Does your pubic area swell when pregnant?

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Gray scale and colour Doppler ultrasonography (US) reveals dilated, tortuous channels (white arrows) at the left inguinal region (a, b).

Click on the image to see a larger version.

Pubic bone pain during pregnancy is fairly common. In later pregnancy, the hormone relaxin causes the pelvis to loosen, particularly at the pubic bone. In general, this is a good thing: It makes birth easier for parent and baby. However, sometimes this loosening is exaggerated. This can be quite painful and can persist in the early postpartum period.

When there is too much laxity in a joint, there can be instability and pain. Most of the pain is centered upfront in the pubic bone area, above the mons pubis (below pubic hair). Certain movements can be painful, including getting out of bed, getting into the bathtub or car, putting on pants, sitting for long stretches, or performing repetitive tasks.

You may also note some swelling in the area of your pubic bone and experience waddling in the way you walk or notice that your legs don't quite come together. You may notice that you can feel or hear a clicking noise when walking or moving your legs. Your doctor or midwife can help you best understand your symptoms.

The waddle often associated with pregnancy is also often a result of the relaxing and loosening of the pelvic ligaments.

The term for instability in the pelvic area is symphisis pubis dysfunction (SPD; also called symphisis pubis diastastis or pelvic girgle pain). It happens because of the way relaxin loosens joints and ligaments throughout the body. There's also increased pressure on the pelvis and pubic bone during pregnancy because of the weight of the uterus.

You may be more likely to experience pubic bone pain if you are carrying multiples, if this is not your first baby, or if you have a very large baby. Having SPD in a prior pregnancy is also a risk factor.

Because X-rays are not recommended during pregnancy, your practitioner may order an ultrasound. The ultrasound can look at the space between the bones of the pelvis. It is more common, however, to make a diagnosis based on your symptoms alone. If you have already had your baby and you are still having pain, an X-ray is the best diagnostic test available.

SPD is usually relieved once you have your baby. In the meantime, there are some treatments available to reduce discomfort during pregnancy.

Stabilize your pelvis as much as you can via a pregnancy/maternity binder, which can help to relieve back pain as well. You may also try using a rebozo Mexican shawl. Studies suggest that a flexible belt or binder works better than a rigid one. This can also help you prevent further injury from having a less stable pelvis.

Ask your doctor or midwife about these treatments. They may help in the long term. While they may be time-intensive, many say it's worth it. Ask your therapist or acupuncturist for advice on what you can do at home in between visits.

Avoid situations that cause pain. For example, sit down to put pants on, or sit on the side of the tub and swing both legs over together.

It is also best to avoid standing for long periods of time. If you must stand, wear comfortable shoes and try to move around, even if this means you simply shift from foot to foot every so often. You can also use a small stool or box to prop one foot up as you stand.

Certain forms of exercise can help reduce pain. Ask your doctor, midwife, or physical therapist for moves you can do. The buoyancy involved in swimming, for example, can provide pain relief.

Occasionally, pain medication is appropriate. However, this should be done under the supervision of a doctor, as some painkillers are not safe during pregnancy and breastfeeding, and some medicines should not be taken later in pregnancy.

The good news is that shortly after delivery you should be feeling much better, as the production of relaxin stops. If you do not feel notably better after a few weeks, ask your practitioner for additional screening. You may need to add additional therapies, like physical therapy, to help build muscle strength in the pubic bone area.

Pubic bone pain during pregnancy can be quite uncomfortable and make basic tasks feel more difficult. A healthcare provider can help you make a plan to minimize pain. Most of the time this will involve lifestyle adjustments and waiting until the baby is born. However, there are some treatments that can help lessen pelvic discomfort.