Pain over the pubic bone almost always comes from the joint where the two halves of the pelvis meet at the front, or from the muscles and organs packed around it. What’s behind it usually depends on what your body has been doing lately, such as carrying a baby, giving birth, or playing a kicking or running sport. Pain in this spot can also come from the bladder or pelvic organs behind the bone, which is why it isn’t always a bone problem at all.1Texas Children’s. Pelvic pain? Endometriosis isn’t always the culprit A few less common causes, including infection and fractures, need prompt medical care, and they have clear warning signs.
What the Pubic Bone Joint Does and Why It Gets Sore
The two pubic bones are joined at the front by a firm disc of cartilage and ligaments.2PubMed Central. Comparison of Biomechanical Characteristics and Pelvic Ring Stability Using Different Fixation Methods to Treat Pubic Symphysis Diastasis The joint keeps the front of the pelvis stable and helps protect the organs behind it.3PubMed Central. Comparison of Biomechanical Characteristics and Pelvic Ring Stability Using Different Fixation Methods to Treat Pubic Symphysis Diastasis It soaks up pulling forces when you stand on both legs, squeezing and sliding forces when you stand on one, and twisting when you turn.4PubMed Central. Comparison of Biomechanical Characteristics and Pelvic Ring Stability Using Different Fixation Methods to Treat Pubic Symphysis Diastasis On top of that, the abdominal muscles pull up on the bone while the inner-thigh muscles pull down on it.5PubMed Central. Osteitis Pubis Syndrome in the Professional Soccer Athlete: A Case Report Anything that loosens the joint or unbalances those muscles can make it sore.
The pain sits low and central, just above the genitals, where the bone feels hard under the skin. It can spread into the groin, inner thighs, lower belly, or lower back. Tenderness when pressing directly on the bone suggests the joint itself, while a diffuse ache with no tenderness over the bone may point more toward the organs behind it, though this is only one clue among several.
One-legged movements tend to hurt most, because standing on one leg shifts the load unevenly across the joint. That’s why stairs, getting dressed, getting out of a car, and rolling over in bed often set it off.
Pregnancy and Childbirth
Pubic and pelvic girdle pain is common in pregnancy and is often called symphysis pubis dysfunction. The pregnancy hormone relaxin is often blamed, yet the evidence linking hormone levels to the pain is weak.6PubMed Central. Pregnancy-related pelvic girdle pain and its relationship with relaxin levels during pregnancy: a systematic review What does help is specific strengthening exercises plus advice on how to do daily tasks, which reduced pain and improved function in pregnancy.7Physical Therapy. Management of Symphysis Pubis Dysfunction During Pregnancy Using Exercise and Pelvic Support Belts Adding a rigid or soft pelvic support belt did not help more than the exercises and advice alone.8Physical Therapy. Management of Symphysis Pubis Dysfunction During Pregnancy Using Exercise and Pelvic Support Belts So ask for a referral to a pelvic health physiotherapist rather than relying only on a belt.
Pelvic girdle pain is usually felt at the pubic joint, the back of the pelvis, or both. It tends to be worse with weight-bearing and better with rest. It feels different from the tightening, rhythmic cramps of labor or the sharp one-sided pain that needs urgent assessment. Report sharp one-sided pain promptly, and also any pain that comes with bleeding, fluid leaking, fever, or regular contractions.
A few habits make daily life easier, in pregnancy or in the first weeks after birth. Keep your knees together when getting out of bed or a car. Sit down to put on underwear and trousers. Take stairs one step at a time, leading with the less painful leg. When you sleep on your side, put a pillow between your knees.
