Diastasis Symphysis Pubis During Pregnancy: When Your Pelvis Splits (2023)

Diastasis Symphysis Pubis is when your pelvis splits at your symphysis pubis (the cartilage holding your pelvis together). That split pelvis can cause intense groin pain and takes a long time to heal. There are treatments that can help though. Can you pelvis split during pregnancy? Yes, but often it is not that simple.

Diastasis Symphysis Pubis During Pregnancy: When Your Pelvis Splits (1)

Diastasis Symphysis Pubis

Diastasis basically means split (I also have a post on diastasis recti).

The Symphysis Pubis Joint is the line of cartilage at the front of your pelvis. During pregnancy, it relaxes to let a baby through, but it can relax too much and can split, leaving your muscles trying to hold your body together.

This can be known by a few names included Pubic Symphysis Dysfucntion, pubic symphysis separation, pregnancy-related pelvic girdle pain, and Pubic Symphysis Diastasis. Some people just call it SPD. It is characterized by intense pain in the pelvic area — but it’s so much more, especially in pregnant women.

Hi, I’m Hilary — many people know me as The Pregnancy Nurse 👩‍⚕️. I have been a nurse since 1997 and I have 20 years of OB nursing experience, I am also the curly head behind this website Pulling Curls and The Online Prenatal Class for Couples. 🩺​ Besides my own pelvis splitting during pregnancy, I have seen hundreds of other patients who have a serious dysfunction that affects their lives. So, let’s talk about what you can do.

Oh, and if you’d ilke for me to follow you through your pregnancy, giving you helpful advice for the spot you’re at — join here:

If you’re looking for lots of information on your pelvis splitting — check out this podcast I did with a physical therapist on the subject (SO MUCH GOOD INFO!):

Split Pelvis during Pregnancy

At the age of 28 I had a nine pound baby. My previous one had been a pound and a half smaller than him. I thought I was going to have to push for the rest of my life to get him out. When he did come out, I noticed that things were “off” with my hips (and hips don’t lie).

My tailbone hurt like CRAZY when I was sitting. Even after he was a few months old, I was having SO much pain while sitting. It never even occurred to me that it was my pubis symphysis (at least not initially).

I kept thinking it would heal, but itdidn’t seem to be healing at all.

Church was miserable. For YEARS!

During that same time frame, I was trying to get pregnant — for about 4 years.

When I did — the tailbone pain came back with a vengeance. But, the further along in my pregnancy I noticed that things felt really “unstable” and that putting pants on was putting me to almost a 10 on the pain scale. There were sometimes tears shed over that daily task.

I also have a whole post that talks about how to relieve pelvic pain. I also have a post if you’re 38 weeks and the pelvic pain makes it so you can’t walk.

Symptoms ofDiastasis Symphysis Pubis or Dysfunctional Symphysis Pubis

I started to notice other things — there are a few symptoms of SPD

  • A weird “electric” feeling pain in the middle of my pelvis (which I knew was my symphysis pubis).
  • A nerve pain that ran down the inner part of my thigh (I had always felt sciatic pain run down the back of my thigh, and this felt weird — more “electric”)
  • If I rotated my hips (like a hula hoop motion) things just started to feel more and more off in my pelvic region
  • Difficulty walking and putting pants on (lifting one leg)
  • Stairs were hard and pushing beds at work was getting more and more painful.
  • You can have tailbone, low back pain and also pelvic girdle pain — sometimes it would be categorized as “severe pain”

I talked to my doctor about it pretty frequently, and I actually finally stopped working at around 30 weeks of pregnancy, just because the pains were so bad.

Because the majority of the pain was in my tailbone area, I never really thought of it being my symphysis pubis — or really anything related to the pelvic bones. In fact, I even visited a physical therapist (because I also had a weird pain on my rib — which she finally diagnosed as scoliosis related to pregnancy — although I think it may have been from the symphysis pubis) after I was off work. In fact, no one ever mentioned it.

Pro Tip: Your tailbone extends from your sacroiliac joints — which is also where your pelvis can bend and flex during pregnancy — so, it makes sense that it could shift and be painful!

