Severe Pelvic Pain: Pubic Symphysis Separation?

Seven weeks ago, at 12 weeks, I began having severe pelvic pain. At the end of my last pregnancy, I had similar pain. It started out feeling like a bladder infection, but neither my doctor nor a urologist could find any problems. The pain continues to get worse. The pain is more severe after I urinate. I have 21 more weeks to go and a very active toddler who needs his mom.


Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

I am so sorry that this pain has intruded upon your pregnancy and your life. Such pain is never normal, and my initial advice is to seek another opinion until you find our what is wrong. Despite the fact that your own doctors sound supportive, I think you need to seek further care. Several things come to mind right away when I imagine the type of pain you are describing.

Pubic symphysis separation is a recognized complication of pregnancy with incidence estimates ranging from one in 300 to one in 30,000. Characteristic symptoms of symphyseal separation include suprapubic pain and tenderness with radiation to the back of legs, difficulty ambulating and, occasionally, bladder dysfunction. A diagnosis can often be made on the basis of clinical history, presenting symptoms but sometimes x-ray or ultrasound documentation of symphyseal separation are frequently used to confirm the diagnosis. We don't really understand the cause of this condition. We do know it is associated with two or more children, large babies and an abnormal loosening of the joints typical of pregnancy. We tend to treat this condition conservatively with bedrest, pelvic binders, ambulation devices and mild analgesics.

Bladder or ureter stones are another possibility. Ultrasound is used to view any residual urine left in the bladder after voiding and is able to detect renal and bladder calculi better than plain x-ray. Ultrasound will probably miss stones in the ureter, but this is an uncommon condition.

Interstitial cystitis is another painful condition of the bladder, which causes a burning pain over the bladder area. Urine analysis may reveal mast cells in this condition but their significance is debated. Some studies have reported greater numbers of these cells in the detrusor muscle of patients with interstitial cystitis than in normal detrusor muscle.

My last differential diagnosis is intrauterine synechiae or adhesions. Some scar tissue forms in the uterus spontaneously or as a result of infection or some types of procedures. These can be detected with ultrasound as well. They should also check for ovarian torsion and adenomyosis.

You've probably had one or more ultrasounds, but if they were looking specifically for one of these, it would reveal an abnormality.

I would recommend that you also seek a consultation with a perinatolgist. Such a specialist would have more ideas and approaches to your pain. If nothing is found, the use of analgesics or transcutaneous electronic nerve stimulation might help (TENS). Also I would readily suggest some complementary therapy regimens such as acupuncture or acupressure.

An MRI of your spine and lower back might be a good idea but it may be a long shot. Some back problems, such as herniated disk, may cause such pain.

And make sure you have been checked for beta strep infection. Also, such pain and anxiety have the potential to cause preterm labor -- so make sure you are checked for this on a regular basis.

I certainly wish you the best with this and hope you are able to get some relief. Please let us know how you are doing.

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