Osteitis Pubis
Osteitis Pubis – it’s one of those terms that sounds fake, right? Okay, maybe that’s just me, or maybe it’s because I’ve been reading article after article about osteitis pubis lately and it’s making me go a little loopy. It’s like if you say the word “door” (or any word!) a hundred times in a row–after a while, you start to question whether it’s even a real word! Anyway, let’s chat about osteitis pubis today– I hope you leave this chat a bit wiser about the condition and not with your mind melting, like mine seems to be!
What is osteitis pubis?
Osteitis Pubis is a noninfectious inflammation of the pubic symphysis. To better understand this, let’s go back to some pelvic anatomy. The bony pelvis is made up of two pelvic bones and the sacrum/coccyx. The pelvic bones come together in the front of the body and connect at the point of what you might call your “pubic bone.” Any time two bones come together, they form a joint. The joint in the very front of your pelvis, at your “pubic bone” is called the pubic symphysis. This is a cartilaginous joint that is essential for stabilizing the pelvis and helping with the transfer of weight between the two sides of the pelvis. It may seem very immobile, but it does allow for a small bit of movement.
Pelvic Girdle Graphic
What causes osteitis pubis?
When the pubic symphysis becomes inflamed, this is osteitis pubis. It can be caused by a number of things including sports, pregnancy/childbirth, surgery, or rheumatologic disorders (1, 2). Let’s dive a little bit deeper into each of these:
Sports: Osteitis pubis usually affects athletes that are using their core and hips to twist repetitively. Motions like cutting, pivoting, kicking, and sprinting have been associated with osteitis pubis (2). Such sports where this is the case includes soccer, rugby, ice hockey, and long distance running (2).
Pregnancy/Childbirth: While pelvic girdle pain (PGP) is extremely common during pregnancy, osteitis pubis, though a related condition, is much more rare. I have yet to come across any studies that describe the incidence of osteitis pubis in pregnant or postpartum folks. However, there are many published case studies that describe incidences of osteitis pubis in postpartum women (3).
Surgical Procedures: Urological surgeries can increase the risk of osteitis pubis (1). While rare, the condition can occur after procedures such as Transurethral Resection of the Prostate (TURP), prostatectomy, cystectomy, among others (4).
Rheumatological Disorders: Disorders such as including ankylosing spondylitis, osteoarthritis, and rheumatoid arthritis have been associated with osteitis pubis (2).
How is osteitis pubis classified?
One journal article classified athletes with osteitis pubis into four categories:
Stage 1: Pain on one side that is worse after a training session.
Stage 2: Pain on both sides that is worse after a training session.
Stage 3: Pain on both sides with the inability to continue participation in the sport.
Stage 4: Groin pain involving the adductor muscles, abdominal muscles, pelvic girdle, and lumbar spine that occurs on activities such as defecation, sneezing, walking on uneven terrain and impedes the individual’s ability to complete normal activities of daily living (5).
How is it treated?
Osteitis pubis can be a debilitating condition. In its worst form, people have difficulty completing their normal daily activities due to high levels of pain and discomfort. The good news is that, according to many studies, osteitis pubis is often a self-limiting condition, meaning it may resolve on its own without medical treatment or intervention (6). The condition could last anywhere from a couple weeks to a couple months to a couple years. However, treatment and medical intervention can improve management of the condition and help folks that are afflicted to return to their normal activities.
Typical conservative (ie non-surgical) treatment for osteitis pubis includes rest, ice, activity modification, anti-inflammatory medication, and a stretching/strengthening program aimed at improving any muscle imbalances that might exist among the muscles attached to the pelvis (7). Studies have shown that with conservative management, athletes may be able to return to competition within 3 months of diagnosis (7, 8).
In cases where typical conservative management fails to help symptoms improve, local corticosteroid injections may be used (7).
In some rare cases where all conservative management does not resolve the issue, surgery may be indicated. The specific surgical procedure(s) performed will be patient-dependent and will be based on what the provider has determined to be the reason for the continued inflammation of the pubic bone (7).
Overall, the research into osteitis pubis is fairly limited. This is, in my opinion, due to the condition being self-limiting and non-life-threatening (thank goodness!). Also, much of the research that exists is relating to athletes, especially elite athletes, who are hoping to return to sport. This leaves little information available for other folks experiencing the condition, such as those recently postpartum. If you have pelvic or groin pain at any point in life, talk with your medical provider about it so that they can help direct you toward the appropriate treatment and care. Osteitis pubis can make it difficult to complete even the most basic tasks, so it is important to find a care team that can get you back on your feet (literally!) as quickly as possible.
XOXO,
Your Pelvic Bestie
References:
https://my.clevelandclinic.org/health/diseases/24610-osteitis-pubis
Scott DL, Eastmond CJ, Wright V. A comparative radiological study of the pubic symphysis in rheumatic disorders. Ann Rheum Dis. 1979;38:529–534. doi: 10.1136/ard.38.6.529.
Madhusoodanan V, Katz JE, Bhat A, Shah HN. Endourological management of osteitis pubis secondary to a calcified prostate ossifying into the pubic symphysis. BMJ Case Rep. 2021 May 20;14(5):e242009. doi: 10.1136/bcr-2021-242009. PMID: 34016634; PMCID: PMC8141447.
Rodriguez C, Miguel A, Lima H, Heinrichs K. Osteitis Pubis Syndrome in the Professional Soccer Athlete: A Case Report. J Athl Train. 2001;36:437–440.
Angoules AG. Osteitis pubis in elite athletes. World J Orthop. 2015;6(9):672–679. doi: 10.5312/wjo.v6.i9.672.
Via AG, Frizziero A, Finotti P, Oliva F, Randelli F, Maffulli N. Management of osteitis pubis in athletes: rehabilitation and return to training - a review of the most recent literature. Open Access J Sports Med. 2018 Dec 24;10:1-10. doi: 10.2147/OAJSM.S155077. PMID: 30613167; PMCID: PMC6307487.
Jardí J, Rodas G, Pedret C, et al. Osteitis pubis: can early return to elite competition be contemplated? Transl Med UniSa. 2014;10:52–58.
*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives
