Tiap kali nk duduk nk bangun, mmg seksa oooiiii..... So, saya mencari2 la kenapa saya rasa sakit? org lain tak rasa ke seperti yg saya rasa ni? ermmmm......
What is symphysis pubis dysfunction?The two halves of your pelvis are connected at the front by a stiff joint called the symphysis pubis. This joint is strengthened by a dense network of tough, flexible tissues, called ligaments. To help your baby pass through your pelvis as easily as possible, your body produces a hormone called relaxin, which softens the ligaments.
As a result, these joints move more during and just after pregnancy (Kristiansson 1997; Bjorkland et al 1999; Bjorkland et al 2000), causing inflammation and pain, known as symphysis pubis dysfunction or SPD.
A related condition is diastasis symphysis pubis (DSP), in which the gap in the pubic joint widens too far. The average gap between the bones in a non-pregnant woman is between 4mm and 5mm, and during pregnancy it's normal for this gap to widen by 2mm or 3mm. If the gap is 10mm or more, DSP is diagnosed. It's rare, and can only be identified by X-ray.
What causes SPD?We are not sure exactly what causes SPD, but it's thought that if one side of the pelvis moves more than the other when you walk or move your legs, the area around the symphysis pubis becomes tender (Buyruk et al 1999; Damen et al 2001). The amount of discomfort isn't related to the size of the gap in the joint. Many women with a normal-sized gap feel a lot of pain.
When does SPD happen?SPD can occur at any time during your pregnancy or after giving birth. Many women notice it for the first time around the middle of their pregnancy. If you have SPD in one pregnancy, it is more likely that you'll have it again next time you get pregnant (Shephered 1997: 239-45; Snow 1997: 438-43). The symptoms may also come on earlier and progress faster, so it is important to seek help promptly. It can help if you allow the symptoms from one pregnancy to settle before trying to conceive another child.
What are the symptoms of SPD?Pain in the pubic area and groin are the most common symptoms. But you may also have the following signs:
- Back pain, pelvic girdle pain or hip pain.
- A grinding or clicking sensation in your pubic area.
- Pain down the inside of your thighs or between your legs. It can be made worse by parting your legs, walking, going up or down stairs or moving around in bed.
- Worse pain at night. It can stop you sleeping well and getting up to go to the toilet in the middle of the night can be especially painful.
How is SPD diagnosed?SPD is becoming more widely understood by doctors, physiotherapists and midwives. It can be diagnosed by listening to your description of your symptoms and by testing the stability, movement and pain in your pelvic joints (Kristiansson and Svardsudd 1996; Vleeming et al 2002; De Groot et al 2006). Your doctor may refer you to a physiotherapist who will have experience in treating it.
How is SPD treated?SPD is often managed in the same way as pelvic girdle pain, and treatment will include:
- Exercises, especially for the tummy and pelvic floor muscles, to improve the stability of your pelvis and back (Richardson et al 2002; Van Wingerden et al 2004). You may need gentle, hands-on treatment of your hip, back or pelvis to correct stiffness or imbalance. Exercise in water can sometimes be useful.
- You should also be given advice on how to make daily activities less painful and on how to make the birth of your baby easier.
- Acupuncture may help, but make sure your practitioner is trained and experienced in working with pregnant women (Bourne 2007; Elden et al 2007; Kvorning et al 2004; Lund et al 2006; Ternov et al 2001).
- Osteopathy and chiropractic may help, but again, make sure you see registered practitioner who is experienced in treating pregnant women.
- A pelvic support belt will give quick relief (Mens et al 2006; Ostgaard et al 1994; Vleeming, 1992).
Self-help tips for SPDThere are things you can do yourself to ease your pain:
- Regular pelvic floor and tummy exercises can ease the strain on your pelvis. Get down onto your hands and knees and level your back so that it is roughly flat. Breathe in and then as you breathe out, squeeze in your pelvic floor muscles and at the same time pull your belly button in and up. Hold this contraction for between five and 10 seconds without holding your breath and without moving your back. Relax the muscles slowly at the end of the exercise.
- Avoid moving your legs apart when your back is slumped or you are lying down. Take care when getting in and out of the car, bed or bath. If you are lying down, pulling your knees up as far as you can stops your pelvis from moving and makes it easier to part your legs. If you are sitting, try arching your back and sticking your chest out before parting or moving your legs, as this also helps to stop the pelvis from moving.
- Avoid pushing through any pain. If something hurts, if possible don't do it. If the pain is allowed to flare up, it can take a long time to settle down again.
- Move little and often. You may not feel the effects of what you are doing until later in the day or after you have gone to bed.
- Rest regularly by sitting on an exercise or birth ball or by getting down on your hands and knees. This takes the weight of the baby off your pelvis and holds it in a stable position.
- Avoid heavy lifting or pushing. Supermarket trolleys can often make your pain worse, so shop online or ask someone to shop for you.
- When climbing stairs, go up them one step at a time. Step up onto one step with your best leg and then bring your other leg to meet it. Repeat with each step. Only use stairs when you have to.
- Avoid swimming breaststroke and take care with other strokes. You may feel swimming is helping your pain while you are in the water, but it could make you feel worse when you get out.
- When getting dressed, sit down to pull on your knickers or trousers.
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