Pubic symphysis - what is it?
The bony pelvis of the woman is formed from the sides by two pelvic bones, and from behind - by the sacrum. The pelvic bones in front are connected by the pubic joint - symphysis, and at the back - by two sacroiliac joints. The fusion of both pubic pelvic bones by means of a fibrous-cartilaginous disk is called pubic symphysis. In the center of this fusion there is an articular cavity in the form of a gap, filled with an articular fluid.
Symphysis is strengthened by ligaments that give strength to this joint. Lone articulation is a semi-joint, because it has a very limited range of motion.
Normally, the width of the symphysis (the distance between pubic bones) can be up to 1 cm. In front of the symphysis is the pubis with its fat pad and ligament that lifts the clitoris. Below, the symphysis is accompanied by nerves and vessels. Behind the symphysis is the urethra and bladder.
What is symphysitis?
Symphysitis (from Latin symphysit) means inflammation of the pubic symphysis. This is the common name for the changes and lesions of the lone articulation. Such changes most often occur and are manifested during pregnancy, childbirth and the postpartum period.
In medical sources, such terms as symphysiopathy and sacroiliopathy, symphysitis, arthropathy of pregnant women, divergence and rupture of the pubic articulation are used to describe pathological changes from the joint of the pelvis during pregnancy and after childbirth.
To characterize the pathological conditions from the side of the pelvic joints during pregnancy and after childbirth, many authors recommend using the term dysfunction of the pannus joint.
Causes of symphysitis
During pregnancy, the substance relaxin is released in the ovaries and placenta, with a specific relaxing effect. Under the joint action of relaxin and female sex hormones articular cartilage and ligaments swell, in the joints appear additional slits filled with fluid, resulting in an increase in mobility in the joints of the pelvis and an increase in the distance between the bones forming each joint.
Especially, these changes are expressed in the lap joint, where there is increased blood supply, edema and loosening of the entire ligamentous apparatus. As a result of such changes, the width of the lone articulation increases by several millimeters. Moderate softening of the joints of the pelvis and stretching of the pubic joint promotes a favorable passage of the fetus through the bone pelvis. Sometimes these changes go to physiological boundaries. In this case, there is excessive relaxation of the joints of the pelvis, accompanied by pain syndrome and having to their excessive stretching and even rupture during childbirth.
The pain that occurs after childbirth can be the result of traumatic births (the imposition of obstetric forceps, excessive hip dilatation during childbirth, etc.). The discrepancy of the lone articulation can be very significant, the symphysis is more mobile, and the ligaments are too stretchy, as a result of which the symphysitis occurs.
Symphysitis is characterized by many symptoms and signs, the most common of which are:
- pain in the pubic region, "shooting" pain;
- pain when walking, changing posture, pain in hip abduction, pain in any movement;
- pain, giving down the abdomen, groin, perineum, back, thigh or leg;
- pain that occurs when you lean forward, stand on one leg, rise from a chair, climb and descend the stairs, turn in bed;
- pain that disappears when resting;
- clicking, crackling or grinding, audible at the palpation of the heart;
- a difficult act of defecation.
Pain may appear immediately after birth or after 24 hours.
Methods for diagnosing symphysitis
Special methods of investigation (X-ray, computed tomography, magnetic resonance imaging, ultrasound) are used to diagnose symphysitis, which allow to determine the extent of symphysis stretching, articulation and other pathological conditions.
Ultrasound is used to assess the condition of the symphysis. A computerized tomography is used to investigate the lump articulation after childbirth. The method of magnetic resonance imaging (MRI) allows you to assess the status of symphysis, the state of bone tissue, as well as soft tissues. In addition to stretching of the pubic joint, it is necessary to distinguish between the lacerations of the pubic joint, which most often occur in childbirth.
For the diagnosis of symphysitis, differential diagnosis is performed with the following diseases:
- urinary tract infection;
- inguinal, femoral hernia;
- lumbago (acute pain in the lower back);
- sciatica (pain associated with lesion or irritation of the sciatic nerve);
- thrombosis of the femoral vein;
- compression of the nerve (eg, damage to the intervertebral disc);
- infection of the pelvic bones (osteomyelitis, syphilis).
It is also advisable to consult with neuropathologists, orthopedic traumatologist, surgeon, radiologist, physiotherapist and other specialists. This is important, since the complexity of diagnosing this disease lies in its symptoms, similar to the aforementioned diseases.
There are three degrees of divergence of the bones:
- the first degree - the divergence of the bones of the bones by 5-9 mm;
- the second - by 10-20 mm;
- the third - more than 20 mm.
Among the symptoms of the disease can be as mild discomfort, and intolerable pain.
If there is a discrepancy between the first-degree frontal bones, the pregnant women and the puerperas do not usually complain.
It is possible to find out about the discrepancy of the lateral bones after careful interrogation and palpation of the lone articulation. The final diagnosis allows us to establish an ultrasound, X-ray study. In most cases, the discrepancy of the first degree articulation does not require treatment.
Pain in the symphysis region and in the sacrum, difficulty in walking signals a divergence of second-degree bones of the chest.
With the third degree of discrepancy of the bones, the signs are most pronounced. Paralysts complain of severe pain in the region of the pubis and sacrum (sacroiliac joints), can not perform active movements in the lower limbs, turn on his side.
For the treatment of symphysitis, it is recommended to limit motor activity, use a bandage, a capturing trochanter of the hips. Sometimes use crutches, canes or even strollers.
Paracetamol is used for the purpose of analgesia, non-steroidal anti-inflammatory drugs and opiates are used to eliminate postpartum pain.
Also resort to percutaneous electroneurostimulation, use ice or external heat, do massage.
Bed rest is combined with exercises. Apply for the treatment of symphysitis after birth, calcium preparations, vitamins of group B. If you can not remove the pain, then they resort to the help of qualified specialists.
One of these can be an osteopathic doctor. Recommendations osteopath for holding complexes of therapeutic gymnastics can significantly improve the postnatal condition of a woman.