Osteitis pubis is the inflammation of the pubic symphysis and the surrounding muscle insertions. Osteitis pubis is identified by sclerosis and bony changes of the pubic symphysis. This condition was first observed in patients undergoing urologic procedures. Nonetheless, further research shows that there are multifactorial causes of osteitis pubis. One cause is abnormal sheering forces across pubic symphysis triggered by muscle imbalance and poor flexibility. This microtrauma to the pubic symphysis results in inflammation and muscle spasms. Other examples of microtrauma include the following: pregnancy and childbirth, gynecologic surgery, urologic surgery, major trauma, repeated minor trauma, rheumatologic disorders, sacroiliac (SI) joint dysfunction, running, kicking, or rapid lateral movements that occur in soccer, sprinting, ice hockey, and football.
The prevalence of osteitis pubis is unknown; however, this condition has been reported to commonly occur in men aged 30 to 50 years old. Women are affected in their mid-30s. Patients will often complain of vague symptoms such as groin or lower abdomen pain localized over symphysis that may radiate to the groin, scrotum, perineum, mid-thigh, hip, or abdomen. Athletes will complain of adductor pain to lower abdominal pain that radiates to the pubic area. Many times, the pain will be described as unilateral and present for a few days to weeks, exacerbated by activity such as running, pivoting on one leg, kicking, or pushing off to change one direction, and lying on the side. Pain also occurs while walking, climbing stairs, coughing, or sneezing.
If you or anyone you know have these symptoms, please contact your primary care physician or general practitioner for a physical assessment and work-up. The treatment plan may consist of rest and time (2 weeks to 3 months for non-athletes; 3 months to 6 months for athletes with a gradual return to sports), ice, heat, NSAIDs (ibuprofen), and physical therapy. If pain persists, a consultation with a gynecologist, urologist, infectious disease physician, podiatrist, or physical therapist may be necessary. Osteitis pubis has a good prognosis.
References
Goitz, H. (2018). Osteitis Pubis. https://emedicine.medscape.com/article/87420-overview.
Gomella, P., & Mufarrij, P. (2017). Osteitis pubis: A rare cause of suprapubic pain. Reviews in urology, 19(3), 156–163. https://doi.org/10.3909/riu0767.
Vipman. (2020). [Illustration]. Human pelvic bone with highlighting of the area of pain in the symphysis pubis. https://www.shutterstock.com/image-vector/human-pelvic-bone-highlighting-area-symphysis-1855070950.