger the pain. Women complain of pain in the pubic area. It becomes stronger at night, when the woman relaxes, and becomes somewhat dull during the day. With the progression of the disease, the pain syndrome begins to persist in the daytime.

The divergence of the pelvic bones leads to the appearance of pain in the lumbar and sacral regions. A woman may complain about the appearance of unpleasant pain in the hip joints. Walking becomes difficult. The same “duck” gait appears, in which the woman clearly rolls over from side to side when walking, and she herself feels “clicks” in the pelvic joints during the step.

You can diagnose symphysitis by asking a woman to spread her legs apart. When diluted, the pain in the pubic joint increases.

The most difficult for a woman with symphysitis is climbing the steps of the stairs, bending forward. It is practically impossible to raise straight legs up from a supine position. All attempts to do this end in the occurrence of severe acute pain and a feeling of limited movement. Pain can also appear during sex. Sometimes a woman has problems with defecation - it hurts to push, constipation occurs. Most expectant mothers with symphysitis can get out of bed only from a position on their side in several stages, independent lifting from a horizontal position on the back becomes impossible.

At the beginning of the inflammatory process in the pubic area, swelling can be visualized. The more neglected the disease, the greater the swelling. When the bones diverge, there is a feeling of heaviness in the lower abdomen. Many expectant mothers take it for the threat of premature birth and go to the doctor for this very reason.

The severity becomes more pronounced after a long stay in an upright position. If you lie down, then it temporarily decreases somewhat.

Most often, the first symptoms of symphysitis appear on the term 28-36 weeks and beyond. In some cases, the symptoms characteristic of this disease develop before 28 weeks, but this is extremely rare. Also, the first symptoms of symphysitis may appear after childbirth, and then the appearance of the problem will be associated with injury to the pubic joint during the passage of the baby through the birth canal.

More than 70% of expectant mothers are characterized by discomfort in the pubic area in the last 2-3 months of pregnancy, do not confuse them with symphysitis. True symphysitis differs from physiologically justified aching discomfort in that there is a limited range of motion, the pain becomes unbearable.

Types of disease and forms

Problems with the divergence of the pubic pelvic bones may be associated with pregnancy and the postpartum period. There are several degrees, which are determined by the magnitude of the discrepancy:

• The discrepancy from 5 to 9 mm allows you to install symphysitis of the first degree.
• A discrepancy from 10 to 19 mm is the basis for establishing symphysitis of the second degree.
• A discrepancy from 20 mm is the third degree of symphysitis.

Danger and Consequences

Symphysitis is not at all dangerous for a child. To a greater extent, it threatens the health of a woman, because after childbirth she may remain disabled. If the discrepancy is less than 1 centimeter, the prognosis is the most favorable, with such symphysitis even natural childbirth is allowed. Symphysitis of the 1st degree is the easiest, and therefore easily treatable.

A discrepancy of more than 1 centimeter, which corresponds to grades 2 and 3, does not cause such rosy forecasts for doctors. It all depends on how fast this distance increases. Usually a woman is recommended delivery by caesarean section.

Excessive divergence of the symphysis can lead to rupture of the ligaments, and this is considered a severe pathology of the musculoskeletal system. A woman who has survived a breakup cannot stand, lift her legs, or walk. She may be disabled.

A discrepancy of more than 5 centimeters is considered the most dangerous. In this case, in addition to trauma to the pubic joint, the edges of the bones can injure the bladder, urethra. Hemorrhage occurs in the region of the hip joints. Later, this almost invariably leads to the development of arthritis.

Rupture can occur at the time of delivery if the cartilage disc is excessively depleted. It is for this reason that natural childbirth with a discrepancy of more than a centimeter (11 mm, 12 mm, and so on) is considered undesirable. Caesarean section avoids a possible rupture of the pubic symphysis.

The nature of childbirth affects the likelihood of a rupture. With rapid and rapid delivery, the likelihood increases. Also, natural childbirth in a woman with symphysitis, pregnant twins or triplets are considered risk factors for undesirable consequences. Such an anatomical feature as a narrow pelvis is also a factor provoking rupture of the womb.

Most often, the gap occurs gradually during childbirth, and you can guess that it happened 2-3 days after the baby is born. The pain will increase and the ability to move will be lost. Much less often, a rupture occurs suddenly, then a woman in the process of childbirth can hear a characteristic sound that accompanies damage to the ligaments.

A woman after a break cannot roll over on her side on her own. She has access to the only position in which she feels some relief - the so-called "frog pose"

If the bladder is injured, then the outflow of urine becomes difficult, swelling and symptoms of intoxication appear.

Diagnostics

If a woman has characteristic symptoms and complaints, she should definitely consult a doctor. If symphysitis is suspected, an examination is prescribed. The fact is that the magnitude of the divergence of the pubic joint is not always directly related to the intensity of pain. With a small discrepancy, a woman may experience a fairly strong pain syndrome, and with a large discrepancy, the pain may be insignificant. That is why it is important to find out exactly what the discrepancy is and what degree of symphysitis it corresponds to.

For this, it is carried out Ultrasound of the pubic joint. Diagnosis is carried out by an external sensor, it allows you to measure the discrepancy and determine if the expectant mother has signs of inflammation. After the examination, it is possible to choose further tactics of pregnancy management and choose the optimal and safe for the woman's health method of delivery.

Much more diagnostic information can be provided by methods such as radiography and MRI. But for obvious reasons, they are not prescribed to pregnant women. Such diagnostic methods are widely used after childbirth, if the symptoms of symphysitis do not disappear or there is a suspicion of a joint rupture.

In the process of diagnosis in pregnant women it is important for the doctor to distinguish symphysitis from some other pathologies that are similar in their manifestations. Pain in the pubic area can be caused by problems with the sciatic nerve (sciatica), pain in the spine (lumbago), infections of the genitourinary system, and tuberculosis of the bones.

