Abdominal Pain During Pregnancy
Some abdominal pain during pregnancy is normal: After all, your organs are constantly shifting, your uterus is expanding, and your ligaments are stretching. And let's not forget morning sickness. But abdominal pain during pregnancy can be much more serious (though much rarer). Consult our guide to learn how to decode your aches and pains, determine when it's time to call the doctor, and get simple symptom soothers.
What are some harmless causes of abdominal pain during pregnancy?
From constipation to round ligament pain, here are some common culprits that cause benign abdominal aches and pains during pregnancy. If the pain you're experiencing continues, or if you have symptoms such as bleeding or strong cramping, check in with your ob-gyn.
Your growing uterus
As your uterus grows, it displaces your bowel, "which can lead to nausea, a sense of feeling full easily, or distention in your abdomen," says Patrick Duff, M.D., professor of obstetrics and gynecology at the University of Florida at Gainesville. The solution? Eat more frequent, smaller meals, exercise regularly, get rest, and empty your bladder often.
Round ligament pain
"Sometimes as the uterus enlarges, it stretches the round ligaments--two big ligaments that travel off the front of the uterus and down into the groin," Dr. Duff says. You may feel this as lower abdominal discomfort that radiates into the groin; it may be sharp and stabbing when you change positions or dull and achy. It usually begins in the second trimester and will resolve on its own, but if you're extremely uncomfortable ask your ob-gyn if you can take acetaminophen.
Constipation and gas
Constipation and gas are, unfortunately, often part and parcel of pregnancy. Progesterone, a hormone that increases during pregnancy, slows down your entire gastrointestinal tract, making foods travel more slowly through it. To combat constipation, drink plenty of water and eat fiber-rich foods. If that doesn't relieve the problem, your midwife or ob-gyn may recommend a stool softener or a fiber supplement.
Braxton Hicks contractions
"Braxton Hicks contractions are not associated with dilation of the cervix," Dr. Duff says. "They are annoying, but totally benign." The trick is to differentiate these "practice contractions" from real premature labor. "True contractions tend to get closer and closer together," Dr. Duff says. "If someone can carry on a conversation, watch television, or read, then the contractions are probably not real labor." Dehydration can trigger Braxton Hicks contractions, so be sure to drink plenty of fluids. If the contractions persist, or you're not sure whether they're Braxton Hicks or true contractions, call your ob-gyn.
What are more serious cases of abdominal pain during pregnancy?
Many women have healthy pregnancies, but serious complications can develop that require immediate attention from your ob-gyn. Some red flags to watch out for include bleeding, severe pain, fever, and visual disturbances.
Ectopic or tubal pregnancies, in which the egg implants someplace other than the uterus, most often in the fallopian tube, occur in 1 in 50 pregnancies, according to the March of Dimes. In the unlikely event that you have an ectopic pregnancy, you may experience intense pain and bleeding between your 6th and 10th weeks of pregnancy, as the tube becomes distended. Women at increased risk for an ectopic pregnancy include those who have had an ectopic pregnancy in the past, or have had pelvic, abdominal, fallopian tube surgery, and those who have had endometriosis, a tubal ligation, an intrauterine device (IUD) in place at the time of conception, or a pelvic infection. An abnormally shaped uterus and the use of artificial reproductive techniques also seem to increase the risk.
Ectopic pregnancies cannot continue and require immediate treatment. If you had a positive pregnancy test but have not yet had your pregnancy confirmed by a medical exam, and you experience abdominal pain, you should be evaluated immediately by your ob-gyn, says Linda Chambliss, M.D., chief of obstetrics at St. Joseph's Hospital and Medical Center in Phoenix. Your ob-gyn or midwife can perform an ultrasound to confirm whether the egg has implanted in the uterus.
When women experience abdominal pain in the first trimester, "you always have to be concerned about miscarriage," Dr. Duff says, because the unfortunate fact is that 15 to 20 percent of pregnancies end in miscarriage. Symptoms of miscarriage include bleeding and cramping that can be rhythmic or resemble menstrual cramps.
If you're experiencing regular contractions before you're 37 weeks pregnant, and you have a persistent backache, you could be having preterm labor. Now is not the time to wait it out--call your ob-gyn right away. The contractions may or may not be accompanied by leaking vaginal fluid or blood or a decrease in fetal movement. Even experienced pros on their third pregnancy may not be able to tell if contractions are just Braxton Hicks or true preterm labor, Dr. Chambliss says, so she asks her patients to call anytime they feel contractions. You may end up being sent home because it's a false alarm (Dr. Chambliss says that up to 30 percent of the women who show up in her triage unit are), but it's better to be safe than sorry, especially in this case.
