Abdominal pain or discomfort is common during pregnancy. Eventually, ligaments stretch, hormone levels change, and organs shift to make room for your growing uterus. But sometimes pain is a warning sign that something more serious is wrong.
Consult our guide to learn how to decode your pain, determine when it's time to call the doctor and get easy symptom pacifiers for pelvic pain during pregnancy.
What Causes Pelvic Pain During Pregnancy?
From relaxed pelvic joints to pressure from the weight of your growing baby, here are the most common causes of benign pelvic pain during pregnancy. If your pain doesn't go away — or if you have symptoms like bleeding, an unusual discharge, or severe cramping — call your gynecologist.
Dysfunction of the pubic symphysis (SPD)
Estrogen, progesterone, and relaxin (which helps stretch ligaments for childbirth) levels increase during pregnancy. "An increase in these hormones causes the pelvic ligaments to become more relaxed and soft, and the joints to become more flexible," says Heba Shaheed, a physiotherapist specializing in women's and pelvic health who founded The Pelvic Expert in Sydney, Australia. The joint in front of your pelvis - called the symphysis - can become particularly stretchy and unstable, which can lead to pelvic pain during pregnancy. Shaheed says the pain can start soon after conception but tends to get worse towards the end of the pregnancy. Some women like to use pelvic support belts, which can help stabilize the area. Note that pubic symphysis dysfunction (SPD) can also be referred to as pelvic girdle pain.
Between the 8th and 12th week of pregnancy you may experience cramping pain that feels like your period is coming. As long as it's not bleeding, it's probably just your uterus expanding. You're likely to feel this less in your first pregnancy than in subsequent pregnancies, says Stanley Greenspan, M.D.
Circular Ligament Pain
As you begin your second trimester, you may begin to feel pain in your side as the ligament that stretches from the top of the uterus to the groin. "Women tend to feel this when they're walking or getting up from a chair," says Dr. Suzanne Merrill-Nach, midwife in San Diego. "The uterus tilts and pulls on the ligament." Lying on the side that's bothering you can make the pain go away — and it should go away for good in about 24 weeks.
Diastasis recti, which occurs when your rectus muscles separate during pregnancy, can also cause pelvic pain similar to SPD. "The muscles in your abdomen attach from your breastbone down to your pubic bone, and the pubic muscles are stretched by hormone changes," explains Shaheed. Diastasis recti is very common during pregnancy. If you develop it, your doctor will likely suggest an at-home exercise plan after the birth. In rare cases, severe cases of diastasis recti can be operated on.
Pressure from Your Baby's Weight
Once you are in your third trimester, you may begin to feel pressure in your pelvic region as the weight of your rapidly growing fetus puts pressure on the nerves that run from your vagina to your legs. "This pain typically occurs with movement, such as walking or driving, because the baby is bouncing," says Dr. Merrill-After. To relieve pelvic pressure during the third trimester, lie on your side and rest.
Functional ovarian cysts, which form due to changes in the way your ovaries produce or shed eggs, are very common, noncancerous, and generally harmless. They can get bigger during pregnancy, and the pressure your growing uterus puts on your ovaries can cause persistent pain. If the cyst ruptures, the pain can suddenly get worse.
Be sure to tell your gynecologist if you have had ovarian cysts in the past or if you think you may have developed them during your pregnancy. They may do an ultrasound to make sure the cysts haven't grown too large.
In rare cases, a cyst can twist (called a torsion) — a serious condition that usually occurs after sudden or vigorous activity, such as B. running to catch a bus or having sex. "A patient with torsion is usually heartbroken," says Dr. Greenspan. "The pain is very sharp, strong, and constant, and nausea, vomiting, and sweating may occur." If you suspect you have a torsion, call your doctor right away.
Braxton Hicks Contractions
Pelvic pressure or tightness that comes and goes could be contractions, but if they're intermittent and generally not painful, they're most likely exercise contractions called Braxton Hicks and not real labor. These "exercise" contractions usually appear after about 20 weeks and can be triggered by dehydration, so make sure to drink plenty of water. (You'll know it's a contraction when you lie down and feel your stomach; your womb will harden and then relax.) They should go away on their own, but if you're having more than four contractions an hour for two hours, call your doctor doctor. "When we talk about preterm labor generally before 37 weeks, we're looking for contractions every 15 minutes or less that last for more than two hours, even if the patient has an empty bladder and is lying down," says Dr. Merrill-After.