Rarely, the joint separates during birth, which is called pubic symphysis diastasis.9PubMed Central. Peripartum Pubic Symphysis Diastasis—Practical Guidelines Women often describe something giving way at the front, sometimes with an audible crack at delivery.10PubMed Central. Pubic Symphysis Diastasis: A Case Series and Literature Review Pain above the pubic bone, spreading to the back of the pelvis or lower back, can appear within about 48 hours after birth.11PubMed. Peripartum pubic symphysis separation–Current strategies in diagnosis and therapy and presentation of two cases Walking, climbing stairs, and moving side to side can hurt so much that walking is impossible at first.12PubMed Central. Pubic Symphysis Diastasis: A Case Series and Literature Review Severe cases can include bleeding or leaking urine.13PubMed Central. Pubic Symphysis Diastasis: A Case Series and Literature Review How wide the gap is doesn’t reliably predict how much it hurts.14PubMed Central. Pubic Symphysis Diastasis: A Case Series and Literature Review
If you can’t bear weight after birth, say so before you leave the hospital or right after. Leaking urine or a feeling that the pelvis is unstable should be checked, and your doctor may order imaging.
Most cases heal with a pelvic brace, physiotherapy, and pain relief.15PubMed. Peripartum pubic symphysis separation–Current strategies in diagnosis and therapy and presentation of two cases Pain usually eases within 6 weeks, though it can take up to 6 months.16PubMed. Peripartum pubic symphysis separation–Current strategies in diagnosis and therapy and presentation of two cases Surgery to plate the joint is needed only if the separation persists.17PubMed. Peripartum pubic symphysis separation–Current strategies in diagnosis and therapy and presentation of two cases
Sports and Overuse Injuries
Osteitis pubis is an overuse problem causing pain and tenderness over the pubic joint.18PubMed Central. Osteitis pubis in elite athletes: Diagnostic and therapeutic approach It’s common in soccer and rugby because of the kicking, twisting and cutting involved, and less so in distance running.19PubMed Central. Osteitis pubis in elite athletes: Diagnostic and therapeutic approach An imbalance between strong inner-thigh muscles and weaker abdominal muscles is thought to be the main driver.20Open Access Journal of Sports Medicine. Management of osteitis pubis in athletes: rehabilitation and return to training – a review of the most recent literature Stiff hips that don’t rotate inward well add stress to the pelvis.21Open Access Journal of Sports Medicine. Management of osteitis pubis in athletes: rehabilitation and return to training – a review of the most recent literature The bone reacts to overload much like a stress injury, usually without true inflammation.22Open Access Journal of Sports Medicine. Management of osteitis pubis in athletes: rehabilitation and return to training – a review of the most recent literature The joint ends up taking the difference between those pulls, so the same movement repeated over many sessions can irritate it even though no single moment caused an injury.
Athletic pubalgia, often called sports hernia, is an injury where the abdominal muscle attaches to the pubic bone, often with inner-thigh tendon injury too.23Musculoskeletal Key. Occult Groin Injuries: Athletic Pubalgia, Sports Hernia, and Osteitis Pubis Despite the name, there is usually no actual hernia found on examination.24PubMed. Athletic pubalgia and “sports hernia”: optimal MR imaging technique and findings The pain is typically felt low in the abdomen or groin, often on one side, and comes on with sprinting, sudden changes of direction, and twisting. Coughing, sneezing, or doing a sit-up can bring it on, because these tense the abdominal wall where it attaches to the bone. Many people expect a visible bulge, but there usually isn’t one.
Runners, triathletes, and military recruits can develop small stress fractures in the lower pubic bone near the joint.25Sports Injury Bulletin. Pelvic stress fracture: a rare but real risk in distance athletes The pain in the groin, hip or buttock worsens with activity and eases with rest, often with a limp.26Sports Injury Bulletin. Pelvic stress fracture: a rare but real risk in distance athletes Overstriding may contribute.27Sports Injury Bulletin. Pelvic stress fracture: a rare but real risk in distance athletes
The three often feel different, though they can overlap and need assessment to tell apart. Bone overload pain is usually central over the joint and tender to press. Tendon injury pain tends to sit off to one side, near the groin crease or inner thigh. Stress fracture pain tends to build during long runs and can make you limp. All three often start mild and get worse over weeks if training continues.
