In professional circles, inflammation of the pubic bone is also called osteitis pubis. The term “inflammation” is misleading in that the symptoms are not caused by infections. Rather, they generally stem from repeated trauma to the affected areas due to misuse or overuse.
What is inflammation of the pubic bone?
Pubic osteitis primarily affects the pubic bone, the symphysis pubis, and the structures around it. Pubic osteitis is also known as symphysis osteitis or pubalgia. The pubic bone forms part of the hip bone. The other two parts are the ischium and ilium. Every person has two hip bones and a sacrum, which in turn form the pelvis. The so-called pubic symphysis is a joint of fibers and cartilage that connects the two pubic bones. This allows them to move to a certain degree. In pregnant women, relaxin is secreted. This hormone provides additional mobility of the pubic symphysis to facilitate birth and prevent fractures as much as possible. Athletes are particularly affected by pubic symphysis. Up to seven percent of athletes contract the inflammation every year. The rate is highest among soccer players, tennis players and basketball players. The average age of men is 30. On average, women are not affected until they are 35. Depending on the severity of the disease, the affected person must abstain from sports for a longer period of time and can only slowly return to training.
Causes
The main cause of osteitis pubis is overuse and excessive strain on the symphysis. This can cause scar tissue to form, which can lead to bone breakdown. This breakdown triggers cysts in adjacent areas. In addition, so-called stress fractures can occur. Stress-related fractures are referred to as such. Sports with many changes of direction, sprints or shooting elements are particularly frequently affected, as strong tensile forces act on the pubic symphysis. In addition to the sports mentioned above, running sports and American football are also included. Athletes are therefore a special risk group. But pregnant women are also affected. Pregnancy and childbirth can also be the cause of inflammation of the pubic bone. According to studies, postpartum hemorrhage can occur in the symphysis area. In some cases, the adjacent bone is also affected. Cracks in the cartilage are not uncommon. Pelvic inflammatory disease can also be caused by an operation in the pelvic area. Here, the inflammation occurs as a complication. Examples include prostate surgery or the placement of a catheter for the bladder. This type of bladder catheter passes by the pubic bone and thus can also lead to osteitis pubis.
Symptoms, complaints, and signs
Several symptoms may indicate osteitis pubis. The swelling in the area of the symphysis is noticeable. It is often tender and reacts to pressure, which is associated with pain. Pain in the area of the pubic rami and the symphysis pubis is the most important symptom of the disease. Sometimes this pain is severely distressing. Sports activities can no longer be performed, depending on the case, because the inflammation leads to massive limitations. In addition, pain may radiate to the hip or groin. Not infrequently, pubic inflammation is associated with pain in the lower abdomen or pelvic floor. In addition, pain when standing up after prolonged sitting is typical. This “start-up pain” usually subsides again with uniform movements. In contrast, climbing stairs or jerky movement often causes pain to those affected.
Diagnosis and course of the disease
The diagnosis is not easy. Many sports injuries are accompanied by similar symptoms. The condition is often confused with groin complaints such as strains. Overuse of some tendons can also cause similar pain. Inflammation of the pubis must be differentiated from avulsion fractures, osteomyelitis, rheumatic diseases and inguinal hernias. Adductor strains or diseases of the urinary and genital tracts can also lead to similar complaints. To make a diagnosis, the physician will first ask about the symptoms and medical history. Only then will he instruct various physical examinations. Imaging techniques may serve to diagnose pubitis.Similar to a blood test, a distinction must be made here between inflammatory diseases. Depending on the infection, the diseases are not always easy to distinguish. In the case of osteitis pubis, however, the inflammatory parameters in the blood are not elevated. X-ray and MRI may also be used for differentiation.
Complications
Pubic osteitis usually heals without complications. However, as the disease progresses, the pain may spread and radiate to the hip, groin, lower abdomen, and pelvic floor. Particularly in the case of protracted illnesses, the pain can lead to malpositions and occasionally also to psychological sequelae. Typical of chronic diseases are, for example, depressive moods, which can develop into severe depression if the disease is severe. Surgical treatment may be associated with bleeding and wound healing problems. Very rarely, nerve injuries occur that require further surgery. Prescribed medications may result in side effects and interactions such as headache, gastrointestinal tract discomfort, edema, skin redness, and temporary visual and hearing disturbances. Allergic reactions and intolerances cannot be ruled out either. With cortisone treatment, complications such as cardiovascular problems, increased susceptibility to infections and weight gain are possible. In addition, water retention in the tissues may occur. Cortisone also promotes the development of osteoporosis. Skin damage, circulatory disorders, cardiac arrhythmias, sensory disturbances and other complications can occur during electrotherapy. If exercise is resumed too soon after treatment, pubitis is likely to recur.