The other hard thing about this is that your provider will likely not find anything on physical examination. It is mostly the act of lifting one leg up that causes the pain (but no pain with pressure per se)

Not one.

After that baby was born I was MISERABLE. The shooting pains on my pelvis got worse and worse. I went back to work after 6 weeks (I split my maternity leave since my husband was off for the summer) and after my shifts, I was SO miserable. Much worse than regular days — which didn’t really make sense.

I had a friend who worked for a chiropractor, and she gave me a pelvic girdle belt. That started to help a lot at work (mainly because scrubs weren’t tight enough to keep my pelvis together). I was finally not dying. It gives some external support to the pelvis (because my muscles weren’t ready). This was the first thing that gave me any significant improvement.

BTW, if you’re still pregnant check out some belly straps that might help.

BTW, I wish I’d just GONE to a chiropractor. One who is certified in the Webster method, like the one that came on my podcast.

My doctor sent me to a different physical therapist, who thought it was all due to my vagina and had me doing weird exercises and she was adjusting me in weird ways. Finally, I just got grossed out enough, and things weren’t helping at all — I finally quit.

I saw a neurological pain doctor who gave me a steroid shot in my sacrum (which they do under fluoroscopy). The first one worked pretty well, but the second one didn’t work at all — the pain was still there.

I then went to a chiropractor and did a bunch of session with him (dropping huge amounts of money) and that wasn’t helping at all either.

Finally — thanks to the internet, I realized that tailbone pain after pregnancy is VERY often caused by SPD.

I also noticed that when I did yoga (especially down dog — stretching out my glutes) that the tailbone pain stopped for a bit. Also, during all of this my plantar fasciitis was horrible. in the mornings I could barely walk (don’t miss my full post on ankle pain in pregnancy).

After a long time of stretching and working on my plantar fasciitis, the tailbone pain started to resolve. About the time that P turned 2 we moved to Arizona, and I was FINALLY able to sit in the car for long periods without crying. BTW, I have a great post on heel pain during pregnancy you might like too.

However, she’s turning 8 next month and I still have it flare up every now and then, especially around my period I’ll get that extra boost of relaxin in my bloodstream and I’ll feel the twinges.

Symphysis Pubis Dysfunction is when your pelvis relaxes a lot (so hasn’t split entirely) — which is what I think I had.

But, even though my pelvis didn’t entirely split, it was still extremely painful.

If you’re looking for ways to understand pregnancy, and communicate with your healthcare team better, I recommend The Online Prenatal Class for Couples. You’re guaranteed to understand more about your pregnancy journey, and be more prepared for delivery!

I also have a full post on if you’re experiencing hip pain early in pregnancy and one on just general hip pain during preganancy.

Groin Pain in Pregnancy

It is easier to pull a groin muscle when you’re pregnant because of your changing center of balance and “loose” hips.

However, it can also be your groin muscles & pelvic ligaments trying to hold your pelvis together — which it was in my case. It feels different than a pull (although still very painful). So, it’s something to keep an eye on. Usually, a pelvic support belt helps that groin pain a lot (vs if you pulled a muscle, the belt won’t help). Some people may even find the pain extends into their upper thighs as well.

FAQ’s about Groin/Pubic Pain in Pregnancy

Is groin pain normal in pregnancy?

Yes, it totally is. As your hips relax, those muscles get stretched and can hurt.

Why does my pubic area hurt during pregnancy

It is NORMAL for your pubic symphysis to expand a bit during pregnancy. Many women have SOME pain in that area, but if you find that it’s hurting your normal daily activities, I’d talk to your health professionals.

As I said above — it hurts because of the hormone relaxin, which is allowing that symphysis pubis to expand and the muscles/ligaments around there are stretching.

Why does my inner thigh hurt while pregnant?

Besides actually pulling a groin muscle, if your pelvis twists as it separates it can make your inner thigh hurt a LOT.

Again, small amounts or bouts of pain are normal. I’d recommend using a pillow between your legs while you sleep to help with this. But, if it’s impinging your ability to lift your legs or function in regular activities, talk with your doctor — a pelvic support girdle might help!

