Causes, treatment, prevention pain in the hip joint and pelvic bones during pregnancy

A Sore pelvis in pregnancy and discomfort amplified with every movement? Don't worry, as a rule, this is another manifestation of pregnancy or hormonal shifts that accompanied it. After all, it is during carrying a child for 40 weeks, the mother's body is experiencing a huge load and activate specific mechanisms of adaptation.

hormonal Changes allow your body to completely change to meet the needs of the fetus and maintenance of all organs and systems of the mother. The hormones affect the organs and tissues to prepare them for the birth, but for various reasons, causing negative manifestations in the form of discomfort and pain in the pelvic bones.

In Addition to hormonal changes, of great importance in the development of pain in the pelvic area and back has weight gain women and changing the center of gravity in the last two trimesters.

This problem becomes relevant, because the pelvic and low back pain before labor in recent years, complain of 20 to 40% of pregnant women. Most often, the discomfort occurs in the late stages – with 26 to 30 weeks of pregnancy (end of second beginning of third trimester). Let's see why pain occurs and how long it lasts?

hormonal Changes

The Important point is that in different periods of pregnancy, the actions of some hormones are more pronounced, in others less. Consider the mechanism of action of hormones that affect pregnancy, and their changes according to each trimester of pregnancy.

the Impact of hormones on the ligaments of the pelvis

1. Action of hormones in norm.

It is Assumed that the main role in the change of ligaments in the area of pubic and ilio-sacral joints relaxin plays (there are many studies that show that there are still other factors, in addition to this hormone, affecting the development of dysfunction of the joints in the pelvis). The peak concentration in the blood is found before birth in the later time – in the middle and at the end of the third trimester (28 to 40 weeks).

It prepares the pelvic bone of the mother for childbirth due to the weakening of the ligamentous apparatus of the pelvic floor and joints, which gives the opportunity for greater mobility of bones. This protects the baby's head from unnecessary trauma during childbirth, as the pelvic bones diverge at the time of her passing. It affects fibrous-cartilaginous disk that lies between the pubic bone in the pubic area, and on interosseous, dorsal and ventral sacroiliac ligaments, which are located at the iliac-sacral articulation.

2. Excessive hormone action.

The Significant influence of hormones in some cases exceeds the physiological norm and may cause excessive relaxation of the cartilaginous and ligamentous apparatus of the pelvic floor. It all leads to such consequences as rupture of the symphysis pubis. Proven that pregnant women who complained of pain in the pelvic bones to the birth for several weeks, in the blood are very high levels of relaxin compared to the rest.

If the affected pubic articulation, develops simfiza (or symphysis pubis dysfunction – DLS), with lesions of the iliac-sacral – acrolophia (or dysfunction of the sacroiliac joint – DCPS). Usually they occur simultaneously, as the hormones act systemically, in this regard, consider the clinic of these diseases together. These conditions are accompanied by persistent pain of moderate intensity. Amplified pain when pressing over the pubis and the sacrum, and the sudden change of body position, for example, when moving from a lying to a sitting position.

The Pain may be localized in the pubic, groin area, hip area and hip joint, lower back, sacrum and tailbone. Most often the maximum severity of pain syndrome in the morning and night, in the afternoon, when a woman is “at odds” with the unpleasant sensations are less pronounced. Also pain can occur during sexual intercourse with your partner. Increased fatigue and difficulty in defecation before birth are among the symptoms that many doctors may not pay attention, but they are the consequences of simpatica.

Diagnosis of pubic dysfunction and ileocekalnom of articulation

The diagnosis it is better to trust your gynecologist, just when visiting the consultation to draw the attention of a specialist to troubling symptoms.

Objective data

In Addition to the typical complaints when movements in the region of the womb, you can feel or hear crackling or crunching. Also on palpation of the symphysis is determined by the gap and found swelling in that area. Palpation of joints, usually painful. Positive can be symptoms of Trendelenburg (in 19% of patients), Lasegue, Patrick (47,5%).

Diagnostic criteria simpatica (DLS) is the difficulty or impossibility of the notion of direct legs in the supine position (approximately 8% of patients). Gait due to pain is also changing, it is called “duck”, it is characterized by very short steps. Before the birth pregnant women often complain of heaviness or inability to climb stairs and the pain worsening when bending forward or to the sides.

