Patient's question:
I developed diastasis symphysis pubis after giving birth, measuring 2.13 cm. After using a bandage for stabilization, a check-up 40 days later showed a recovery to 0.7 cm. It has been 5 months now, and walking and climbing stairs basically cause no problems. However, I have been experiencing persistent pain:1. A continuous ache from the left thigh root to the left foot root, as if a tibia is particularly painful.
2. Persistent pain from the posterior pelvic bone to the coccyx-lumbar spine. Bending over or doing anything for more than 5–10 minutes causes severe pain, making it difficult to straighten up.
I’m wondering if this is due to the birth itself or as a of the symphysis pubis condition. Is it...
Doctor's answer:
The bending over or doing activities for more than 5 to 10 minutes causes severe pain, making it difficult to straighten up, which is similar to my symptoms last year. Additionally, when I walk for a while, the pain intensifies, and my lower back seems to stiffen, making it hard to relieve the pain. At that time, I had an X-ray taken at the hospital and found it to be sacroiliac joint osteitis. The doctor only said that this condition is more common in women of childbearing age, especially postpartum, so my case is relatively rare, and there is no effective treatment method. It is important to prevent cold exposure. Later, I took some medication, which helped a bit. Then I suspected that I might be calcium deficient, so I took calcium supplements for two months, and it seemed to improve a lot. Now, although I still occasionally experience pain, it is not as severe as before.The information I found online at that time is for your reference. It is best for you to get an X-ray to confirm the diagnosis:
[Pathogenesis]
1. Traditional Chinese Medicine (TCM) Understanding
TCM has long recognized that women are prone to developing joint and muscle stiffness after childbirth. The Ming Dynasty's Puji Fang states that postpartum blood deficiency leads to weakness in the body's organs, and if overexertion occurs before the full moon, wind and cold can invade the meridians, causing stubborn stiffness and numbness. The Good Method for Women points out: "The kidneys govern the waist. If a woman has lower back pain, it is due to kidney qi deficiency, and external wind-cold or internal emotional injury can all cause it." It also provides classification and treatment methods. The Qing Dynasty's Ye Tianshi's Gynecology that postpartum body pain is due to abnormal fluctuations in qi and blood, which stagnate in the limbs, and advocates using the "Pain Relieving Powder" for treatment.
Based on the characteristics of this condition, its pathogenesis can be divided into three aspects:
(1) Postpartum blood deficiency: Excessive blood loss after childbirth leads to lack of nourishment for the tendons and joints, resulting in stiffness and bone atrophy, which can cause this condition.
(2) External wind-cold: Postpartum blood and qi deficiency, combined with disharmony in the defensive Qi and exterior, make the body more susceptible to wind and cold, which can stagnate in the meridians and joints, causing lower back pain.
(3) Qi and blood stagnation: Pressure on the pelvic bones during pregnancy can disrupt the smooth flow of qi and blood, leading to lack of nourishment for the bones.
2. Western Medicine Understanding
This condition is commonly found in the ilium, and the exact cause is not fully understood. It may be related to chronic overuse, impaired blood supply, or infection. It is more common in obese women.
[Clinical Diagnosis]
1. More common in women, with a peak incidence between 20 and 25 years old. It is often seen in women of childbearing age and multiparous women, with a higher prevalence among standing workers.
2. Often presents with multiple lower back pain points, mild symptoms, occasional lower back and sacral pain, which may radiate to both buttocks and thighs but is not radicular pain.
3. Physical examination shows only local tenderness, and the straight leg raise and pelvic separation tests can be positive.
4. X-rays are helpful for diagnosis.
[Imaging Diagnosis]
X-ray examination primarily shows high-density bone hardening near the sacroiliac joint, most commonly occurring in women aged 20 to 25. The pain can be unilateral or bilateral. X-ray findings include symmetrical triangular areas of uniform bone hardening in the lower part of the ilium near the sacroiliac joint. The apex of the triangle points upward, the inner edge reaches the sacroiliac joint surface, and the outer edge is indistinct from normal bone tissue. The sacroiliac joint space is normal, and the joint margins are sharp. Common X-ray positions for the sacroiliac joint include the anteroposterior and oblique views.
[Pattern Differentiation]
This condition is more common in women, especially those with a history of childbirth. The clinical presentation includes lower back pain, which may radiate to both buttocks and thighs and worsens after activity.
1. Postpartum blood deficiency type: Lower back aching pain, dizziness, palpitations, pale yellow complexion, postpartum lochia not flowing, accumulation of masses, intermittent fever and chills, pale red tongue with little coating, and thin, weak pulse.
2. External wind-cold type: Lower back pain, heaviness, difficulty walking, relief with warmth, muscle warmth and red face, headache, fever with aversion to cold (more cold than heat), pale complexion, low voice, pale tongue with white coating, and deep, weak pulse.
3. Qi and blood stagnation type: Lower back pain with continuous leakage, fever in the evening, hot palms, dry lips and mouth, lower abdominal urgency, fullness and tenderness, pale purple tongue, and deep, () pulse.