Disclosures: Kristen D. De Vries, DO, MS: Nothing to disclose

Case Description: The patient had a pelvic X-ray performed immediately post-partum, revealing a 2.8 cm pubic symphysis separation. She was referred to Rehabilitation Medicine for evaluation. The patient was independent prior to giving birth, without pain and activity limitation. However, upon evaluation 2 weeks post-partum, she reported significant, constant pubic pain leading to difficulty with ambulation. She required the use of a rolling walker when outside of her home with a restricted distance of about three blocks. The patient completed four sessions of physical therapy, including basic core strengthening, pelvic floor exercises, and education on a home exercise program.

Setting: Tertiary Care Center, Outpatient General Rehabilitation Clinic

Patient: A 22-year-old G1P1 female who presented with pelvic pain immediately post-partum.

Assessment/Results: The patient was evaluated in clinic after the completion of physical therapy. She was ambulating independently, no longer requiring the use of a rolling walker, and reported significant reduction of her pain. Repeat X-ray at that visit showed improvement of the pubic symphysis diastasis to 1 cm.

Discussion: Pubic symphysis diastasis is a post-partum complication that is rare and can easily go unrecognized. During the first trimester of pregnancy, the cartilaginous joint relaxes about 3-7 mm; however, post-partum separation of more than 1 cm is considered pathological. The size of the separation does not always correlate with severity of symptoms and it appears that there is no clear treatment algorithm currently available. Intervention is often conservative, however early surgical intervention for patients with separation of greater than 3 cm has demonstrated some success.

Conclusion: Pubic symphysis diastasis is an easily missed diagnosis. This case demonstrates that early intervention, including physical therapy, can lead to significant improvement even with a severe pubic symphysis separation. Early intervention is key as failure to recognize and treat this condition can lead to significant disability and chronic pain.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2019

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/post-partum-pelvic-pain-a-case-report-of-pubic-symphysis-diastasis/