Urinary tract infection (UTI)
According to the March of Dimes, up to 10 percent of expectant mothers will get a urinary tract infection (UTI) at some point during their pregnancy. Typical symptoms include a sudden urge to urinate, pain or burning when urinating, and bloody urination, but some people with a UTI also experience abdominal pain, says Linda Chambliss, M.D., director of obstetrics at St. Joseph's Hospital and Medical Center in Phoenix.
"The concern with UTIs during pregnancy is that they can lead to infection of your kidneys, which increases the risk of preterm labor," she adds. That's one of the reasons your OB-GYN will test your urine at every visit to look for signs of bacteria that can lead to a UTI. The good news is that if caught early, a UTI should be easily treatable with antibiotics.
Constipation, which is common when you are pregnant, can cause pelvic pain or discomfort during pregnancy. (Hormones slow down the digestive tract, as do the iron supplements your gynecologist may recommend.) Drink plenty of water and eat high-fiber foods like raw fruits and vegetables. If that doesn't help, ask your obstetrician if you can try a stool softener or glycerin suppository, suggests Dr. Greenspan before.
Vulvodynia During Pregnancy
Vulvodynia is a condition that causes chronic vulvar and vaginal pain but has no obvious source. It's not caused by an infection, obvious trauma, or injury — and yet the pain can be really bad. It is difficult to diagnose, and even when a doctor diagnoses it correctly, many women are treated ineffectively and disrespectfully because the source of the pain is nothing for doctors to see or test. If you have vulvodynia, an epidural can help with labor and birth pains.
Can Pelvic Pain During Pregnancy Be Serious?
Some women develop serious complications during pregnancy that cause various types of pain. If you have pelvic pain that is accompanied by certain symptoms, such as fever and bleeding, call your doctor right away. Here are the more serious causes of pelvic pain during pregnancy.
When women experience abdominal pain in the first trimester, "there's always a concern about miscarriage," says Dr. Patrick Duff, professor and director of the residency program in the Department of Obstetrics and Gynecology at the University of Florida at Gainesville. Unfortunately, 15 to 20 percent of pregnancies end in miscarriage. Symptoms of miscarriage include bleeding and cramping, which can be rhythmic or resemble menstrual cramps.
If you have persistent back pain and pelvic pressure that comes and goes, you may be in labor. "My rule is, if you're having four or more contractions per hour and they last for two hours, even after you've urinated and laid down, you should come for an evaluation," says Dr. Merrill-After. If these symptoms appear before the 37th week, it is considered preterm labour.
Ectopic, or tubal, pregnancies, in which the egg implants somewhere other than the uterus, most commonly the fallopian tube, occurs in 1 in 50 pregnancies, according to the March of Dimes. In the unlikely event that you have an ectopic pregnancy, you may experience severe pain and bleeding between the 6th and 10th week of pregnancy as the fallopian tube expands.
You may be at increased risk of an ectopic pregnancy if you have had an ectopic pregnancy in the past or had pelvic, abdominal or fallopian tube surgery, endometriosis, a tubal ligation or intrauterine device (IUD) at the time of conception, or a pelvic infection. An abnormally shaped uterus and the use of artificial reproductive techniques also appear to increase the risk.
Ectopic pregnancies cannot continue and require immediate treatment. If you've had a positive pregnancy test but your pregnancy hasn't yet been confirmed by a physical exam and you're experiencing abdominal pain, you should see your gynecologist right away, says Linda Chambliss, M.D., chief of obstetrics at St. Joseph's Hospital and Medical Center in Los Angeles Phoenix. Your gynecologist or midwife can do an ultrasound to confirm if the egg has implanted in the uterus.
