Pubic bone inflammation (osteitis pubis) is a non-bacterial inflammation of the pubic bone that is common in athletes. The cause of an inflammation on the pubis is usually an overload during training. As a rule, pubic inflammation with anti-inflammatory drugs and physical therapy exercises can be treated well. Although the therapy may take several months, surgery is rarely necessary. Here you can find out what signs you recognize a pubic bone infection and what you need to know about diagnosis and treatment.
Pubic bone pain as a symptom
A pubic bone inflammation usually develops creeping in the context of permanently intensively practiced sports. The most important signs are pubic pains that can radiate into the groin, hip or lower abdomen. Initially, the complaints usually only noticeable during sports or during activities such as climbing stairs or sneezing.
If you do not take a break from exercise, the symptoms often appear after a while due to the constant irritation when you are walking or resting. Pubic pains are also characterized by pain on the pubic bone or the tendons and tension in the inner thigh muscles.
Cause: Micro injuries due to overload
The pubic bone is part of the anterior pelvic ring, where numerous tendons of the abdominal and leg muscles attach. Because these two muscle groups pull in opposite directions, the pubic bone is exposed to high loads in sports with fast direction changes and sprints - for example, football, basketball, hockey or running sports.
Excessive or incorrect training can lead to repeated inflammation of the pubic bone, the tendons and the cartilage-joint connection in the middle of the pubis (symphysis).
Factors that favor pubic bone inflammation
In addition, the following factors may favor pubic bone inflammation:
- Current or previous pregnancy
- Births in the past
- Operations on the lower abdomen
- gynecological or urological operations
- Pubic bone or other injuries in the area of the pubis
- Rheumatological diseases
Which doctor in pubic bone pain?
The decision as to which doctor to consult for pubic bone pain is not that easy. Because in addition to a pubic bone infection, other causes may cause pain in the pubic bone. In principle, the family doctor is always a good first point of contact: Through targeted questioning and a physical examination, he can often already recognize which colleague he should best refer you to.
In the case of pubic bone inflammation in most cases an orthopedist or sports physician is the specialist of choice - depending on the history and clinical picture may also be a referral to the gynecologist in women or urologist in men may be useful.
PubMal infection: diagnosis by MRI
To get to the bottom of the cause of pubic bone pain, the doctor will usually first make an X-ray of the pelvis after a survey of the medical history (anamnesis) and a thorough physical examination. The X-ray image helps to rule out a fatigue break and may already find evidence of a pubic bone infection. In addition, an ultrasound scan can be performed to rule out other causes.
In general, the diagnosis of pubic bone inflammation can be secured by an MRI. In unclear cases, further imaging examinations such as skeletal scintigraphy can be performed - this is useful, for example, in the case of fever to exclude osteomyelitis of the pubic bone. In addition, the inflammatory values in the blood are usually determined for this purpose.
Physiotherapy important part of the treatment
A pubic bone inflammation can usually be treated conservatively - ie without surgery. At first, a sports break is important so that the inflammation can subside. Anti-inflammatory analgesics with drugs such as ibuprofen or diclofenac can relieve pain and aid healing.
An important part of the treatment is also the physiotherapy, in which the musculature is strengthened and stretched by specific exercises. In addition, physical therapies such as ultrasound treatment, cold or electrotherapy, as well as osteopathy or chirotherapy may be used to treat pubic bone inflammation.
What helps? Cortisone for the inflammation
If the pain in the pubic bone does not improve after a few weeks, despite a break from exercise and despite physiotherapy exercises, the temporary intake of cortisone-containing tablets may be useful in case of pubic inflammation, as cortisone has a strong anti-inflammatory effect.
In addition, an orthopedist may inject a mixture of cortisone and a local anesthetic into the symphysis. The advantage of this is that the active ingredients act directly at the site of inflammation, which can reduce side effects.
Pubic bone inflammation: OP as last option
The treatment of pubic bone infection can last for several months and often requires a lot of patience. As a rule, surgery should not be considered for pubic inflammation until all conservative treatments have been exhausted.
In an operation, the inflamed tissue can be scraped off in these cases by a so-called curettage. As a last resort, a stiffening of the symphysis (arthrodesis) or a partial removal of the pubic bone can be performed.
Good chances for healing
Although the treatment can be very tedious, the chances of curing it in a pubic bone infection are very good: in about 90 percent of the cases there is a complete regression of the pain without surgery.
Prevent pubic inflammation by stretching
To prevent pubic bone inflammation or prevent relapse, you can do a few things yourself:
- Warm up sufficiently before exercise, such as running and stretching muscles.
- Have a trainer or physical therapist perform stretching and strengthening exercises for your abdominal and thigh muscles. Regular stretching helps to avoid muscular tension and imbalance.
- Wear well-padded jogging shoes while jogging to reduce the stress on your bones and joints.
- Avoid sports with abrupt movements on hard ground.
- Do not overdo it with exercise and give your body regular exercise breaks.