QuestionHi
My wife is possibly suffering from pubic symphysis separation. She has limited mobility, pain while lying on her back but more so on her side & and has to walk with crutches. We saw a othopod last night & has suggested pelvic binding. + 800mg Brufen tid.
Questions:
1) The fact that she cant lift her legs to walk properly could be considered as neurologic defecits. What should we do next.
2) Or should we manage this as recommended.
3) We were not sent for x-rays. Is a X-ray needed to confirm diagnosis?
4) She is breastfeeding. Is 800mg OK in this situation?
5) We are living abroad and the only binding device I could find is one used for lumbar support. Is this OK?
6) Can you advise on which position she should sleep in to encourage healing?
7) We were told not to wear the bind while sleeping. Do you agree?
8) We were also told to avoid sitting as this slows blood flow. Would you agree?
Sorry for all the questions but we are living in a foreign country and good advice is difficult to obtain.
Regards
Marc
AnswerHello,
I'm sorry for your wifes pain, and I won't call it "discomfort" because it IS pain.
Unfortunetly, this condition has not been studied very well, hence the lack of truley helpful treatments! I'm not sure where you are living but I'll try to help. I am not a specialist in this area, but I would like to help as much as I can. If the birth has been recent, I hope it's temporary and will begin to resolve itself.
However, pain now or pain in the future, if you have a doctor MAKE him listen, if he doesn't try another. Don't give up or be brushed off, which happens to many women with this who are thought to just be complainers. Demand referrals to physical/physio thearpy if necessary! Call or look up Chiropractors as well and ask for their opinion.
1. It is typically not considered a neurologic condition unless their is significant involment unless it effect bowel and bladder function.
2 & 3. Without xrays it's impossible to know if it is TRUE pubic symphsis seperation or the degree of it.
It is also possible during pregnancy and following birth ot have inflammation of the pubic symphysis called symphysitis. This usually resolves, but takes time.
4. Brufen also called Ibuprofen is cleared for pediatric use and is the most commonly used medication for pain while breastfeeding. Levels of ibuprofen transferred into milk following 400 mg maternal doses are generally less than 1 mg per liter of milk.
5. Any type of support for this pain needs to be worn from the upper thigh and up. A trochanteric belt, a Tubigrip (size K) or a sacro-iliac support are sometimes recommened. cut and paste the links Some recommend a brace such as the FemBrace
http://www.urable.co.uk/modules/shop/view.asp?catid=132&Prodcode=SU2000-000765
A Tubigrip (size K or L) is worn double from the upper thigh to the upper abdomen. An extra single layer around the thighs (mini skirt style) is brought up to the level of the hip bones to give three layers around the lower abdomen, this will give added support.
http://www.physioroom.com/shop/index.php?main_page=product_info&products_id=364&...
6. Removing a binder during sleep is sometimes recommended to increase blood blow and decrease the risk of tissue damage. If there is greater pain with it's removal, perhaps a larger, looser device that is not a compressive, such as a firm control pantyhose.
Some things that may be helpful for her:
Keep your legs and hips as parallel/symmetrical as possible when moving or turning in bed
Some women also find it helpful to have their partners stabilize their hips and hold them 'together' when rolling over in bed or otherwise adjusting position
Some women report a waterbed mattress to be helpful
Swimming may help relieve pressure on the joint
Keep your legs close together and move symmetrically
When standing, stand symmetrically, with your weight evenly distributed through both legs
Sit down to get dressed, especially when putting on underwear or pants
Avoid 'straddle' movements
Swing your legs together as a unit when getting in and out of cars; use plastics or something smooth and slippery (like a garbage bag) on the car seat to help you enter car backwards and then turn your legs as a unit
An ice pack may feel soothing and help reduce inflammation in the pubic area
Move slowly and without sudden movements
If bending over to pick up objects is difficult, there are devices available that can help with this
Listen to your body on whether to use these or any other comfort measures.
I wish you all the very best and I hope she finds some relief soon!