Your placenta is your baby's source of oxygen and nutrients. It is usually implanted high on the uterine wall and only detaches after your baby is born. In rare cases (1 in 200 births), the placenta can detach from the uterine wall, a dangerous complication that most commonly occurs in the third trimester.
dr Duff describes pain from placental abruption as "severe, constant, progressively worsening lower abdominal pain." Your uterus can become rock hard (when you press on your stomach, it doesn't buckle) and you can also bleed dark, red blood without a clot. In some cases, it's possible for labor to be induced by placenta separation, in which case a doctor will usually deliver the baby via emergency caesarean section. If the termination is easy, a doctor can continue the pregnancy or induce labor and perform a vaginal delivery.
You could be at risk for this condition if you have a history of abrupt placenta, high blood pressure, preeclampsia, and abdominal trauma.
Uterine fibroids are benign growths of the uterus. They are most common during childbearing years, and pregnancy can encourage fibroids to grow; they may or may not hurt. "When a fibroid grows rapidly, it can overwhelm its blood supply and degenerate, causing pain," says Dr. Greenspan. "Most of the time we only observe them during pregnancy, but sometimes they need to be surgically removed in order for the pregnancy to continue."
It's rare but possible for the uterus to rupture, especially if you have a scar from a previous cesarean section or other abdominal surgery. When it happens, it feels like "sudden severe tearing pain in the midline where there is a previous scar," and it can be catastrophic and potentially fatal to both mother and baby, says Dr. Greenspan.
Ruptures that occur outside of labor usually follow some type of trauma to the abdomen. "There is no way to prevent a uterine rupture," says Dr. Greenspan. "However, if the patient has a risk factor for a fracture, she should be closely monitored by her doctor and her symptoms taken seriously, especially if the pain occurs and worsens later in the pregnancy."
According to the Preeclampsia Foundation of America, 5 to 8 percent of all pregnant women have preeclampsia and other hypertensive disorders. Preeclampsia can develop anytime after 20 weeks of pregnancy, which is one reason your doctor will check your blood pressure at every appointment, and is characterized by high blood pressure and protein in the urine. Because high blood pressure narrows the vessels in the uterus that carry oxygen and nutrients to the fetus, the baby's growth can be slowed.
Preeclampsia also increases the risk of placental abruption, where the placenta detaches from the uterine wall before delivery. Severe preeclampsia may be accompanied by upper right abdominal pain, nausea, headache, swelling, and visual disturbances such as blinking lights. If you suspect you have preeclampsia, call your gynecologist right away.
Another unlikely but serious cause of severe pelvic pain during pregnancy: Your ovaries may become twisted. This can happen at any time but is more likely to occur in the early stages of pregnancy. "The ovary is like a hammock or spindle, so it can turn over and cut off its own blood supply," says Dr. Greenspan. A risk factor for ovarian torsion is ovulation induction, as this can lead to enlarged ovaries. Symptoms include abdominal pain, nausea, and fever.
Appendicitis can also occur during pregnancy. Generally, you would feel pain in the lower right part of your abdomen. "Appendicitis can be insidious during pregnancy because it pushes the appendix higher in the abdomen as it progresses," says Dr. Merrill-After. Appendicitis requires emergency surgery to remove the appendix to avoid risk of rupture.
If you feel severe pain that waxes and wanes and progresses down your side, you may have a kidney stone. "Usually we make women more comfortable and just wait for the stone to pass," says Dr. Merrill-After. Talk to your doctor if you suspect you have kidney stones.
How to relieve pelvic pain during pregnancy
- Try these tips for common pelvic ailments.
- Take a warm—never hot—bath or stand in the shower and let the water hit your back.
- Get a prenatal massage.
- Try pelvic support clothing, which can prevent the uterus from pressing down on your pelvis.
- Wear shoes with low heels and good arch support.
- Try to avoid quick movements and sharp bends in the waist.
- Get regular exercise - it might help prevent pain in the first place.
When to call the doctor
Don't hesitate to call your doctor if you feel something is wrong. "I'd rather call a patient with any concerns because I don't want her not to call and find out later that it was something important," says Dr. Greenspan. Call right away if you have any of these signs:
- Pelvic pain that makes you unable to walk or speak
- Any bleeding
- fever and/or chills
- Strong headache
- Sudden swelling of the face, hands and/or feet
- Persistent nausea and/or vomiting
- Less than 10 fetal kicks in an hour, from 28 weeks to delivery
- More than four contractions in an hour for two hours
- Watery, greenish or bloody discharge