Playing through it is a common mistake. Pushing through groin pain often turns a weeks-long problem into months, while resting early from kicking and sprinting shortens recovery. Pain-free cycling or swimming can fill the gap while you get assessed.
Bladder and Pelvic Organ Causes
Interstitial cystitis, also called painful bladder syndrome, is a long-lasting bladder pain condition more common in women.28PubMed. Etiology, pathophysiology and biomarkers of interstitial cystitis/painful bladder syndrome It brings urgency, frequent night-time peeing and pelvic pain.29PubMed. Etiology, pathophysiology and biomarkers of interstitial cystitis/painful bladder syndrome The spot above the pubic bone is the most common place it hurts, and the pain often changes with filling or emptying.30PubMed. Sites of pain from interstitial cystitis/painful bladder syndrome
It’s easy to mistake for a bladder infection. A typical infection comes on over a day or two with burning on peeing and a positive urine test, and it clears with antibiotics. Painful bladder syndrome lasts months and the urine test is usually clear, so it is often missed or mistaken for repeated infections. If you’ve been treated for infections more than once without lasting relief, mention that pattern to your doctor.
Endometriosis can cause pelvic pain that comes with periods or all month, plus pain with sex, peeing or bowel movements.31Journal of Endometriosis and Pelvic Pain Disorders. How to Understand the Complexity of Endometriosis-Related Pain Its symptoms can be hard to tell apart from painful bladder syndrome, and women with endometriosis are more likely to have both.32Texas Children’s. Pelvic pain? Endometriosis isn’t always the culprit
For the appointment, keep a short diary of pain, periods, and bathroom trips for two weeks. A urine test will usually come first, to rule out an ordinary infection. Mention pain with sex too, which people often leave out.
Less Common but Serious Causes
Infection of the pubic joint causes severe pain, often trouble walking, and sometimes intermittent fever.33PubMed Central. Septic arthritis and osteomyelitis of the pubic symphysis – a retrospective study of 26 patients It can follow childbirth complicated by infection, pelvic surgery, or a bloodstream infection.34PubMed Central. Septic arthritis of the pubis symphysis: clinical and therapeutic features After surgery it can appear without fever and be mistaken for pubic bone overload.35PubMed. Postoperative pubic osteomyelitis misdiagnosed as osteitis pubis: report of four cases and review It’s treated with at least 6 weeks of antibiotics, and sometimes surgery.36PubMed Central. Septic arthritis and osteomyelitis of the pubic symphysis – a retrospective study of 26 patients
It’s easy to miss because the pain mimics a sports injury or pregnancy-related pain, so a doctor may reasonably think of those first. Clues that should raise suspicion are pain that is severe and getting worse, trouble walking, and a recent childbirth complication, surgery, or infection elsewhere in the body. Diagnosis relies on blood tests showing inflammation and on MRI, and sometimes on a sample from the joint to find the germ.
Fractures of the pubic bone can occur without a fall when bones are weakened.37PubMed. Insufficiency fractures of the pubic ramus Risks include osteoporosis, rheumatoid arthritis, kidney failure, long-term steroid use, pelvic radiation, and hip surgery.38PubMed. Insufficiency fractures of the pubic ramus These fractures bring groin pain that builds, a limp, and eventually trouble walking.39PubMed. Insufficiency fractures of the pubic ramus
Ankylosing spondylitis, an inflammatory arthritis mainly of the spine, sometimes affects the pubic joint.40PubMed. MR imaging of ankylosing spondylitis In one group with this kind of arthritis, about 1 in 5 had active inflammation around the pubic joint on MRI.41PubMed. Active inflammatory changes around the pubic symphysis in patients with axial spondyloarthritis: Magnetic resonance imaging characteristics and association with clinical factors Clues include back stiffness in the morning that eases with movement, onset typically in younger adults, and pain that improves with exercise rather than rest.