How do you relieve pregnancy groin pain:

  • You can use LIGHT heat (nothing much more than “warm” as the baby is very close to your pelvis) >> I have a whole post on heating pads in pregnancy.
  • Use a pillow between your legs when you’re laying on your side.
  • Use a pelvic girdle after discussing it with your doctor.

What Causes Symphysis Pubis Dysfunction:

Pregnancy seems to be the main thing that causes it — but there are other risk factors:

  • Overweight (my 3rd pregnancy found me lighter than I was during my 2nd) or heavy weight gain.
  • If your baby is super low (called a low station) — and my baby was HIGH, so these aren’t always true.

The two sides of your pelvis are held together by a small band of cartilage — during pregnancy, your body releases a hormone called Relaxin that helps that tissue relax (and can also help your baby come out more easily).

The pelvic joints do have some flex normally, but during pregnancy it allows it to stretch a lot more.

It’s like a separation of the joint without a fracture. It’s a fairly rare complication (although I think it’s not reported and most doctors ignore it as regular postpartum pain).

It helped me to think of it more as a dislocation of that joint — it allows extra movement in those areas. It sometimes causes pain in your lower back and sides (as your body tries to keep it together).

Symphysis Pubis Dysfunction Treatment

  • Go to a physical therapist that can give you exercises unique to your situation. This isn’t something that most obstetricians are trained to help in (which is good, we all need to know our specialties).
  • Talk to your doctor — they might recommend a lower pelvic support.
  • Doing Kegels and pelvic tilts will help to strengthen your pelvic girdle — the muscles surrounding your pelvis.
  • You can’t actually strengthen the tissues that hold your pelvis together. That is what it is (but you can strengthen the muscles surrounding the tissues).
  • If some women have it bad enough, they’ll do a cesarean section, rather than have women push and possibly have the head bump it and hurt it further.
  • Bed rest and trying to not spread your legs as much as possible.
  • Put on your birth plan that you’d like to watch your pelvic joint and only pull your knees apart if very necessary (like for a shoulder dystocia).

Exstrophy of the Bladder

Along with your pelvis having issues, it sometimes doesn’t support your abdominal walls and you can have issues with your bladder. This can lead to incontinence.

Pubis Symphysis After delivery

A lot of women heal pretty quickly after delivery because that hormone isn’t being secreted any longer.

There is no reason to muscle through the pain — you aren’t strengthening anything. Some women even find a walker very helpful.

If you’re still hurting after a few weeks, definitely talk to your doctor. In fact, if it’s still hurting at your check-up with your provider, I’d ask for a PT consult — to discuss treatment options and to help strengthen your pelvic floor muscles.

Continue to wear your pelvic girdle (although, you are also going to have to strengthen your own muscles — so you can’t rely on that forever) — also, tight pants often took the place of the girdle.

Ask to see a physical therapist.

Sometimes there are people who specialize in this, so definitely ask around.

When I asked around, most doctors just said it would take a lot of time to heal.

And it sure did. It could have taken MUCH less time if I had seen a physical therapist who was trained in how to help.

Some doctors will order an MRI scan, although it may show you what degree the bones are separated, the symptoms are much more conclusive than that test.

I just wish that I had known more about it when I was pregnant. Not a single doctor mentioned it — and I work in labor and delivery! Early diagnosis would have made it SO much easier to treat and cope with.

The good news is that there are a LOT of trained professionals that can help!

**IF you are in extreme pain find someone that can help you. Keep pushing until you find that person.

I have a list of 5 things you can do to help your pelvic pain. I hope they help you! It’s certainly not fun!

NOW is the time to get prepared for your upcoming birth. Check-out this online prenatal class for couples that can get you prepared in just a few hours!

And, if you’re looking for more information on SPD, here are a few other smart articles I found about it:

Alright, now that you’ve figured that out — let me help you have your confident birth!





What is a split pelvis during pregnancy? ›

Diastasis symphysis pubis (DSP) means that the pubic joint is separated too far. The space between the pelvic bones normally widens about 2 to 3 millimeters (mm) during pregnancy, but sometimes it widens even further and becomes unstable. DSP is when the joint opens more than 10 mm.

