Diastasis of the pubic symphysis

Separation of the pubic symphysis (Latin: diastasis symphysis pubis) is a pathological condition involving excessive widening of the surfaces of the pubic symphysis – the structure that connects the two pubic bones at the front of the pelvis. Physiologically, during pregnancy there is a slight relaxation of this area under the influence of hormones, mainly relaxin, which enables the pelvis to adapt for childbirth. A separation is considered pathological when the width of the symphyseal gap exceeds values regarded as normal (usually >10 mm), which leads to pain, pelvic instability and limitation of motor function.

Separation of the pubic symphysis – causes

The etiology of pubic symphysis diastasis is multifactorial and includes biomechanical, hormonal, and traumatic factors. During pregnancy, hormonal changes play a key role, especially an increase in the levels of relaxin and progesterone, which cause relaxation of the pelvic ligaments.

The most important causes include:

pregnancy and vaginal delivery – especially rapid deliveries and those involving instruments (forceps, vacuum extractor),
large fetal weight (macrosomia),
multiple pregnancy,
excessive joint mobility (hypermobility),
mechanical pelvic injuries (e.g., traffic accidents),
previous damage to pelvic structures,
insufficiency of muscles stabilizing the pelvis, including the pelvic floor muscles and the transversus abdominis.

An important risk factor is also the lack of proper central (so-called core) stabilization, which leads to overload of the ligamentous structures and increases susceptibility to pathological separation of the symphysis.

Separation of the pubic symphysis – symptoms

Symptoms of pubic symphysis separation are both pain-related and functional. They most commonly occur in the area of the pubic symphysis, the groins, and may also radiate to the inner surfaces of the thighs or the lower back.

Typical symptoms include:

pain in the front of the pelvis, worsening during walking, standing up or changing position,
a feeling of pelvic instability ("bones moving apart"),
difficulty walking, a characteristic waddling gait,
pain when lifting one leg (e.g. while dressing),
limited mobility in the hip joints,
clicking or catching in the area of the pubic symphysis.

In advanced cases the patient may experience significant mobility limitation, and even an inability to move independently. These symptoms significantly affect quality of life and functioning during the peripartum period.

Separation of the pubic symphysis – how to treat

Treatment depends on the degree of separation and the severity of symptoms. In most cases conservative treatment is used, aimed at pelvic stabilization and pain reduction.

Basic treatment methods include:

urogynecological physiotherapy – individually tailored exercises strengthening the pelvic floor muscles and deep abdominal muscles,
manual therapy – techniques reducing tension and improving pelvic biomechanics,
use of pelvic support belts,
movement education – learning safe movement patterns (e.g., rising, walking),
analgesic pharmacotherapy (according to the physician's recommendations).

In severe cases, when the separation exceeds significant values and is accompanied by structural instability, surgical treatment aimed at stabilizing the pubic symphysis is considered.

Contemporary therapeutic approach also includes:

work on central (core) stabilization,
breathing re-education affecting intra-abdominal pressure,
fascial therapy improving tensions within the pelvic area.

Pubic symphysis separation – when to see a specialist

A specialist consultation is recommended in any case of suspected diastasis of the pubic symphysis, especially when symptoms interfere with daily functioning. Early diagnosis allows for the implementation of effective treatment and prevention of complications.

You should see a doctor or physiotherapist if you experience:

severe pubic symphysis pain, persistent or worsening,
difficulties walking or standing up,
a feeling of pelvic instability,
no improvement after childbirth,
pain preventing caregiving for the child.

Diagnosis includes a clinical examination and – if necessary – imaging tests such as ultrasound (US) or X-ray (after pregnancy).

In clinical practice, interdisciplinary collaboration is important, involving a gynecologist, an orthopedist and a urogynecological physiotherapist. This approach enables comprehensive treatment and speeds the patient's return to full function.