During pregnancy, various changes occur in a woman's body, which are accompanied by discomfort. Expectant mothers experience pain in the pelvic area at various times. Gynecologists explain this phenomenon by the divergence of the pelvic bones. How many weeks before birth does the pelvis begin to expand? Which symptoms are considered normal and which indicate pathology?
How does it happen and why does pelvic bone divergence occur in pregnant women?
The pelvic bone of an adult woman consists of three main parts: the pubis, the ischium and the ilium. In front, the two bones meet at the pubis to form the symphysis pubis. Together with the sacrum and coccyx they form the pelvis. It is held together on all sides by ligaments and cartilage.
In its normal state, the pelvis is not mobile. However, during pregnancy, a woman's body produces the hormone relaxin. It softens cartilage discs and ligaments, so bones become mobile.
The discrepancy of the bones mainly affects the areas of the pubis and sacrum. The cartilage connecting the pubic bones becomes soft and can spread up to 0.5 cm. This process facilitates the passage of the child through the birth canal and prevents fractures of the woman’s pelvic bones during childbirth.
In addition to the divergence of the bones, the position of the tailbone changes. Under the influence of relaxin, it acquires the ability to lean back. A woman’s discomfort is caused by mobility of the pelvic apparatus, changes in the position of the bones and stretching of previously immobile ligaments. However, pain in the pelvic area often occurs for other reasons:
- heavy load on the spine due to excess body weight;
- change in the position of the ligaments connecting the uterus and the musculoskeletal system;
- insufficient calcium and vitamin D in the body;
- pathologies of the spine and bones.
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What signs accompany pelvic expansion?
The changes are noticeable not only to the woman herself, but also to those around her. Pelvic expansion is accompanied by the following symptoms:
- The gait changes. Due to processes in the musculoskeletal system, a woman instinctively places her feet wider. The gait resembles that of a duck.
- The stomach protrudes forward. The mobility of the sacral joint leads to changes in the angle of the pelvis. To maintain balance, a pregnant woman has to push her stomach forward and bend her upper body back.
- Pain appears in the pubis. Discomfortable sensations occur when the expectant mother remains in one position for a long time.
- Pain in the coccyx area when sitting for a long time.
Should a pregnant woman stop working?
Maintaining an active and productive life during pregnancy allows time to pass faster and creates a feeling of satisfaction. Working during pregnancy is not a problem if the pregnancy is progressing normally and the work is not associated with harmful factors. If your work involves sitting in one place for a long time, you need to get up from the table once every 40 minutes and walk around a little. It is necessary to drink plenty of fluids and be able to take breaks from work. If the work is associated with harmful factors, it is necessary to consult with the obstetrician-gynecologist who is managing the pregnancy to resolve the issue and the possibility of work.
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When does this process begin?
Intensive production of relaxin in the body of a pregnant woman begins at 17–20 weeks. During this period, most women begin to feel the divergence of the pelvic bones. However, the process of pelvic expansion can occur at any stage of pregnancy.
Many women begin to walk like a duck and feel pain in the pubis already in the first trimester, and for some expectant mothers the bones do not separate until the 30th week of pregnancy. Both late and early onset of the process are not considered signs of pathology. Experts name the following reasons for the different timing of changes in the pelvic bones:
- hereditary predisposition;
- the individual ability of the body to produce different amounts of hormones;
- complications accompanying pregnancy;
- concentration of calcium and vitamins in the body;
- pelvic parameters.
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In what cases does pain become a sign of complications?
Discomfort when the pelvic bones separate is a normal physiological process during pregnancy. However, a woman should inform her doctor about any changes in her health, since sometimes pain in the pelvic area indicates complications. The main danger during pelvic expansion is the development of symphysiopathy.
Symphysiopathy is a pathological divergence of the bones of the pubic region by more than 5 mm. The following symptoms occur:
- discomfort during sexual intercourse;
- acute pain in the pubis;
- increased pain in the pubic bones when moving;
- it hurts to touch the pubic area;
- sensation of clicking in the pubis;
- urinary incontinence;
- feeling of pressure in the lower pelvis;
- lower back pain.
