Osteitis pubis is a non-bacterial inflammation in the area of the pubic bone, which often occurs in athletes. The cause of inflammation of the pubic bone is usually overuse during training. As a rule, pubic bone inflammation can be treated well with anti-inflammatory medication and physiotherapy exercises. Although the therapy may take a few months, surgery is rarely necessary. With us, you can learn about the signs you can recognize pubitis and what you need to know about diagnosis and treatment.
Pubic bone pain as a symptom
Pubitis usually develops insidiously in the context of long-term intensive sports. The most important sign is pubic bone pain, which can radiate to the groin, hip or lower abdomen. Initially, the symptoms are usually only noticeable during sports or during exertion such as climbing stairs or sneezing. If there is then no break in training, the symptoms often occur after some time due to the persistent irritation even when walking or at rest. Pain is also typical of pubitis when pressure is applied to the pubic bone or tendon insertions, as well as when the inner thigh muscles are tensed.
Cause: micro-injuries due to overuse
The pubic bone is a part of the anterior pelvic ring where numerous tendons of the abdominal and leg muscles attach. Because these two muscle groups pull in opposite directions, the pubic bone is subject to high stresses during sports that involve rapid changes of direction and sprinting – for example, soccer, basketball, field hockey, or running. Thus, if training is too intense or incorrect, repeated micro-injuries can lead to inflammation of the pubic bone, the tendon insertions, and the cartilage-joint junction in the middle of the pubic bone (symphysis).
Factors that promote pubic bone inflammation
In addition, the following factors may promote pubic symphysisitis:
- Current or previous pregnancy
- Births in the past
- Operations on the lower abdomen
- Gynecological or urological operations
- Pubic bone fracture or other injuries in the pubic region
- Rheumatological diseases
- Obesity
Which doctor for pubic bone pain?
Deciding which doctor you should contact for pubic bone pain is not so easy. Because in addition to pubic bone inflammation, other causes can also lead to pain in the pubic bone. In principle, the family doctor is always a good first point of contact: through specific questioning and a physical examination, he can often already recognize to which colleague he should best refer you. In most cases, an orthopedist or sports medicine specialist is the specialist of choice for an inflammation of the pubic bone – depending on the history and clinical picture, a referral to the gynecologist in women or to the urologist in men may also be appropriate under certain circumstances.
Pubitis: Diagnosis by MRI
To get to the bottom of the cause of pubic pain, the doctor will usually first take an x-ray of the pelvis after taking a medical history (anamnesis) and performing a thorough physical examination. The x-ray helps rule out a fatigue fracture and may already find evidence of pubic bone inflammation. In addition, an ultrasound examination may be performed to rule out other causes. Usually, the diagnosis of pubitis can be confirmed by an MRI. In unclear cases, further imaging examinations such as a skeletal scintigraphy can be performed – this is useful, for example, in the case of fever to rule out osteomyelitis of the pubic bone. In addition, inflammation levels in the blood are usually determined for this purpose.
Physiotherapy important part of treatment
Osteomyelitis of the pubis can usually be treated conservatively – that is, without surgery. In this case, a break from sports is important at first so that the inflammation can subside. Anti-inflammatory painkillers with active ingredients such as ibuprofen or diclofenac can relieve the pain and support healing. An important part of treatment is also physiotherapy, in which the muscles are strengthened and stretched through targeted exercises.Supportive physical therapies such as ultrasound treatment, cold or electrotherapy, as well as osteopathy or chiropractic therapy can be used for pubic tendinitis.
What helps. Cortisone against the inflammation
If the pain in the pubic bone does not improve after a few weeks, despite sports breaks and physiotherapy exercises, the temporary use of cortisone-containing tablets may be useful for inflammation of the pubic bone, since cortisone has a strong anti-inflammatory effect. In some circumstances, an orthopedist may also inject a mixture of cortisone and a local anesthetic into the symphysis. The advantage of this is that the active ingredients act directly at the site of inflammation, which can reduce side effects.
Inflammation of the pubic bone: surgery as the last option
Treatment for pubic bone inflammation can take several months and often requires a great deal of patience. Surgery should generally be considered for pubic tendinitis only after all conservative treatment methods have been exhausted. In an operation, the inflamed tissue can be scraped out in these cases by means of a so-called curettage. As final measures, a stiffening of the symphysis (arthrodesis) or a partial removal of the pubic bone can be performed.
Good chances of recovery
Although treatment can be very lengthy, the chances of recovery from osteitis pubis are very good: in about 90 percent of cases, there is complete recovery from pain without surgery.
Prevent pubic tendinitis by stretching
To prevent pubic tendinitis or prevent a recurrence, there are things you can do yourself:
- Warm up sufficiently before exercising, such as by running loosely and stretching your muscles.
- Have a trainer or physical therapist show you stretching and strengthening exercises for abdominal and thigh muscles. Regular stretching can prevent muscular tension and imbalances.
- Wear appropriate, well-cushioned jogging shoes when jogging to reduce stress on bones and joints.
- Avoid sports with abrupt movements on hard surfaces.
- Do not overdo it with the training and give your body regular training breaks.