When should you see a doctor?
If acute pain recurs during jogging or sit-up exercises, pubitis may be underlying. A visit to the doctor is indicated if the symptoms occur repeatedly and make it difficult to exercise. The complaints usually develop gradually and should be clarified at an early stage. Affected are mostly athletically active people who frequently cycle, jog or ride. Those who lift heavily for occupational reasons are just as at risk as pregnant women, rheumatism patients and people with a pelvic obliquity. If you belong to one of these risk groups, it is best to consult a doctor when the above-mentioned symptoms appear. Affected individuals consult their family doctor or an orthopedist. Other points of contact are sports physicians and pain therapists. Ostitis pubis can generally be treated well, provided it is detected at an early stage. Often, however, the ostitis pubis is based on another condition that must be determined in the course of intensive examinations. Therefore, symptomatic treatment should be accompanied by further visits to specialists. The physician must be informed of any increase in symptoms as well as any side effects of the prescribed painkillers.
Treatment and therapy
As a rule, inflammation of the pubic bone heals on its own. If this is not the case, injection therapy or surgery may be considered. In principle, however, the inflammation is treated primarily conservatively. Sometimes it can take several months until the disease is finally healed. At best, pain-inducing movements and sports should not be performed during the healing phase. Patience is essential during therapy, otherwise relapses may occur. Physiotherapy is one option for treatment. Anti-inflammatory drugs such as ibuprofen can also help against the pain and provide short-term relief. Treatment with cortisone is also possible. Other options include electrotherapy and ultrasound treatments. After inflammation has healed, it is important to return to training slowly. Heavy loads on the pelvic girdle should be avoided.
Prevention
As a preventive measure, it is important to warm up before training to best prevent overuse. Stretching the adductors and targeted training of the trunk and abdominal muscles reduces the risk. Any abnormalities in the arch of the foot can be adjusted with insoles. This prevents false footing and minimizes the risk of osteitis pubis due to incorrect loading.
Aftercare
Provided the pubic bone inflammation has been well cured, a single follow-up examination is sufficient.The doctor must clarify whether the patient still has complaints. Prescribed medications must be gradually discontinued after recovery. Depending on whether anti-inflammatory or stronger drugs have been prescribed, the tapering off must be monitored by a doctor. After cryotherapy or electrotherapy, psychological support may be useful for the patient under certain circumstances. The doctor will usually recommend a break from sports. After an inflammation of the pubic bone, intensive physical exercise should be avoided for at least one to two weeks. After a surgical procedure, follow-up care takes place in the hospital. If curettage was used, the surgical wound must be carefully observed. Competitive athletes require intensive aftercare following pubic bone inflammation. Otherwise, the symptoms may recur and considerably limit performance. On the one hand, repeated illnesses can be prevented by early therapy. On the other hand, comprehensive aftercare is necessary. The orthopedist or general practitioner is responsible for the aftercare of pubic bone inflammation. If the pain is intense and radiates to the lower abdomen and pelvic floor, further treatment by a pain therapist is usually necessary. If necessary, the physical therapist may also be involved in follow-up care.
Here’s what you can do yourself
The pubic symphysis is a neuralgic point of the human body, which is something that competitive athletes in particular have to realize on a regular basis. Inflammation of the pubic bone or pubic symphysis results almost exclusively from continued overuse. The best self-help measure is therefore not to constantly overstrain the body, but to adapt the training to one’s own condition and physical capacity. In particular, short, fast movements, hitting hooks or sprints with abrupt stops put undue strain on the pubic bone. If such behavior cannot be avoided, which is likely to be the case only with professional athletes, regular countermeasures must be taken. Physiotherapeutic measures can help to strengthen and relieve the stressed body region. Very often, however, it is necessary for those affected to take a longer period of rest during which they do no or only light endurance sports. Those who do heavy lifting at work may have to take a break for a longer period of time or engage in another activity. Affected persons should absolutely follow the instructions of their treating physician here, since pubic bones inflammation can otherwise be very persistent or even become chronic. The pain associated with the inflammation can usually be treated well with over-the-counter anti-inflammatories such as ibuprofen.