Symphysiopathy most often appears due to the individual ability of a woman’s cartilage to stretch excessively. Experts also identify the following causes of pathology:
- weakening of ligaments and cartilage due to lack of vitamins and microelements;
- kidney disease;
- congenital or acquired diseases of the musculoskeletal system;
- short breaks between pregnancies.
The complication does not affect the fetus, but causes significant discomfort to the expectant mother. With severe symphysiopathy, a woman may lose the ability to walk. If the bones diverge by more than 5 mm, then delivery is carried out by cesarean section.
Sometimes the pubis and perineum are very tight and painful before childbirth. If such pain occurs before 37 weeks of pregnancy, you should consult a doctor to rule out premature birth.
Does the age of the father affect the likelihood of having a child with anomalies?
Currently, there is no convincing evidence that the age of men affects the development of fetal chromosomal abnormalities in the same way as it does in women. With age, the concentration of pathologically altered sperm increases, but they cannot fertilize the egg. At the same time, with age, the likelihood of transmitting genetically programmed diseases that are inherited in an autosomal dominant manner increases. These conditions include multicystic dysplastic kidney disease, achondroplasia, Marfan syndrome and neurofibromatosis. If there are cases of these diseases in a man’s family, it is necessary to undergo a medical genetic consultation before a planned pregnancy.
What to do for pain in the pelvic bones: methods of treatment and prevention
If pain in the pelvic bones is moderate, they do not require special treatment. To reduce pain, the expectant mother is advised to reduce physical activity and enrich her diet with foods containing large amounts of calcium. To reduce the load on the spine and pelvic bones, women are recommended to do a special supportive massage.
In case of severe pain, methods for eliminating the pathology are determined by the doctor after clarifying the nature of the disease. To eliminate discomfort, the following therapy methods are used:
- Use of calcium and vitamin D supplements. The dosage and frequency of use are determined after testing for calcium levels in the body. Calcium is not prescribed in the last weeks of pregnancy because it leads to early ossification of fetal cartilage.
- Taking painkillers. Medicines do not eliminate the causes of the pathology, but help improve the woman’s well-being. They are prescribed in moderate doses only for severe pain.
- Physiotherapy. Most procedures during pregnancy are dangerous, so they are prescribed on an individual basis.
Prevention of pain due to divergence of the pelvic bones must be carried out not only during pregnancy, but also during its planning. Preventive measures include:
- Proper nutrition. The expectant mother needs to eat foods that will provide her body with a sufficient amount of vitamins and minerals. It is necessary that the food be varied and properly prepared. You should not abuse fatty, fried, salty and spicy foods.
- Body weight control. If you are overweight, the pelvic bones experience increased stress, which leads to pain and excessive separation of the bones.
- Moderate physical activity. During pregnancy, you should take daily walks. Sudden movements, jumping, and heavy lifting should be avoided. Gymnastics for pregnant women, yoga, and swimming in the pool help strengthen the musculoskeletal system and prepare ligaments for stretching. A separate set of exercises has been developed for each trimester.
- Avoiding staying in one position for a long time in the last stages of pregnancy.
- Wearing comfortable clothes and shoes.
Reasons for the development of cervicitis
The cervix serves as a natural physiological barrier that protects the upper reproductive system from infection. If there are disturbances in the functioning of the body, the protective functions are reduced, pathogenic microflora penetrates into the cervical canal and cervix, and a pathological inflammatory process develops.
The development of cervicitis is always provoked by pathogenic pathogens - viruses, bacteria and fungi that enter the vagina during sexual intercourse. All the main pathogens can be divided into the following groups:
- STIs – gonococci, trichomonas, chlamydia;
- human papillomaviruses (HPV);
- own pathogenic bacteria located in the intestines and genitourinary system, which develop against the background of dysbiosis, vaginosis, causing inflammation of the vulva, vagina and cervix.
In addition to the listed pathogens, the development of cervicitis is promoted by:
- injury to the cervix during abortion, installation of an IUD, medical procedures, or during sexual intercourse;
- scar deformities;
- insufficient or, conversely, excessive intimate hygiene, leading to disruption of the microflora;
- uncontrolled use of hormonal drugs;
- reduced immunity;
- menopause
Diagnostics
As with any dysfunction, early diagnosis is important to prevent it from becoming a long-term problem. Diagnosis is usually made based on symptoms, but in fact, imaging is the only way to reliably diagnose symphysis pubis dysfunction
MRI, X-ray, CT, or ultrasound are used to confirm pubic symphysis dehiscence. Although radiography is not considered as a method of choice due to the danger of exposing the fetus to ionizing radiation. The most suitable method with excellent spatial resolution is MRI, which also avoids ionizing radiation.
