Pelvic Separation

Q.I gave birth to my fifth child two years ago. He was a very large baby — 10 pounds, 23 inches, with a head circumference of 15 inches. A few weeks after he was born I was still having severe pain in my pelvic bones and hips. My doctor said it was from the bones separating in order for the baby to pass, and only time would tell if they went back. Those bones feel no better now then they did then. Is something broken? Am I going to feel this way forever?

Erika

A.Symphysis pubis diastasis usually occurs during childbirth to allow the baby to exist through the pelvis. You mentioned that two years ago you delivered a 10-pound, 23-inch baby with a head circumference of 15 inches. I would expect some degree of symphysis pubis diastasis at the time of delivery with a baby this size, but this usually corrects itself in the early postpartum period.

A. Since it has been two years since the birth of your child and you still have severe pain, I would recommend that you have both a thorough gynecologic evaluation as well as a thorough orthopedic evaluation.

In my office, I would order X-rays of the pelvis to assess the symphysis pubis (the front of the pelvis where the two halves come together). If you have persistent widening of the symphysis pubis and no gynecologic cause is found for your pain, then I would suggest that you consider surgical correction.

There are two surgical options. In external fixation, pins are inserted through the skin into the pelvis, and then an external clamp is used to bring the pelvis back to its proper position. This device can be worn for a period of time to allow the tissues to heal back into their proper place. The other option is an open surgery to plate the symphysis pubis in its proper position.