Pubic symphysis diastasis

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Pubic symphysis diastasis
X-ray showing pubic symphysis diastasis
Synonyms	Symphysis pubis dysfunction, pelvic girdle pain
Pronounce	N/A
Specialty	N/A
Symptoms	Pelvic pain, lower back pain, difficulty walking
Complications	Chronic pain, urinary incontinence
Onset	Pregnancy, childbirth
Duration	Varies, can be weeks to months
Types	N/A
Causes	Hormonal changes, mechanical stress
Risks	Multiple pregnancies, macrosomia, instrumental delivery
Diagnosis	Physical examination, X-ray, MRI
Differential diagnosis	Pelvic fracture, osteitis pubis, sacroiliitis
Prevention	N/A
Treatment	Physical therapy, pain management, pelvic support belt
Medication	Analgesics, NSAIDs
Prognosis	Generally good with treatment
Frequency	Affects 1 in 300 to 1 in 30,000 pregnancies
Deaths	N/A

Pubic symphysis diastasis is a condition characterized by the separation of the pubic symphysis, a cartilaginous joint located between the left and right pubic bones of the pelvis. This separation can occur due to trauma, childbirth, or other factors that exert excessive force on the pelvic region.

Anatomy

The pubic symphysis is a non-synovial amphiarthrodial joint, which means it allows for limited movement. It is composed of a fibrocartilaginous disc that connects the two pubic bones. The joint is reinforced by several ligaments, including the superior pubic ligament, the inferior pubic ligament, and the posterior pubic ligament. These structures provide stability to the pelvis and allow for slight movement necessary for activities such as walking and childbirth.

Causes

Pubic symphysis diastasis can be caused by:

• Trauma: Direct impact or injury to the pelvic region, such as in a car accident or a fall, can lead to separation of the pubic symphysis.
• Childbirth: During vaginal delivery, the pubic symphysis can separate to accommodate the passage of the baby. In some cases, this separation can be excessive, leading to diastasis.
• Hormonal Changes: During pregnancy, the hormone relaxin is released, which increases the elasticity of the ligaments in the pelvis, potentially contributing to diastasis.

Symptoms

Individuals with pubic symphysis diastasis may experience:

• Pain: Severe pain in the pelvic region, especially during movement.
• Instability: A feeling of instability or "clicking" in the pelvis.
• Difficulty Walking: Due to pain and instability, walking can become difficult.
• Swelling and Bruising: In cases of trauma, there may be visible swelling and bruising around the pubic area.

Diagnosis

Diagnosis of pubic symphysis diastasis is typically made through:

• Physical Examination: A healthcare provider will assess the patient's symptoms and perform a physical examination.
• Imaging: X-rays or MRI scans can be used to visualize the separation of the pubic symphysis and assess the extent of the injury.

X-ray showing diastasis of the pubic symphysis

Treatment

Treatment options for pubic symphysis diastasis include:

• Conservative Management: Rest, pain management with medications, and physical therapy to strengthen the pelvic muscles.
• Pelvic Support: Use of a pelvic support belt to stabilize the pelvis and reduce pain.
• Surgical Intervention: In severe cases, surgical fixation may be necessary to realign and stabilize the pubic symphysis.

Prognosis

The prognosis for individuals with pubic symphysis diastasis varies depending on the severity of the separation and the treatment received. Many individuals recover with conservative management, although some may experience persistent pain or instability.

See also

• Pelvis
• Childbirth
• Relaxin
• Pelvic fracture