Treatment

The usual uncomplicated symphysitis does not need special medical treatment. It goes away on its own a few months after birth, less often the clinical symptoms of softening of the symphysis persist during the first year after the birth of the baby. But it is mandatory to treat a rupture of the pubic joint, if it has occurred. Without proper and timely therapy, a woman can remain disabled for life. The gap is being treated exclusively surgically and long-term (for several months) fixation. The operation is aimed at recreating the affected ligaments.

With symphysitis during pregnancy, therapy is primarily aimed at relieving pain and preventing rupture of the ligaments of the womb. The treatment regimen may include anti-inflammatory painkillers - antispasmodics, such as "No-shpa", "Baralgin", "Paracetamol". It is allowed to take them only in doses approved by the doctor and only in cases where a woman has to spend a long time in an upright position. Uncontrolled and frequent use of painkillers can cause drug addiction.

Regardless of the degree of illness, relative rest is prescribed for the pregnant woman. The pubic joint should not experience heavy loads. With a mild degree of symphysitis, it may be recommended to reduce the usual load, with degrees 2 and 3, bed rest is often prescribed. Expectant mothers with suspected symphysitis or a confirmed illness are not recommended to walk up and down the stairs, sit for a long time, stand in one position, and walk for a long time.

A woman is recommended to take multivitamins, complexes created specifically for expectant mothers with a high content of calcium, or calcium supplements in addition to the vitamins she takes. Unauthorized start taking calcium in any form means endangering the baby, because an excess of this mineral in the body of a future mother can harm the baby, especially in the third trimester of pregnancy. It is generally not recommended to take calcium before childbirth for several weeks.

With a slight degree of symphysitis, it is enough to add foods with a high mineral content to the diet - milk, cottage cheese, chicken eggs, spinach, fresh herbs, nuts.

If symphysitis is diagnosed, more careful weight control will be required. Excessive weight gain increases the load on the weakened pubic joint, the risk of rupture increases proportionally. A woman is recommended a universal diet for pregnant women, the correct drinking regimen, as well as fasting days. Starting from 6-7 months of pregnancy, a woman can wear a prenatal brace-corset, it will support a growing belly and reduce the load on the bosom. You can buy a bandage at any pharmacy or orthopedic salon.

After childbirth, another bandage will be required, the wearing of which is designed to reduce the distance between the bones of the pelvis. It can also be purchased at an orthopedic salon. In some cases, a woman after childbirth is advised to walk with a cane or crutches.

Far from the last place in the removal of painful and painful signs of symphysitis is given to physiotherapeutic effects, for example, magnetotherapy. But a gynecologist and an orthopedist will give a referral for such procedures only when the expectant mother has no threat of termination of pregnancy and other contraindications.

A woman with identified symphysitis should not sleep on a very hard surface; during sleep, it is necessary to put a small pillow or cushion under her feet, and a small blanket or blanket rolled up with a “tube” will do.

Similarly, the pelvic area is also lifted - a pillow is also placed under the buttocks.

A pregnant woman is prescribed a set of special gymnastic exercises that are effective for symphysitis. They help reduce pain:

• cat pose. A woman on a flat surface takes a knee-elbow position. Then she arches her back and shoulders, straightens them and arches. At the same time, the chin drops and the abdominal muscles slightly tense. This exercise should be repeated 10 to 15 times.
• Gymnastics according to Kegel. These exercises are aimed at training the muscles of the pelvic floor. The woman needs to lie on her back and tighten her pelvic muscles in the same way as when trying to hold on to urination. Tension should be maintained for a few seconds, then the muscles relax. Exercise is done from 15 to 20 times per session of gymnastics.
• Bridge Pose. Lying on her back, a woman should bend her knees, raise her pelvis and hold it in that position for a few seconds, then slowly and carefully lower herself. The exercise is repeated 10-15 times per session.

Such gymnastics should be done only with the permission of a doctor and only if the exercises do not cause an increase in pain.

If the pain becomes stronger, you should refuse to perform these exercises; in no case should you force yourself to do gymnastics.

Prevention

There are no specific measures to prevent symphysitis during pregnancy. Even for those expectant mothers who fulfill all the doctor's prescriptions, visit their obstetrician regularly and pass all the tests necessary in an "interesting position", there is a risk of developing the disease. Oddly enough, it will help to reduce the likely risks proper pregnancy planning. If a woman had diseases of the musculoskeletal system, pelvic injuries, there are problems with metabolism, special attention should be paid to pregnancy planning.

Do not neglect visiting a doctor while carrying a child. It is only at first glance that there is no benefit in such visits - they weighed, measured the stomach and released. In fact, at each appointment, the doctor controls the weight, measures the size of the pelvis, the beginning symphysitis will not escape the professional eye.

From the very first weeks of pregnancy, a woman should make sure that her diet is correct - with a low content of carbohydrates, with a sufficient content of calcium, magnesium and other substances and vitamins necessary for healthy bones and joints. You can not overeat and "feed" the baby to large and giant sizes.

You should not limit your physical activity if problems with the pubic joint have not yet appeared. A woman needs to do special gymnastics for expectant mothers, you can do yoga, swim, take half-hour walks in the fresh air. Moderate physical activity will help keep all muscles and ligaments, including the pubic ones, in good condition.

If the work of a woman is associated with prolonged sitting in one place, you need to arrange small workouts for yourself every hour. And here heavy loads should be abandoned, as well as climbing stairs on foot especially in the second and third trimesters of pregnancy.

If symphysitis still happened and the doctor recommends a caesarean section, you should not insist on natural childbirth - the risks of ruptures are too high.