Pain in the center of the pelvis can be a deeply unsettling experience, often making simple daily movements challenging. The pubic bone is part of the pelvic girdle, meeting its counterpart at the front of the body to form the symphysis pubis joint. This cartilaginous joint acts as a shock absorber and provides stability to the pelvis. While this joint normally allows for very little movement, pain suggests an underlying issue, such as inflammation, instability, or mechanical stress. Understanding the cause of this discomfort is the first step toward effective relief.
Pubic Pain During Pregnancy
The most frequent cause of pubic bone pain is the physiological changes that occur during pregnancy. This discomfort is broadly termed Pelvic Girdle Pain (PGP), or more specifically, Symphysis Pubis Dysfunction (SPD). The condition results from hormonal and biomechanical factors preparing the body for childbirth.
The hormone relaxin, which increases significantly during pregnancy, is largely responsible for softening and loosening the ligaments throughout the pelvis. This natural process allows the pelvic joints to become more flexible and widen slightly. If the ligaments around the symphysis pubis loosen too much or too soon, it can create instability and lead to pain and misalignment in the joint.
Symptoms of SPD often manifest as sharp, shooting, or aching pain directly over the pubic bone. This pain is frequently exacerbated by asymmetrical movements that put stress on the joint, such as walking, climbing stairs, or standing on one leg. Many individuals also report hearing a distinct clicking or popping sensation when attempting to roll over in bed or get out of a car. Since the pain can radiate to the lower back, groin, or inner thighs, it can severely limit mobility and impact daily activities.
Pain Caused by Athletic Overuse
For individuals who are not pregnant, chronic pubic pain is often linked to repetitive physical stress and is commonly diagnosed as Osteitis Pubis (OP). This is a non-infectious inflammatory condition that affects the symphysis pubis and the surrounding muscle attachments. The underlying cause is generally repetitive microtrauma or chronic shearing forces placed across the joint.
Osteitis Pubis is prevalent in athletes, particularly those involved in sports requiring frequent kicking, pivoting, sudden acceleration, or rapid changes in direction. Soccer, hockey, and long-distance running are activities that place intense, repeated strain on the hip adductor and abdominal muscles which attach directly near the pubic bone. This chronic muscular imbalance and tension pulls on the joint, causing irritation and inflammation.
The onset of Osteitis Pubis is typically gradual, starting as a dull ache or constant pain localized over the center of the pubic bone or radiating into the groin. The pain worsens with activity and often includes tenderness when pressure is applied directly to the joint. Unlike acute injuries, this condition develops slowly, leading to inflammation that can persist for months.
Acute Injury and Systemic Causes
While pregnancy and athletic overuse are the most common causes, pubic pain can also result from sudden trauma or less frequent systemic conditions. An acute injury, such as a severe fall or a motor vehicle accident, can cause a pelvic fracture or a significant separation of the joint, known as pubic diastasis. These injuries result in immediate, severe pain and often the inability to bear weight, requiring prompt medical intervention.
Other causes are systemic or referred, meaning the pain originates elsewhere but is felt strongly in the pubic area. Degenerative conditions like osteoarthritis can cause the cartilage within the symphysis pubis to wear down over time, leading to joint pain. Rarely, osteomyelitis, an infection of the pubic bone, may cause pain along with systemic symptoms like fever and chills. Referred pain from a “sports hernia,” which is a weakness in the abdominal wall, or from hip joint issues can also be felt as pubic discomfort.
Managing Pain and Seeking Treatment
Initial management of pubic pain focuses on reducing inflammation and stabilizing the pelvic area. Avoiding movements that cause sharp pain, such as standing on one leg or climbing stairs, is an immediate step. Applying a cold compress to the affected area for 10 to 20 minutes can help decrease localized pain and swelling after activities that worsen the symptoms.
A pelvic support belt can be worn during necessary movements, providing external compression and stability to the joint. Physical therapy is a primary non-surgical treatment, focusing on strengthening the deep core muscles, pelvic floor, and hip stabilizers to improve the pelvis’s overall support system. Therapists teach specific body mechanics, such as keeping the knees together when getting out of a car or rolling over in bed, to minimize asymmetrical strain.
It is important to contact a healthcare provider if the pain is severe, constant, or significantly limits your mobility. Immediate medical attention is necessary if the pain is accompanied by red flag symptoms, as these may indicate a serious infection or an acute fracture. While most causes of pubic pain respond well to conservative management, early diagnosis guides the most effective treatment plan.
Red Flag Symptoms
- High fever
- Sudden inability to walk
- Numbness in the legs