The Functional tests to identify dysfunction of the sacroiliac joint are:

1. Test for elasticity.
2. Sample patica.
3. Flexion test.
4. Definition of mobility.
5. pressure tests and assessment of symptom Mandela.

x-ray, MRI, ultrasound,

If sacroileitis Radiographically distinguish several stages:

• I stage – on the radiograph is determined by the vagueness of the contours of the sacroiliac joint (KPS), the slight expansion and sclerosis.
• stage II – significant KPS sclerosis of the pelvic bones,erosion, joint gap expanded unevenly and there is a characteristic “string of pearls”.
• stage III – there is a significant expansion on the background of sclerosis, multiple erosions, and gradual narrowing of the gap.
• stage IV – develop the full pathological stiffness in the joint.

Also there are three degrees of severity of simpatica (L. V. Vanina, 1954; L. S. Persianinov, 1964) depending on the magnitude of the divergence of the pubic bone (according to interoperabiltiy):

• grade I – the extension from 5 to 10 mm;
• grade II – from 10 to 19 mm;
• grade III – more than 20 mm.

The Rest of the laboratory and instrumental research data required for the survey will not give.

Treatment of pain

The Treatment is focused on strengthening each muscle and ligament of the pelvis and its fundus and also to eliminate discomfort at rest and making the right body position due to the C-shaped orthopedic pillows. Pregnant women assigned to wearing a brace, which will pull the bones of the pelvis and protects the pubic symphysis from pathological differences. In severe pathology is assigned a course of anti-inflammatory drugs to relieve the pain and remove the swelling. It is also recommended to control your weight and observe the motor mode.

It is recommended that Pregnant as much as possible to walk, but for short distances, but when you are in pain you need to relax. To strengthen and stimulate each muscle of the pelvic floor prescribe special exercises for pregnant women, massage therapy, swimming and doing exercises in the water.

Gymnastics

The Most effective exercises that quickly strengthen the muscles and ligaments of the pelvic area

1. In the supine position with legs bent at the knee feet and located in the buttocks feet pregnant makes abstraction of the lower extremities to the sides and return them to the Ghost. The movement is made synchronously and simultaneously with both feet. Only 6-8 times.
2. In the same position, but the feet are arranged so that the knees formed an angle of 90°. Pregnant then lifts the pelvis up and back down very slowly. Perform 6-8 times.
3. a Woman kneels and rests his hands on the floor. Next, smooth motion, you should arch your back upwards, like diving with his head down. Try to perform the exercises so that you could feel the tension of each muscle of the abdomen, hips and back. At least 6-8 times.

Mainly in compliance with the treatment plan by the time of delivery be impossible to stabilise the condition of the pregnant woman and to hold a birth through the vagina. Indication for natural childbirth is the expansion of the symphysis pubis is not more than 10 mm, if the extension is greater then produce a cesarean.

Recommendations

Early referral to specialists with complaints of pain in the pelvis or other symptoms that cause discomfort, will allow to diagnose the disease and develop a treatment plan. It will also give the opportunity in the early stages to choose the method of delivery is the most secure for you and your future child, considering all factors.

we Strongly recommend that before birth, especially after 26-30 weeks, pay attention to the slightest variations in health and is under the supervision of a doctor.

Sources:

1. Obstetrics / V. I. Duda – Minsk – 2013 – 576 pages
2. Obstetrics and gynecology V. 1 / V. M. Zaporozhan – 2005 – 472 pages.
3. Obstetrics. National posobie / E. K. Aylamazyan, V. I. Kulakov, V. E. Radzinsky, G. M. Savelieva – 2009 – 1200 pages
4. Assessment of the severity of symphysis pubis dysfunction and the choice of method of delivery. Acad. The RAMS, Professor V. N. Serov , doctor E. V. Ananiev. Russian Bulletin of obstetrician-gynecologist 3, 2011
5. Ultrasonic diagnostics of the condition of the symphysis pubis in women. Logutova L. S., M. A. Chechneva, Lysenko S. N., Cherkasova N. Yu. Russian medical journal.