Postpartum Osteitis Pubis

For the first time in over a year, I woke up without pain in my hips. I rolled over in bed, and it didn’t hurt. I used my legs to lift the covers by my feet, and it didn’t hurt. When I got out of bed and walked to the bathroom, my chronic & acute case of postpartum osteitis pubis was no longer causing me pain.

Yesterday, I had a minor surgical procedure to get a cortisol shot in between my pubic bones. The procedure required full anesthesia, and a breathing tube down my throat, and marked the end of a medical journey that began before I gave birth, when I needed a belly band to walk around at work. There was a time when I was 8 months pregnant when, for my birthday, I tried to walk down the main street of Annapolis for a holiday event. I made it less than a mile before I had to retreat to the car, nearly in tears from the pain — and that was with the belly band.

I got a referral to a physical therapist, who tried to help, but there’s not a lot you can do with a woman who’s eight months pregnant when it comes to physical therapy and the pelvic region.

I thought things would get better after I had the baby, and I wasn’t carrying around an 8 lb bowling ball in my tummy anymore. My initial recovery went well enough according to my doctors, and after six weeks I was at the gym taking every yoga class they offered. I took it easy, of course, but I could feel myself getting better, recovering. I went for walks at the park, nothing too strenuous. I thought I was getting better.

About a month later, I knew I wasn’t going to get all the way better on my own. But then the pandemic hit, and I just didn’t see the point of a virtual pelvic exam. So I waited until the summer before I could finally get a referral to a pelvic physical therapist who might be able to help and in the meantime did virtual stretches with a friend who is a dancer, and at least knew about physical therapy and it’s principles and did her best to help my body — and in fact when I finally did get in to see the physical therapist she offered me a lot of the same exercises that my friend had given, but, as I'd expected, being in person made all the difference.

She thought I had adductor tendinosis, perhaps caused by a long hike I’d made a couple of years back with my husband where we got a little lost and hiked a little farther than we meant to, and I wound up in so much hip pain I couldn’t drive for two days.

It seemed plausible that I pulled something, didn’t let it heal enough, and then exacerbated the pre-existing injury with my pregnancy.

And physical therapy helped a lot. I went from being unable to lift my foot more than a couple of inches off the floor without pain to actually being able to, you know, do that. Yoga helped too, giving me the vocabulary I needed to articulate what problems I was having and helping to improve my strength in an environment that encouraged me to listen to my body instead of push through the pain.

But after 6 months of physical therapy, I had plateaued. I could still only walk about a mile without pain, although at least now it wasn’t utterly debilitating. And in some ways I’d actually gotten worse, the pain migrating from my groin up to my lower abdominal muscles. The physical therapist suggested I tried dry needling to deal with the knot in my abdominals. At that point I was willing to try anything, an insurance was willing to pay for it, so I gave it a go.

An hour of awkward, excruciating pain later, during which I had to simultaneously relax while someone put a needle in me and also describe the sensations I was feeling in terms of hot, sharp, or spasm. I couldn’t just zone out and focus on something different, the way you do when you get a blood draw or regular shot. Unlike the pain of labor, I had no guarantees of success, and no endorphins to help. In a word, it sucked. It also didn’t help at all; the tech who performed the procedure never did get the kind of muscle spasm she was trying to get from the knot in my abdominal muscle to force it to relax. She tried other locations, with more success in terms of getting the results she was looking for, but it wasn’t what I have been sent there for, and it didn’t help with anything. When she tried putting a needle into my side — in that precise place that teenage boys like to grab women and squeeze thinking that it tickles and refusing to understand that no, it actually hurts, I’m flinching because it hurts — I stopped her and left.

So then my physical therapist sent me to an orthopedic doctor. During intake, the physician’s assistant had me get an x-ray, which turned up a cam lesion, and possible symptoms of something called femoral acetabular impingement.

She referred me for an MRI, which took about two weeks to get. When they told me that I might need physical therapy before insurance would approve the MRI, I laughed. By that point, I’ve been in physical therapy for 6 months, it was my physical therapist who’d referred me to them.

Thankfully, insurance didn’t argue.

The MRI results threw around words like pre-arthritis, femoral acetabular impingement, and edema possibly caused by pregnancy. It was time to schedule an appointment with the doctor.

When I met with the doctor, 6 months of physical therapy and yoga paid off. I was able to describe my symptoms with enough detail that he could replicate my problems in unexpected ways no one else had. After about 5 minutes of consultation, he pulled up my MRI, pointed at my edema, explained the picture, and told me that while I did, in fact, have a cam lesion and femoral acetabular impingement, I was apparently part of the 10% of the population that doesn’t actually have any difficulties from that per se. I have spectacular range of motion in my hip; by some definitions I’m hypermobile… Which is weird for someone with my bone structure, and is how I’m able to do a full butterfly in yoga even when I’m not stretched, much to the surprise of my dancer friends.

I was diagnosed with postpartum osteitis pubis. The orthopedic doctor was very confident. It’s rare for it to get as bad as I have it (easily accessed internet resources are all very confident that it clears up on its own with only mild intervention, sort of the opposite of the WebMD effect), it’s apparently something that I’m predisposed to because of my bone structure, but usually is only a concern for people who play soccer intensely regularly for a long time, and some small percentage of people who have babies.

In the end, the doctor told me that I had three options: I could wear a belly brace, which might help, but I knew from when I was pregnant that it would be uncomfortable. I could get a cortisol shot which can predispose you to arthritis in joints that articulate, if you get one in one of those joints, such as your hands or your hips, but isn’t really an issue with your pubic bones, which only really matter when you’re giving birth. If that didn’t work (and he was pretty confident that it either would or it wouldn’t and I would know after two days or so), he could try fusing the bones together. When asked if that might cause complications for pregnancy down the line, he seemed confident it wouldn’t, but happily that seems moot.

I elected to get the cortisol shot. After about two days of phone tag, they scheduled me for an appointment about two weeks out, time to be determined the day before. Everything was arranged, until I got a call back: the equipment my doctor would need to do my procedure — a precision x-ray machine so that he could be sure to put the needle in the right place — was only located at the office half an hour from my house, not the office 10 minutes from my house. My husband would need to take off work to drive me there and back.

And then we would need a babysitter, but by this point I was committed. My mother-in-law heroically agreed to come over at 5:30am, so I could make my 6:30 appointment without destroying my son’s sleep and eating schedule.

I woke up this morning, and other than some lingering aches in my back and abdominals, from all the pressure they’ve been under for so long to help support my body when my adductors and stabilizers couldn’t, I feel better than I have since I got pregnant two years ago.

I can finally hold my son for more than five minutes without pressure in my hips. My back and hips are still a little twingey, but it’s only been a day and those areas have been working overtime to support my adductors and stabilizers, so I’m hopeful that with a little time and care, I’ll be back to some semblance of normal — nearly two years after I got pregnant.