A pregnant woman's symphysis pubis may separate during late pregnancy or delivery. It may be due to excessive mechanical loading, effects of hormones (relaxin) and/or laxity in connective tissue.


The term "pelvic girdle relaxation" may be used if other ligaments in the pelvic girdle also show significant separation.


Clinical findings:

(1) The time of separation may be occult or it may with present as a crackling noise or a bursting sensation.

(2) The woman experiences pain in the region of the symphysis with point tenderness to palpation.

(3) Walking worsens the pain and the patient may develop a waddling gait.

(4) Back pain may develop or worsen if the separation is wide.

(5) Bruising, edema or a hematoma may be seen over the symphysis.

(6) Intercourse may be painful or uncomfortable.

(7) Pain may recur during ovulation.

(8) The condition usually resolves. The time may range from a few days in mild cases to 6-8 months when severe.

(9) The separation may recur on subsequent pregnancies.

Separation of the Symphysis Pubis


4-5 mm

normal distance in nonpregnant woman

7-8 mm

distance common in pregnant women

8 - 9 mm


>= 1 cm

abnormal separation


If there is a family history of the condition and the patient shows joint laxity then Ehlers-Danlos or other inherited disorder of connective tissue should be considered.



(1) Deep vein thrombosis may develop if the patient undergoes prolonged bedrest.

(2) Urinary and/or fecal incontinence may occur if a large hematoma forms.


The differential diagnosis is extensive and includes:

(1) osteomyelitis

(2) scoliosis

(3) rheumatologic disorder

(4) pelvic fracture

(5) herniated intervertebral disc

(6) bone tumor

(7) injury to the urinary bladder


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