Can your pelvic bone split in pregnancy? ›

Separated pubic symphysis

This is called the pubic symphysis, or symphysis pubis. As the pelvic bones loosen during pregnancy, the pubic symphysis can temporarily separate. This is not a dangerous condition. But it can be painful.

Why does it feel like my pelvis is splitting while pregnant? ›

During pregnancy a hormone called Relaxin loosens the ligaments in the pelvis causing the pelvic bones to lose some of their stability and become misaligned. SPD is not harmful to your baby, but it can cause severe pain around your pelvic area.

What is a full pelvic split? ›

A pubic symphysis separation or diastasis symphysis pubis is the separation of the pubic bones. The pubic symphysis joint is comprised of the 2 pubic bones and a cartilage disc that sits in between the two pubic bones. With a separation or diastasis, the pubic joint dislocates without a fracture.

How do you fix separated pubic symphysis? ›

How is it Treated? Standard treatment of pubic symphysis separation is conservative: bedrest in the side position, pelvic support with a brace or girdle, walking with a walker or crutches, and a graded exercise protocol. Safe options for analgesia antepartum are more limited than after delivery.

What does pelvic separation feel like? ›

You may feel: Mild discomfort. Sudden, shooting pain coming from the front or back of your pelvis. Steady pain that radiates throughout your lower abdomen, back, groin, perineum (the space between your anus and vulva), thigh and leg.

Can SPD cause permanent damage? ›

The weight of both uterus and baby can press on the weak area and cause an excess separation of the pubic arch. When pushing in this position, your baby's head can also put pressure on the area from the inside. Squatting with SPD can lead to long-term or permanent pain and damage.

How can I open my pelvis during pregnancy? ›

Coming into a wide leg squat position helps open the pelvis, and gravity will naturally promote lengthening in the pelvic floor. This is best performed as a repetitive exercise instead of a position that is held. Step your feet wider then your hips, with your feet angled out slightly.

How can I relax my pelvis during pregnancy? ›

Positions such as hands and knees or side-lying put the pelvic floor in a more relaxed position and are associated with less of a risk of tearing (not a zero risk!). Try practicing relaxing your pelvic floor in these positions, as well as other common positions such as on your back or in a supported squat.

How can I realign my pelvis while pregnant? ›

Chiropractic care throughout pregnancy is a safe and effective way to balance pelvic misalignments. Doctors who are certified in the Webster technique use gentle and specific adjustments to realign the pelvis and restore function to the nerves, muscles, and ligaments associated with pregnancy and birth.

What is severe SPD pain in pregnancy? ›

Some women may develop pelvic pain in pregnancy. This is sometimes called pregnancy-related pelvic girdle pain (PGP) or symphysis pubis dysfunction (SPD). PGP is a collection of uncomfortable symptoms caused by a stiffness of your pelvic joints or the joints moving unevenly at either the back or front of your pelvis.

What are the complications of pubic symphysis diastasis? ›

Reported complications from pubic symphysis separation during pregnancy are rare. Urinary outflow obstruction, hematoma formation, and sustained painful ambulation are the most common complaints in case studies. Venous thrombus embolism is also reported and likely attributable to prolonged immobilization.

Do you need surgery for a cracked pelvis? ›

Pelvic fractures are an uncommon type of fracture that can range from mild to severe. While mild pelvic fractures usually don't require surgery, severe fractures have to be fixed with surgery.

Can you give birth naturally with symphysis pubis dysfunction? ›

“SPD can add additional pain to delivery but doesn't necessarily guarantee that the delivery will be more difficult. Many, many women with SPD have very successful vaginal deliveries.

Does SPD require bed rest? ›

The symptoms:

This is called symphyseal separation or diastasis of the symphysis pubis and can be acutely painful. Bed rest and heat are usually prescribed to manage this, with orthopaedic and physiotherapy assessments required.

Is pubic symphysis curable? ›

Is pubic symphysis pain treatable? Yes! There are a number of at-home treatment options including rest, bracing, and following self-help tips. Many people with pubic symphysis joint pain in pregnancy also benefit from physical therapy, massage therapy, acupuncture, or chiropractic care.

