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6 steps to managing pelvic pain in pregnancy

It is common for expectant mothers to experience acute pain in the front of the pelvis — this is where the pubis symphysis is located. Pubis symphysis pain is also known as symphysis pubis dysfunction, and is localised to the pubic and pelvic areas.

what is pubis symphysis
Pregnancy problem: pubis symphysis pain

The pubis symphysis is a cartilage that functions as a joint to connect the illium plates in the front. As it holds the pelvis together in the front, it is thus essential for maintaining a stable platform for weight transfer from one leg to the other.

Symptoms of pubis symphysis pain include difficulty walking or any activity that involves bearing weight, such as climbing stairs, alighting from a vehicle, or even turning the body over while lying down.

Pubis symphysis

What causes pubis symphysis pain?

Similar to posterior pelvic pain, the culprit is the hormone relaxin, which causes ligaments in the pelvis to lax during pregnancy as the body prepares for childbirth. Resultantly, the space in the pubis symphysis widens, causing instability.

Another reason for this is the partial dislocation or subluxation of the pubis, which consequently weakens stability as well.

Why does the pubis symphysis hurt?

The abdominal muscles, including the core transverse abdominus, inevitably stretches during pregnancy, weakening stability. Resultantly, the adductor muscles in the inner thighs, which are connected to the pubis, work overtime to provide much-needed stability.

This overcompensation can lead to tight adductor muscles, further pulling the loosened pubis symphysis downwards. Our principal physiotherapist, Sylvia shares some dos and don’ts to manage and prevent pubis symphysis pain.

Dos to prevent pubis symphysis pain

Posterior Pelvic tilt

Don’ts to prevent pubis symphysis pain

  • Do not perform butterfly exercises, as they involve the expansion of the pubis symphysis.
  • Do not stretch your adductor muscles.
  • Do not alight from a vehicle with your legs apart as this action will facilitate the downward pull of the pubis symphysis. Instead, keep both legs together while getting out of a vehicle.

Physiotherapy treatment

Similar treatment to posterior pelvic pain will be applied to alleviate pubis symphysis pain, as it involves the same muscles. A certified physiotherapist will guide you on awareness and activation of the correct muscles, namely the transverse abdominus and other abdominal muscles.

The key in physiotherapy in treating pubis symphysis pain is to strengthen these muscles in order to minimise pain and discomfort in the pelvic and pubic area, and it pays to begin treatment early in your pregnancy.


  1. Depledge, J., McNair, P. J., Keal-Smith, C., & Williams, M. (2005). Management of symphysis pubis dysfunction during pregnancy using exercise and pelvic support belts. Physical Therapy, 85(12), 1290-1300.
  2. Bastiaanssen, J. M., de Bie, R. A., Bastiaenen, C. H., Essed, G. G., & van den Brandt, P. A. (2005). A historical perspective on pregnancy-related low back and/or pelvic girdle pain. European Journal of Obstetrics & Gynecology and Reproductive Biology, 120(1), 3-14.
  3. Houghton, P. H. I. L. I. P. (1975). The bony imprint of pregnancy. Bulletin of the New York Academy of Medicine, 51(5), 655.
  4. Jain, S., Eedarapalli, P., Jamjute, P., & Sawdy, R. (2006). Symphysis pubis dysfunction: a practical approach to management. The Obstetrician & Gynaecologist, 8(3), 153-158.
  5. Calguneri, M., Bird, H. A., & Wright, V. (1982). Changes in joint laxity occurring during pregnancy. Annals of the rheumatic diseases, 41(2), 126-128.

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