6 management tips for Pubic Symphysis Diastasis (Separation)

What are the risk factors for PSD?

There are a number of possible risk factors for PSD. Research into exactly how and why all of these come into play is continuing. 

The known risk factors include:

• Asymmetries in the mother’s pelvis
• An increased lumbar lordosis (when the curve in the mother’s lower back is larger than usual)
• Preexisting conditions that lead to increased joint instability, eg. Ehlers Danlos syndrome
• Hormonal conditions leading to altered release of relaxin, oestrogen or progesterone
• Certain metabolic conditions that affect Vitamin D and calcium turnover
• Past history of pelvic trauma
• Inflammation of the sacroiliac joints (SIJ’s) or pubic symphysis 
• Preexisting osteoarthritis (O.A), rheumatoid arthritis (R.A), or osteomalacia (a condition that leads to softening of bones)
• Your baby having an above-average head size or generally being large in proportion to your size
• Your age being “above average”
• Complications during a previous labour
• The use of forceps during delivery
• A long second stage of labour
• The use of epidurals during labour
• Your participation in certain sports, such as football and basketball

How is Pubic Symphysis Diastasis diagnosed?

PSD is usually diagnosed by a combination of medical history taking and physical examination. 

Some common questions asked when trying to diagnose PSD are:

• Is it painful or difficult to roll over in bed?
• Does your pain change when you climb stairs?
• Can you take a full step with a normal stride length?
• Is it painful or difficult to get out of a low chair?

If you have recently given birth, your medical team may want to examine your pelvic area for classic signs of PSD, or to check for other possible causes of your pain. 

You might note that when you lay on your back, your legs tend to move apart all on their own. This is a classic feature of PSD. 

If the diagnosis is not clear, sometimes you’ll need an X ray. This can confirm a widening of the pubic symphysis. X rays can’t be performed during pregnancy. If you’re yet to give birth, you’ll likely have an ultrasound or MRI instead.

The “gold standard” in PSD diagnosis is ultrasound. Ultrasound can provide real-time information as to how the area responds to your movements.

Pubic Symphysis Diastasis is diagnosed when the pubic symphysis is wider than 1cm at its narrowest point. 

Sometimes, if your medical team is still unsure, they’ll require either blood tests or an MRI to rule in or out other potential causes of your pain. 

6 PSD Management tips:

PSD is commonly managed in a number of different ways.

I’ve outlined 6 of the most common methods below.

1. Pelvic Stability belts:

Belts worn low down on the pelvis that aim to provide compressive support help encourage the gap in the pubic symphysis to close over time. 

I am a big fan of the Serola belt for all aspects of pelvic girdle pain, including pubic symphysis diastasis. 

Patients fitted with the Serola belt in my clinic often comment that it is more comfortable yet more supportive than any other belts they may have tried. 

When wearing the Serola belt for PSD, it’s important that you wear it very low down on your pelvis. 

To learn more about how to wear the Serola belt for PSD, as well as the research into pelvic belts for this condition, click here. 

To purchase the Serola belt, click here. 

2. Rest:

Pubic Symphysis Diastasis is one of the few conditions that bed rest is still recommended for. 

It’s important that you lay on your sides as much as possible. This allows your body weight to help compress the pubic symphysis and encourage its closure. 

However, we’ve known for a long time that bed rest should be kept to a minimum to avoid possible complications such as:

• muscle wastage,
• bed sores, and
• the possibility of acquiring other infections. 

3. Ice:

Placing cooling ice packs over the pubic region can help both relieve pain and reduce local inflammation. 

The ideal method of ice application is to wrap it in a thin cloth to help prevent ice burns to your skin. Leave it on for 5-10 minutes at a time, with around 5-10 minutes in between. Repeat this for periods of around 45 minutes. 

4. Pain medications:

Paracetamol is usually considered safe to take during pregnancy, and may help provide some pain relief.

NSAID’s such as ibuprofen are usually considered safe if you’re no longer pregnant. However, NSAID’s should not be taken if you have any of the following conditions:

• High blood pressure
• Heart, liver or kidney disease
• A high risk of stomach ulcers or bleeding
• Stomach issues such as reflux or indigestion
• Previous adverse reactions to fever-reducing medications or other pain medications
• Asthma
• You take diuretic medications (“fluid tablets”)

Talk to your Doctor or Pharmacist before commencing any new medications to discuss your particular risk factors. 

Your Doctor may also suggest a local cortisone injection into the pubic symphysis region. This can be extremely effective in minimising local inflammation. 

I should warn you though- they’re pretty painful to have done! 

However, the patients that I’ve seen who’ve had this performed have generally found cortisone to be an extremely helpful factor in their recovery. 

5. Physical Aids:

Using devices such as crutches or a walking frame to help decrease the weight through your pubic symphysis while you move around can be extremely helpful. 

6. Physical Therapy:

Receiving targeted physical therapy from a professional trained in management of Symphasis Pubis Diastasis can help:

• minimise pelvic misalignment, and
• promote strengthening of the relevant muscles. 