Rarely, pubic pain comes from cancer: some bone cancers favor the pelvis, and cancers like breast, prostate or lung can spread to bone.42Mayo Clinic. Bone cancer
Get same-day care for any of these:
- Fever or chills with pubic pain
- Sudden inability to walk or bear weight
- Pain after a fall in someone with fragile bones
- Pain that keeps worsening at night or at rest
- Unexplained weight loss or a history of cancer
How a Doctor Finds the Cause
Sharp tenderness when the doctor presses on the joint strongly points to the joint itself.43First Look MRI. Osteitis Pubis Pain when squeezing the knees together against resistance, or doing a sit-up, adds support.44First Look MRI. Osteitis Pubis But these squeeze tests miss many cases, catching only about a third to two-thirds.45PubMed. Description of pain provocation tests used for the diagnosis of sports-related chronic groin pain: relationship of tests to defined clinical (pain and tenderness) and MRI (pubic bone marrow oedema) criteria
For the squeeze test, you lie on your back, squeeze a fist or the doctor’s arm between your knees, and push inward while they resist. They may also move the hip through its range, press along the groin, and check the muscles of the lower abdomen and inner thigh. Pain reproduced in a particular spot tells them which structure to suspect, though no single test confirms it.
Plain X-rays are often normal early on.46First Look MRI. Osteitis Pubis MRI is the most sensitive scan, showing bone stress before X-rays change and checking the hip and nearby muscles too.47First Look MRI. Osteitis Pubis Ultrasound can examine the area in real time and guide injections.48PubMed Central. Imaging of Groin Pain: Magnetic Resonance and Ultrasound Imaging Features An X-ray taken while standing on one leg can show if the joint is unstable.49First Look MRI. Osteitis Pubis
It helps to arrive prepared. Note when the pain started and what you were doing, and list which movements hurt, such as stairs, rolling in bed, or kicking. Mention pregnancy, recent surgery, fever, or steroid use. Ask whether a normal X-ray rules things out, since it often doesn’t.
Treatment and Recovery Time
More than 90% of people with pubic bone overload improve without surgery.50PubMed Central. The challenges in diagnosis and management of osteitis pubis: An algorithm based on current evidence Rehab focuses on hip and trunk mobility, inner-thigh strengthening, and core stability.51PubMed. Nonoperative Management, Rehabilitation, and Functional and Clinical Progression of Osteitis Pubis/Pubic Bone Stress in Professional Soccer Players: A Case Series In one series of professional soccer players, all returned to pain-free play within about 11 weeks.52PubMed. Nonoperative Management, Rehabilitation, and Functional and Clinical Progression of Osteitis Pubis/Pubic Bone Stress in Professional Soccer Players: A Case Series
Bone and tendon attachments adapt slowly, so strengthening has to increase gradually to rebuild their tolerance to load. Starting early and following the steps without skipping ahead usually gets better results than waiting for the pain to disappear on its own.
For home relief, over-the-counter pain relievers help short term, though in pregnancy you should check with a doctor first. Ice or heat over the area can ease aches. Avoid wide-legged stretches until the problem has been assessed.
If physiotherapy fails, a steroid injection into the joint can be tried.53PubMed Central. The challenges in diagnosis and management of osteitis pubis: An algorithm based on current evidence About 60% of athletes return to activity after it, while roughly 20% see no improvement.54PubMed Central. The challenges in diagnosis and management of osteitis pubis: An algorithm based on current evidence Relief can be temporary.55International Journal of Sports Physical Therapy. Nonsurgical Management of Adductor-related groin pain with Ultrasound-Guided Platelet-Rich Plasma Injection and Physical Therapy in a Competitive Soccer Player: A Case Report Injections of platelet-rich plasma, made from your own blood, have helped in single reported cases.56PubMed. Osteitis Pubis Treated With Platelet-Rich Plasma: A Case Report Surgery is considered for only 5 to 10% of people, usually after at least 6 months of other treatment.57PubMed Central. The challenges in diagnosis and management of osteitis pubis: An algorithm based on current evidence