Post-partum management of severe pubic diastasis

Pubic symphysis diastasis during pregnancy is a rare complication which can present as pain with ambulation, urinary dysfunction, and pelvic instability. A consensus treatment does not currently exist between surgical and conservative management. The authors present a case of severe pubic diastasis which was successfully treated using a conservative pelvic binder.

A 31-year-old female presented with severe lower back pain following the uneventful delivery of her fourth child. On radiograph, a pubic symphysis diastasis of 5.5 cm was noted and she was subsequently fitted with a pelvic binder on post-partum day 3. She experienced a full range of motion and was pain free at six-week follow-up, with a diastasis of 2.1 cm present. At one year and three-month follow-up, the patient presented with a diastasis of 2.4 cm and continued to have full range of motion and mobility.

This case contributes to the literature in showing that conservative treatment of pubic diastasis could be considered in cases where separation has exceeded normal physiologic limits.