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SPD during pregnancy

What is SPD?

Symphysis pubis dysfunction, or SPD, is pelvic pain, most commonly found during pregnancy, that is recognized by symptoms such as difficulty urinating or incontinence, shooting pains in the pubis, grinding or clicking in the pubis, pain with everyday activities including walking, lifting small children, walking up or down stairs, and/or turning over in bed. A waddling gait can be indicative of SPD as well as frequent UTI’s or suprapubic (area above the pubic bone) swelling. During pregnancy, hormones are released in order to loosen joints and create room for the baby to move through the pelvis for birth. For over 30% of pregnant women, an overproduction of hormones can lead to SPD. SPD can also present in arthritic patients and people with pelvic injuries. Factors that can contribute to SPD include obesity, family genetics, muscle weakness (specifically pelvic floor weakness), high stress levels, rapid weight gain or loss, back or pelvic injury, hypermobility, hyperlaxity of joints, SPD in previous pregnancies, and hip dysplasia. Some cases of symphysis pubis dysfunction are severe enough to cause the pregnant person to be bedridden throughout pregnancy in order to rest the joints and muscles.

What to do if I have SPD?

SPD can be diagnosed in several ways. Speak to your medical provider if you suspect you have symphysis pubis dysfunction. Ways to diagnose SPD can include palpitating for tenderness over pubis or sacroiliac joints and checking for suprapubic swelling. Your medical provider might refer you to a physical therapist specializing in pelvic floor therapy to further diagnose and treat SPD.

SPD can be managed through physical therapy with a pelvic floor specialist. Treatment plans can include strengthening of the pelvic floor, glutes, thighs, and stomach muscles. The physical therapist might also give education on how far to spread your legs during pelvic exams and the pushing stage of birth. Working with a doula who is experienced with SPD can help build a birth plan that includes labor techniques that keep the pelvis active and engaged while not stressing the pelvic region as it opens further during labor.

If you have SPD, it is important to stay aware of your mental health during pregnancy. The pain of SPD can lead to self isolation and depression or irritability. Additionally, the pain of SPD can cause you to change your stance or walking habits to try to relieve the pain which can lead to strain put on other joints such as hips or knees and cause further pain. A physical therapist or sports therapy massage therapist can help you keep your functional movement as aligned as possible to reduce additional joint and muscle strain throughout pregnancy. Chiropractic care can also help keep your hips and pelvis aligned as they loosen and shift throughout pregnancy.

Seeing a physical therapist or sports massage therapist can seem daunting and make you question what does sports therapy have to do with being pregnant. Both physical therapists and sports massage therapists are orthopedic experts on functional body movements. They will be best suited to giving you education and exercises to support and strengthen your body as the joints and muscles relax to accommodate birth.

About the author:

Alexandra (Alex) Gonsor is a labor and postpartum doula working in South Carolina and Georgia. She works closely with a pelvic floor physical therapist in her community to provide a full range of knowledge and support to her clients from pregnancy through postpartum years. Alex is passionate about supporting her community with biweekly support groups and scholarships for her doula services for low income families. She has been supporting new families and pregnant people for 16 years in Texas, California, South Carolina, and Georgia. Alex is available for doula and postpartum support, building birth plans, breastfeeding support, in home consulting for optimal newborn care flow, and remote doula care. Click here to request a free consultation.


Howell, E. (2012). Pregnancy-related symphysis pubis dysfunction management and postpartum rehabilitation: two case reports. [online] PubMed Central (PMC). Available at: (2020). Symphysis pubis dysfunction: Treatment and symptoms. [online] Available at:

Healthline. (2018). What Is Symphysis Pubis Dysfunction?. [online] Available at:

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