This is a condition that most commonly affects females who have given birth at least twice. Patients suffer a central deep pain in the perineal area, worse on activity.
The pelvic bones are held together by tough fibrous ligaments. If these are weakened, then there may be abnormal movement between the bones. This is termed instability, and leads to pain.
Pain may be at the front of the pelvis, or at the rear in the sacro-iliac joints. Physiotherapy can be very effective in relieving symptoms by improving muscle strength. Sometimes a pelvic brace can be used.
Surgery is sometimes used for cases where pain is persistent. Before surgery is considered, the pelvis must be seen to be unstable. This can be investigated by the use of special x-rays. Stork views of the pelvis are taken with the patient standing on one leg, and then the other. If there is abnormal movement then the images will be very different. CT scanning of the pelvis can be very helpful. This may show hardening (sclerosis) of the bone; this is a natural body reaction to the abnormal movement.
Once instability has been demonstrated, we will usually ask our radiologists to inject the pubic symphysis. If the pain resolves then the instability is likely to be the cause of your pain. If the injection wears off, then we will consider surgery to fuse the symphysis.
Surgery takes about 1 hour, and patients are in hospital for a couple of days. You can walk on the day after your operation. You will need crutches for 2-4 weeks after the procedure.