June 5, 2020

Pubic Symphysis Separation After Birth

Pubic symphysis separation (or pubic symphysis diastasis) is defined as the widening of the pubic joint of more than 10 mm and is considered a complication of vaginal childbirth or pregnancy. Is there anything you can do?

We talk about pubic symphysis pain during pregnancy, but many times it resolves pretty quickly after birth. What if the pubic pain doesn’t go away or your doctor tells you you have pubic symphysis separation postpartum?

Pubic symphysis separation (or pubic symphysis diastasis) is defined as the widening of the pubic joint of more than 10 mm and is considered a complication of vaginal childbirth or pregnancy. While you’re still in the hospital or birthing center, you can initiate the following exercises safely if there is no increase in pain:

  • Diaphragmatic breathing

    • Taking deep breaths where you feel your ribcage expand all the way around (360 degree breathing) and then gently relax back down. Consider spending 1-2 minutes doing diaphragm breathing a few times a day.

  • Gentle Transverse Abdominis isometrics

    • Gently contract the deep abdominal muscles known as your TA found just inside your hip bones in the front like you’re putting on a tight pair of pants or fogging up a mirror (like a deep huff). Do this for a few seconds (3-5 seconds), ideally on an exhale, to help with the contraction. Do 5-10 repetitions a few times a day.

  • Gentle Pelvic Floor Isometrics

    • Gently contract your pelvic floor muscles on an exhale like you’re stopping the flow of urine, or holding back gas, or picking up a bean with your vagina. Do this gently for the length of your exhale, then relax on inhale. Repeat 5-10x a few times a day.

  • Gentle Gluteal isometrics (butt squeeze)

    • Squeeze your butt muscles for 3-5 seconds, 10 reps, a few times a day.

How long will it take to heal?

This can really depend on many factors such as the severity of your separation, any other birthing complications, your overall health, etc. It is advised to initiate physical therapy with a PT who specializes in pelvic health/postpartum as soon as you are able to, especially if your symptoms have not improved significantly at 6 weeks postpartum.

What can you expect during outpatient physical therapy?

  • Instruction in movement strategies during functional tasks (stairs, bending, lifting, feeding baby, etc.).

  • Education in progressive exercises for neuromuscular re-education, core stabilization, and posture.

  • Manual therapy including pelvic assessment and muscle energy techniques to address pelvic positioning.

  • At 6 weeks, typically approved to perform internal evaluation of pelvic floor musculature to assess for soft tissue dysfunction or incoordination that may have resulted from disuse/pain associated with pubic symphysis diastasis/separation.

  • Recommendation to use a sacroiliac belt which may provide pain relief when you are upright and moving around your home.

Activities and Position Recommendations

A good rule of thumb is to imagine that you are wearing a pencil skirt during all activity. Separating the knees may create tension through the pubic symphysis and cause you pain.  Over time, you will tolerate more movement through your legs. For now, move only as pain allows.

  • Bed transfer: use the log roll technique

    • Getting into bed

      • Sit where you want your hips to land in the bed.

      • Lay down onto your side.

      • As you exhale, keep your knees together as you bring both legs onto the bed.

      • Keeping knees together, roll onto your back.

  • Getting out of bed

    • Roll onto your side.

    • Keeping your knees together, slowly drop your legs off of the bed.

    • As you exhale, press up with your arms as you bring your torso upright.

  • Sleeping

    • Place a pillow between your legs and lay on your side to help support your pelvis at night.

    • A pillow behind your back serves as a bolster to help you maintain this position.

    • Avoid “frog-leg” position where top leg crosses up and over bottom leg to avoid asymmetry.

  • Vehicle transfer

    • Getting into car

      • Open the car door. Back your body up to the car seat so that the backs of your legs are perpendicular to the seat.

      • Sit down by hinging your hips back.

      • As you exhale, bring your legs into the car while keeping knees and lower legs together.

    • Getting out of the car

      • As you exhale, keep your knees together as you lift your knees and lower legs out of the car.

      • Place both feet on the ground.

      • As you exhale, push off of car seat to help you stand.

  • Lifting baby

    • You may have to squat to lift or lower your baby from their sleeping surface. As you do this, remember to keep your feet square to the surface and maintain even distribution of weight through your legs.

    • Hinge at your hips and let your knees gently bend to come to the height of the surface.

    • As you exhale, gentle lift baby and straighten legs keeping spine in neutral.

  • Walking

    • Walking normally may be painful, especially if you are accustomed to taking longer strides.

    • If you are having pain with walking, try taking shorter steps to reduce pubic stress.

    • Use of a walker or crutches may be required to help manage pain, especially after initial injury.

  • Stairs

    • Going up and down stairs normally may be painful.

    • Try going up and down sideways, one at a time to decrease stress through your pubic area.

    • If you have less pain on the left side of your pelvis, lift the left leg onto the higher step. If you have less pain on the right side of your pelvis, lift your right leg onto the higher step.

    • Hold onto the railing for extra support, especially if you are carrying your baby.

If you need more help understanding how to work through some of these modifications and muscle activation/coordination patterns, consider reaching out to us for a virtual visit by scheduling a session below or finding a local pelvic PT.

Jen Torborg, PT, DPT, CMTPT, is a pelvic floor physical therapist and author of three Amazon bestselling books: Your Best Pregnancy Ever, Your Best Body after Baby, and Your Pelvic Health. Jen treats clients in Ashland and Bayfield, Wisconsin through Orthopedic & Spine Therapy. Kelly Diehl, PT, DPT in La Crosse, WI contributed to the writing of this post.  

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