Your placenta is the source of oxygen and nutrients for your baby. It usually implants high on the uterine wall and doesn't detach until after your baby is born. In rare cases (1 out of every 200 births), the placenta can separate from the uterine wall, a dangerous complication, which is most common in the third trimester. Dr. Duff describes the pain from a placental abruption as "severe, constant, progressively worsening lower abdomen pain." Your uterus may become rock hard (if you press on the abdomen, it won't indent) and you may also have dark, red blood that does not have clots. In some cases, a woman may go into labor when her placenta separates, in which case her ob-gyn will usually deliver the baby by emergency cesarean section. If the abruption is mild, a doctor may allow the pregnancy to continue or may induce labor and do a vaginal delivery. Women at risk for this condition include those who have a history of placental abruption, or who have high blood pressure, preeclampsia, and abdominal trauma.
According to the Preeclampsia Foundation of America, preeclampsia and other hypertensive disorders are experienced by 5 to 8 percent of all pregnant women. Preeclampsia can develop anytime after 20 weeks of pregnancy, which is one reason why your doctor checks your blood pressure at every appointment, and it is characterized by high blood pressure and protein in the urine. Because high blood pressure constricts the vessels in the uterus that supply the fetus with oxygen and nutrients, the baby's growth may be slowed. Preeclampsia also increases the risk of placental abruption, in which the placenta separates from the uterine wall before delivery. When preeclampsia is severe, it can be accompanied by pain in the upper right portion of your abdomen as well as nausea, headaches, swelling, and visual disturbances, such as flashing lights. It you suspect that you have preeclampsia, call your ob-gyn immediately.
Urinary Tract Infection (UTI)
Up to 10 percent of expectant moms will get a urinary tract infection (UTI) at some point during their pregnancy, according to the March of Dimes. Typical symptoms include a sudden urge to urinate, pain or burning with urination, and bloody urination--but some patients with a UTI also experience abdominal pain, Dr. Chambliss says. "The concern with UTIs during pregnancy is that they can progress to an infection in your kidneys that will increase your risk of preterm labor," she adds. That's one reason why your ob-gyn tests your urine every visit, to check for the signs of bacteria that can lead to a UTI. The good news is that if a UTI is caught early it should be easy to treat with antibiotics.
Appendicitis can be difficult to diagnose in pregnancy, says Dr. Duff, because "as the uterus enlarges, the appendix pulls up and can get up near the belly button or liver. That atypical presentation gives us a curve ball." And because a diagnosis can be delayed, it's one of the reasons a woman is at greater risk of dying from appendicitis during pregnancy. Although the usual hallmark of appendicitis is pain in the lower right quadrant of your abdomen, when you're pregnant you may feel it higher up. Other symptoms include lack of appetite, nausea, and vomiting.
Stones in the gallbladder are more common in women, especially if they are overweight, over the age of 35, or have a history of stones, Dr. Chambliss says. The pain from gallstones (also called cholecystitis) is severe and focused in the upper right quadrant of your abdomen. In some cases, the pain may also radiate around to your back and under your right shoulder blade.
When should I call my ob-gyn?
Don't hesitate to call your doctor if you feel like something's not quite right. "If you have anything that you're concerned about you should contact your ob-gyn or be seen," says Rebecca Shiffman, M.D., director of Maternal Fetal Medicine at Lincoln Hospital in Bronx, New York. "That's what we're here for--to provide answers to pregnant women and to provide whatever care they need." Always call your doctor right away if you have any of these symptoms:
- Abdominal pain with or without bleeding before 12 weeks
- Bleeding or strong cramping
- More than four contractions in an hour for two hours
- Severe abdominal pain
- Visual disturbances
- Severe headache
- Severe swelling of the hands, legs, or face
- Pain during urination, difficulty urinating, or blood in your urine
Is there anything I can do to help ease abdominal discomfort during pregnancy?
- Eat small, frequent meals
- Exercise regularly, in moderation
- Choose fiber-rich foods (including fruits, vegetables, and bran)
- Drink plenty of water
- Empty your bladder often
- Rest as often as you can