Other methods that can help in diagnosis and monitoring are transvaginal or transperinal ultrasound using high-resolution transducers. Using a method such as ultrasound, it is possible to measure the interpubic cavity. This may also be a consequence of diastasis of the pubic symphysis after childbirth.
The interpubic distance is mainly measured with electronic calipers.
It is also important to know that ultrasound allows you to measure the interpubic space without ionizing radiation
Outcome assessment
Articulus pubis dysfunction is described as a set of signs and symptoms of discomfort and pain in the pelvic area. There is still no single, 100% understanding of what exactly causes this condition. Therefore, it is not so easy to invent any other criteria other than pain and instability of the pelvic girdle, which could show the difference in the patient’s condition at the beginning and end of therapy.
However, there are studies on the development of a special scale for DLS. More studies related to outcome assessment are needed.
Inspection
It is important to conduct a physical examination to differentiate between other possible causes of symptoms, such as problems with the lumbar spine or a herniated disc. Here are some of the examination methods:. Palpation:
Palpation:
- Soreness of the pubic symphysis.
- Pain in the sacroiliac joints.
- Sacrotuberous ligament.
- Soreness of the following muscles: gluteal, iliopsoas, piriformis and paravertebral muscles.
Provocative tests (when they are positive, this helps establish DLS).
FABER test
The examiner records one of the anterior superior iliac spines. The patient, in the supine position, flexes the hip and places the foot on the opposite knee joint, while the leg hangs passively outward. The test is considered positive if there is pain in the sacroiliac joint
- Active straight leg raise (ASLR)
- Pain in the symphysis when standing on one leg.
- Bilateral compression of the trochanter of the femur.
Range of motion may be reduced due to pain. Especially during lateral rotation and abduction.
The duck gait can occur due to weakness of the gluteus medius muscle, which normally functions as an abductor.
DLS can also be suspected if the patient experiences continuous pain during the following activities:
- Walking.
- Climbing the stairs.
- Turn over in bed.
- Standing on one leg.
- Getting up from a chair.
There are a number of tests for symphysis pain during pregnancy that have high sensitivity, specificity and reliability (Cohen's kappa coefficient > 0.40).
- The patient lies down, the specialist palpates the entire anterior surface of the pubic symphysis. The test is positive if the result is pain that persists for more than 5 seconds after the end of palpation. (99% specificity, 60% sensitivity and 0.89 Cohen's kappa coefficient).
- Trendelenburg's sign: When standing on one leg, the patient is unable to maintain a horizontal pelvic position because the opposite buttock descends (normally it should rise) (99% specificity, 60% sensitivity and 0.63 Cohen's kappa coefficient).
- FABER test (see “palpation”) (specificity 99%, sensitivity 40% and Cohen’s kappa coefficient 0.54).
Evaluation of treatment effectiveness using MRI of the hip joint
After undergoing restorative manipulations, it is important to carry out repeated diagnostics to verify the correctness of the prescribed treatment course. The best way to compare the rate of tissue regeneration is MRI
If there are images from a previous study, the functional diagnostician compares the stage of the disease, identifies the absence or presence of relapses (tumors or infections affecting the pelvis), and migration of metastases.
After surgery, the composition of the fluid in the joint cavities and the degree of fiber restoration are examined. In some cases (with cancer of the bone), it is necessary to remove the hinge part of the hip and replace it with a prosthesis. The implant material is a metal alloy, so MRI scanning of the hip joint is contraindicated. An alternative is the same informative examination as a computer scan.
Hardware examination can be carried out in specialized diagnostic centers containing tomography rooms. You can select the nearest medical facility on the website of the Moscow Unified Recording Center. An expanded list of clinics makes it easier to compare by ratings, location addresses, and prices for services. Mark the best offers and sign up for diagnostics through the service. This will open access to additional discounts on the selected type of tomography.