Can SPD cause early labor? ›

SPD doesn't directly impact your baby and whilst it may cause your labour to be a little more difficult, specifically if you're having a vaginal delivery, it isn't known to cause early labour.

Does SPD affect delivery? ›

SPD doesn't directly affect your baby, but it may lead to a more difficult pregnancy due to reduced mobility. Some women may also have difficulty having a vaginal delivery. Symptoms of SPD often reduce after giving birth. Talk to your doctor if your symptoms still don't improve.

How do you get out of bed with SPD? ›

Lie down on your side and keep your knees together or squeeze a pillow between them as you bring both legs onto the bed. Same for getting out of bed. Remember to stay symmetrical with SPD in pregnancy. Activities that separate the knees should be avoided.

Can a chiropractor help with SPD in pregnancy? ›

Most women who receive chiropractic care for SPD, either after or before giving birth will experience pain relief, especially if the cause of the pain is pelvic misalignment. Chiropractic for pelvic pain aims to address the main cause of the complications rather than merely addressing the symptoms.

Can SPD affect your hips? ›

Symptoms of PGP/SPD in Pregnancy

Lower back pain. Pain in the hips, groin, thighs or knees. A clicking or grinding sensation in the pelvic area when you move.

What relaxes pubic symphysis? ›

BACKGROUND. Separation of the pubic symphysis can occur during the peripartum period. Relaxin (RLX) is a hormone primarily secreted by the corpus luteum that can mediate hemodynamic changes during pregnancy as well as loosen the pelvic ligaments.

What happens if you break your pubic symphysis? ›

Compression of the pubic symphysis or simultaneous compression of both anterior superior iliac spines is usually painful, particularly in severe fractures, and may indicate instability. Depending on the severity of the fracture, patients may or may not be able to walk.

Does a narrow pelvis mean C section? ›

The narrower shape of the android pelvis can make labor difficult because the baby might move more slowly through the birth canal. Some pregnant women with an android pelvis may require a C-section.

How can I open my pelvis naturally? ›

According to Brichter, sitting on an exercise or birthing ball in neutral wide-legged positions prepares the body for labor by increasing blood flow, opening the pelvis, and encouraging cervical dilation. You can also try birth ball exercises such as circular hip rotations, rocking, and gentle bouncing.

How do you release your pelvis? ›

First, take a slow, gentle breath in through your nose, and allow your belly and ribs to flare out to the sides. “Open” your pelvic floor with your inhale breath. Exhale slowly and gently through your mouth, allowing your belly to fall. Let the air out of your upper lungs, relax your ribs, belly and pelvic floor.

What is the best sleeping position for pelvic pain during pregnancy? ›

Sleeping. It might be comfortable to lie on your side with a pillow between your knees. As your pregnancy progresses, try placing an extra pillow or rolled up towel under your bump. This places less strain on your hips and lower back.

Where do you massage SPD when pregnant? ›

Technique for Prenatal Massage & SPD

An experienced prenatal massage therapist will use a firm to deep tissue massage along the upper thighs, groin, hips, glutes and low back to relax the muscles and relieve the pain. This will also help bring back flexibility and energy to the area.

Does walking strengthen pelvic floor muscles? ›

Regular gentle exercise, such as walking can also help to strengthen your pelvic floor muscles.

How long does it take to realign pelvis? ›

Some studies have found that anterior pelvic tilt can be improved in just six weeks. Though, it's essential to recognize that everyone is different. While some people may start to correct anterior pelvic tilt within a few weeks, others might require more time.

Can a chiropractor fix a misaligned pelvis? ›

A chiropractor uses specialized, pregnancy-friendly techniques to restore the pelvis back into alignment with the structure of the spine when a pelvic misalignment occurs. In addition to restoring comfort, this also restores the nervous system's ability to function properly.

Can you get an epidural with SPD? ›

Most women who've had PGP during pregnancy can have a vaginal birth . If you want to then you can still have an epidural. The key thing is to discuss it with your birth team up front.