It’s important that you actually complete any exercises prescribed, as regaining strength and mobility is truly the best way to maximise your chances of complete recovery. 

Research generally shows that mobilising and unloading the region (through the use of devices such as crutches) gives significant improvement within 3 months. 

How long does it take for Pubic Symphysis Diastasis to heal? Does it cause permanent damage?

If you follow the steps outlined above, many people see significant improvement in their symptoms within around 6 weeks. 

Unfortunately, though, some women find that the pain can persist for up to 6 months, or even beyond this. 

That is why it is so important to seek out the right physical therapy provider who will tailor their approach to your specific needs. 

Some providers will prescribe a “one size fits all” approach. This may mean that certain individual factors required for your personal recovery are overlooked. 

If you’re not getting results with one provider once a decent period of time has passed, move on and try something else. 

I’m always so saddened to hear of women who’ve put up with pain for months (sometimes years) before they come to see me, because they’d tried the routine PT prescribed by their maternity hospital and thought that’s all they could do. Helping these women with personalised strategies and seeing their transformations is truly the reason why I do the work that I do. 

Keep your legs as close together as possible during labour and throughout the healing time. This is to avoid further straining of the pubic symphysis ligaments. If you can do this, you’ll minimise your chances of any permanent damage. 

Will I need surgery for my PSD?

Unfortunately, a small percentage of women will not fully recover using the more conservative approaches outlined above. 

Some will feel better for a while as they wear the pelvic support belt, and then find they regress again once they remove it. 

Some women will develop chronic (long-lasting) pain, and others will find that despite their best efforts, the gap just won’t close.

Surgery can be considered in these cases. 

A very small group of women will experience significant disruption to their pubic symphysis during childbirth. If this also causes problems with their urinary system, they will be offered surgery very soon after birth.

Surgery for Pubic Symphysis Diastasis usually involves the insertion of a plate that helps minimise motion at the pubic symphysis. 

Does Pubic Symphysis Diastasis affect my labour choices? Will I need a C-Section?

One of the first questions that many women with PSD have is “will I still be able to have a vaginal birth?”

In the vast majority of cases, the answer is yes. 

The main factor to be aware of if you have a vaginal birth with PSD is to keep your legs together as much as possible. 

Avoid the use of stirrups or pushing a leg against a midwife. 

Some women find it helpful to measure their pain free leg-opening (abduction) gap before labour. They then wear a ribbon or something similar tied around their legs to ensure they don’t go past this distance when things heat up during labour. 

It’s important that your birth team are aware of your PSD diagnosis, so they can make adjustments accordingly.

Listen to your body, and if something aggravates your pain, change positions. Never feel pressured into maintaining a position that you know is not right for you. 

There are no hard and fast rules around when a PSD diagnosis means that a C-section is automatically the best choice. 

Some Obstetricians use a figure of more than 1.5cms of pubic symphysis separation as an indicator that a C-Section is the best delivery method. 

If you know that your separation is quite wide, speak to your medical team to get more specific advice. 

Can you exercise with Pubic Symphysis Diastasis?

Yes and no.

Many common forms of exercise, such as walking, can aggravate your pain and slow down the healing process. 

However, there is evidence to suggest that exercising while in water is an effective pain management strategy. It’s still important to keep your legs together, but it seems that the water both:

• supports some of your body weight, and
• provides enough resistance to help improve your strength. 

Some women find that swimming gentle laps with a floatation device held between their knees can help get their upper body and torso moving, while not aggravating their PSD. 

Many women find aqua aerobics both fun and helpful in relieving their pain. 

Additionally, specific strengthening exercises should form part of any comprehensive treatment program. Ideally, you should have exercises prescribed specifically to you by a suitably qualified health care professional. 

Overall, exercise is a key component of managing all areas of musculoskeletal pain. The key is to perform the right type of exercise for your specific condition. 

Things to avoid with Pubic Symphysis Diastasis:

The “golden rule” with Pubic Symphysis Diastasis is to try to keep your knees as close together as possible at all times. 

The logical conclusion of this is that you should avoid activities that separate your knees. 

Things like:

• Prolonged walking or running 
• Climbing stairs or using stepper machines 
• Cleaning tasks such as vacuuming or mopping
• Sitting cross legged on the floor
• Sexual positions with your legs spread apart

Some of these things are easily avoidable, whereas others aren’t. 

If you know that you have to complete certain tasks that will place strain on your PSD, try to stagger them out and allow sufficient rest in between where possible. 

How to sleep with PSD:

As discussed above, the best position to sleep in when you have PSD is on either side. 

If you’re still pregnant, this is generally the safest sleeping position anyway. To learn more about how to get the best possible sleep during pregnancy, read 12 Pregnancy Sleep Hacks. 

Sleeping on your side will allow your body weight to encourage the two halves of the pelvis to move together. 

Using a pregnancy pillow may help you feel more comfortable when you sleep. 

At the very least, using a small pillow in between your knees may help keep your pelvis in the best possible alignment and take the pressure off your knees.