Is it Pubic Symphysis Disorder or round ligament pain?

Pubic Symphysis Disorder (PSD or SPD) is a painful condition felt in the pubic area and is often mistaken for round ligament pain.  Unfortunately not a lot of OBs will give much heed to PSD (or even round ligament pain) because they cannot do much about it.  However, being able to distinguish the two will allow you to choose a more effective remedy in reducing your pain.

1. Where is the pain?

PSD: Almost always the pain is felt at the pubic symphysis joint—the bony part at the top of the pubic area—and will be very sore to the touch.  The pain usually radiates down into the groin and will often also radiate out into the hip joints.

Round Ligament: The pain is usually felt in the lower abdomen and slightly off to one (or both) sides.  It often radiates into the groin and/or around the sides to the flanks or hips.

2. What is the quality of the pain?

PSD:  Sharp and intense.  For some the pain feels like they are breaking open from the inside or their hip bones are grinding together.  Oftentimes a clicking sound is heard when walking or moving.

Round Ligament:  Also sharp and can be intense.  Many times the pain happens suddenly.

3. When is the pain felt?

PSD:  When standing, walking, shifting while sitting, and intensely when rolling over in bed.  The pain continues even after stopping the movement.

Round Ligament:  When performing sudden movements and usually diminishes if not goes away after a few seconds.

If you still aren't sure which it is here is a simple test: stand on one leg (please use your arms to support yourself when doing this).

PSD: You will experience increased pain or even an inability to stand on one leg (the other leg may give out).  You will find it difficult with activities like walking up stairs, raising one leg to put on pants, or getting in/out of a car.

Round Ligament: You will experience minimal, if any, change in pain and should find it easy to stand on one leg.

Here is a side note: Sciatica and sacroiliac joint dysfunction (SIJD) are sometimes co-conditions of PSD.  The presence of sciatica or SIJD does not rule out PSD, but it doesn’t guarantee it either.

What is relaxin?

If you are pregnant you are well aware of the surge of hormones that has taken over your body. As soon as a woman is pregnant hormones flood through her body, often leading an expectant mother to wonder what happened to her former self. Many pregnant women tell me about feeling happy one minute and weeping the next. Others are plagued with acne, reflux, and low energy levels. This hormone flood may produce side effects that a mom could do without, but they all play a very important role in the development of your baby.

However, one, often maligned, hormone is very specifically important to the health of the pregnant woman. It is relaxin. Relaxin is a hormone produced during pregnancy that allows you to give birth! The way it works is complex, but generally it makes collagen breakdown happen at a much faster rate which causes the cervix and the pubic symphysis to soften and lengthen. It allows the baby to pass through the birth canal. This is a good thing for a pregnant woman.

Relaxin is a hormone that is always present in a woman's body, however during pregnancy, the hormone relaxin is present in 10 times its normal concentration. While relaxin is a great hormone in preparing for labor it can cause some unwanted side effects as well. Relaxin doesn't know the different between the pubis and any other joint in the body so it can lead to abnormal motion, which in turn leads to pain and inflammation. Most of this is mild and can be controlled with Tylenol. Some people are more affected by relaxin than others for reasons we don't entirely understand. Those who experience significant pain due to loosening joints can get relief with the practices listed here.

Upon delivery the raging hormones gradually go back into hibernation and loosey-goosey joints tighten up again. Relaxin has allowed the human body to do something that seems impossible. (Birthing a baby.) So let's hear it for relaxin. It gets a bad rap, but is your best friend come delivery day!