What do doctors do for a cracked pelvis? ›

Your doctor may have put metal screws, pins, or a rod in your pelvis to fix the break. In some cases, surgery is not needed. While your pelvis heals, you will need to keep weight off the hips. Once you are able to walk, a walker or crutches can help you get around.

Can you still walk with a cracked pelvis? ›

With a broken pelvis you cannot walk, sit or move well without pain. The pelvis protects the bladder, intestines and many important blood vessels. Many of the important leg muscles and abdominal muscles attach to the pelvis and allow for body motion and function.

What can be done for a cracked pelvis? ›

Nonsurgical Treatment for Hip & Pelvic Fractures
  1. Activity Modification. After a hip or pelvic fracture, your doctor may advise you not to put any weight on the affected hip for six weeks or more. ...
  2. Electronic and Ultrasonic Bone Stimulation. ...
  3. Physical Therapy. ...
  4. Pain Medication.

How long does it take for a separated pelvis to heal? ›

Recovery After Pelvic Fracture Surgery

Most people with a broken pelvis take about 4-6 months to heal. If anatomic alignment was achieved at surgery and no complications occur, patients are able to return to prior activities and function. By six weeks, patients are fairly comfortable.

Does SPD cause early labor? ›

SPD doesn't directly impact your baby and whilst it may cause your labour to be a little more difficult, specifically if you're having a vaginal delivery, it isn't known to cause early labour.

Does SPD get worse before labor? ›

You may experience the symptoms of SPD long before it's time to give birth. The baby's weight and position are also thought to affect pelvic pain. The symptoms of SPD tend to worsen as the pregnancy progresses. It's much less common for SPD to occur outside of pregnancy, but it does happen.

How common is it to break your pelvis during birth? ›

Conclusion: Pelvic ring fracture is a rare occurrence during childbirth. The mechanism involves hormonally mediated ligamentous laxity of the pelvis combined with the forceful movement of the fetal head.

Can SPD cause long term damage? ›

Over time, untreated SPD may contribute to additional pelvic issues such as urinary incontinence, pelvic organ prolapses, chronic pelvic pain, diastasis recti (abdominal muscle separation), and low back/hip pain.

What does the start of SPD feel like? ›

According to Lamppa, SPD symptoms usually include “pain or tenderness felt in the front of the pubic bone that can also radiate to the hips and other areas of the pelvis.” It usually gets worse with certain movements and can “come on suddenly and be excruciating,” like when you're trying to get out of bed or walking up ...

What is the best position to give birth with SPD? ›

It is recommended that women with Symphysis Pubis Dysfunction give birth in an upright position with knees slightly apart. Another option is the all-fours position, keeping the knees close together. A waterbirth may be preferable as water allows buoyancy that can support the joints.

What is the best way to sleep with SPD? ›

What are the best sleeping positions for SPD? To sleep with SPD, sleep on your side with a pillow between your knees and your knees and ankles in alignment. When you roll over in bed, squeeze the pillow between your knees to roll. You can wear the Serola belt at nighttime if you have pain.

What are the risks of SPD? ›

SPD Risk Factors During Pregnancy

Anyone can develop SPD, but certain factors increase your risk. According to Dr. Hill, these include prior injury to the pelvis, having a large baby, a history of symphysis pubis dysfunction, and excessive weight gain.

Is walking good for fractured pelvis? ›

While your pelvis heals, you will need to keep weight off the hips. Once you are able to walk, a walker or crutches can help you get around. You can help your pelvis heal with care at home. Your doctor may prescribe medicine to relieve pain and prevent blood clots.

Can your pelvis be too small for childbirth? ›

pelvic abnormalities: Some women have a pelvis that causes the baby to turn when approaching the birth canal. Or the pelvis can be too narrow to deliver the baby. Your doctor will assess your pelvis early in the pregnancy to check if you're at risk for birth canal issues.

Can you break your pubic symphysis? ›

Pelvic fractures can involve the pubic symphysis, innominate bones, acetabulum, sacroiliac joint or sacrum. They range from minimally displaced stable injuries caused by low energy falls to dramatically displaced and unstable injures that can cause massive hemorrhage.


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