Is it normal to have some abdominal pain during pregnancy?
Occasional abdominal discomfort is a common pregnancy complaint, and while it may be harmless, it can also be a sign of a serious problem. (Severe or persistent abdominal painshould never be ignored.)
Below we'll describe the most common causes of abdominal pain and discomfort during pregnancy, but don't try to diagnose yourself. If you experience abdominal pain or cramping along with spotting, bleeding, fever, chills, vaginal discharge, faintness, discomfort while urinating, or nausea and vomiting, or if the pain doesn't subside after several minutes of rest, call your
practitioner
.
What serious problems can cause abdominal pain during pregnancy?
Ectopic pregnancy
An
ectopic pregnancy occurs when a fertilized egg implants outside the uterus, typically in one of the fallopian tubes. It may cause some cramping and other symptoms in
early pregnancy.
If left untreated, an ectopic pregnancy can be life-threatening. Call your practitioner immediately if you have any of the following symptoms: abdominal or
pelvic pain or tenderness,
vaginal spotting or bleeding (can be red or brown, copious or scant, continuous or intermittent), pain that gets worse during physical activity or while moving your bowels or coughing, or pain in your shoulder.
If you're bleeding heavily or having signs of shock (such as a racing pulse, dizziness, fainting, or pale, clammy skin), call 911.
Miscarriage
Miscarriage is the loss of a pregnancy in the first 20 weeks. Vaginal spotting or bleeding is generally the first
symptom, followed by abdominal pain a few hours to a few days later.
The bleeding may be light or heavy. The pain may feel crampy or persistent, mild or sharp, and may feel more like low back pain or pelvic pressure.
Call your practitioner if you have signs of a miscarriage. If you have severe pain or heavy bleeding, you need to be seen immediately.
Preterm labor
You're in
preterm labor (also known as premature labor) if you start to have contractions that efface or dilate your cervix before 37
weeks of pregnancy.
Call your doctor or midwife right away if you're having any of the following symptoms in your second or third trimester (before 37 weeks):
- An increase in vaginal discharge or a change in the type of discharge (if it becomes watery, mucus-like, or bloody – even if it's just pink or tinged with blood)
- Vaginal spotting or bleeding
- Abdominal pain, menstrual-like cramping, or more than four contractions in one hour(even if they don't hurt)
- An increase in pressure in the pelvic area
- Low back pain, especially if you didn't previously have back pain
Placental abruption
Placental abruption is a life-threatening condition in which your placenta separates from your uterus, partially or completely, before your baby's born.
There's wide variation in symptoms. A placental abruption can sometimes cause sudden and obvious bleeding, but in other cases there may not be any noticeable bleeding at first, or you might have only light bleeding or spotting. Or you might see bloody fluid if your water breaks.
You might have uterine tenderness, back pain, or frequent contractions, or the uterus might contract and stay hard – like a cramp or contraction that doesn't go away. You might also notice a decrease in your baby's activity. Immediate medical attention is a must.
Preeclampsia
Preeclampsia is a complex disorder of pregnancy that causes changes in your blood vessels and can affect a number of organs, including your liver, kidneys, brain, and the placenta. You're diagnosed with preeclampsia if you have
high blood pressure and protein in your urine after 20 weeks of pregnancy.
Symptoms may include swelling in your face or puffiness around your eyes, more than slight swelling in your hands, and excessive or sudden swelling of your feet or ankles. (This water retention can lead to a rapid weight gain.)
With severe preeclampsia, you may have intense pain or tenderness in the upper abdomen, asevere headache, visual disturbances (such as blurred vision or seeing spots), or nausea and vomiting. If you have symptoms of preeclampsia, call your doctor or midwife immediately.
Urinary tract infections
Being
pregnant makes you more susceptible to
urinary tract infections of all kinds, including
kidney infections.
Symptoms of a bladder infection may include pain, discomfort, or burning when urinating; pelvic discomfort or lower abdominal pain (often just above the pubic bone); a frequent or uncontrollable urge to pee, even when there's very little urine in the bladder; and cloudy, foul-smelling, or bloody urine. Call your caregiver if you have any of these symptoms because an untreated bladder infection can lead to a kidney infection and premature labor.
Signs that the infection has spread to your kidneys – and that you need medical attention immediately – include a high fever, often with shaking, chills, or sweats; pain in your lower back or in your side just under your ribs, on one or both sides (and possibly in your abdomen as well); nausea and vomiting; and possibly pus or blood in your urine.
Other causes
Many other conditions can cause abdominal pain, whether you're pregnant or not. Some of the most common causes of abdominal pain that your practitioner will consider are a stomach virus,food poisoning, appendicitis, kidney stones, hepatitis, gallbladder disease, pancreatitis, fibroids, and bowel obstruction.
Both gallbladder disease and pancreatitis are often a result of gallstones, which are more common during pregnancy. Fibroids may grow during pregnancy and cause discomfort. And the pressure of the growing uterus on previously scarred intestinal tissue may cause bowel obstruction, which is most likely to occur in the third trimester.
What are the most common causes of harmless abdominal discomfort?
Not all
abdominal discomfort is a sign of a serious problem during
pregnancy. For example, you may notice a bit of cramping during or right after an
orgasm. As long as it's mild and short-lived, it's perfectly
normal and nothing to be alarmed about.
Here are some other causes of ordinary abdominal discomfort. But remember, if you're unsure what's going on or your discomfort is severe or persistent, play it safe and call your caregiver.
Gas and bloating
You're much more likely to have
gas pain and bloating during pregnancy because of hormones that slow your digestion and the pressure of your growing uterus on your
stomach and intestines.
Constipation
Constipation is another common cause of abdominal discomfort throughout pregnancy, thanks to hormones that slow the movement of food through your
digestive tract and the pressure of your growing uterus on your rectum.
Round ligament pain
Round ligament pain is generally a brief, sharp, stabbing pain or a longer-lasting dull ache that you may feel on one or both sides of your lower abdomen or deep in your groin, usually starting in your
second trimester. It happens when the ligaments that support your uterus in your pelvis stretch and thicken to accommodate and support its growing size.
You may feel a short jabbing sensation if you suddenly change position, such as when you're getting out of bed or up from a chair or when you cough, roll over in bed, or get out of the bathtub. Or you may feel a dull ache after a particularly active day, if you've been walking a lot or doing some other physical activity. Call your caregiver if this discomfort continues even after you've rested.
Braxton Hicks contractions
Sometime after midpregnancy, you may start to notice some tightening in your uterus from time to time. Before 37 weeks, these
Braxton Hicks contractions should be infrequent, irregular, and essentially painless.
Call your provider if the contractions are accompanied by
lower back pain, if you feel more than four contractions an hour (even if they don't hurt), if they're coming at regular intervals, or if you have any other signs of
premature labor.
Once you're close to your
due date, cramping can be a
sign of labor.
Is there anything I can do to ease abdominal pain?
Here are a few tips for dealing with abdominal discomfort that isn't caused by anything serious:
- Move around or do some gentle exercises to relieve pain that might be caused by gas.
- Take a warm (not hot) bath or shower, or place a hot water bottle wrapped in a towel on the ache.
- Bend toward a pain when you feel it, for relief.
- Drink plenty of fluids. Dehydration can cause Braxton Hicks contractions.
- If the pain is caused by Braxton Hicks contractions, lying down may be helpful. Resting can also help you focus on and identify your symptoms
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 pregnancy
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.
Miscarriage
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 resemblemenstrual cramps.
Preterm labor
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.
Placental abruption
Your placenta is the source of oxygen and nutrients for your baby. It usually implants high on theuterine 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.
Preeclampsia
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.
