All About Pelvic Pain During Pregnancy

Experiencing any kind of pelvic pain when you're pregnant can be scary. Here's how to know whether what you're feeling is normal or requires immediate medical attention.

When you get pregnant, a certain amount of pelvic pain or discomfort is to be expected. After all, your ligaments are stretching, your hormone levels are changing, and your organs are shifting to make room for your growing uterus. But sometimes pain is a red flag, a signal that something serious is going on. We asked the experts how to decipher your pelvic pain during pregnancy, how to treat it, and when to call for help.

Causes of Pelvic Pain During Pregnancy

From relaxed pelvic joints to pressure from your growing baby's weight, there are many reasons people experience pelvic pain and discomfort during pregnancy. Here are the most common reasons for benign pelvic pain during pregnancy.

Symphysis pubis dysfunction (SPD)

Also known as pelvic girdle pain, SPD occurs when estrogen, progesterone, and relaxin rise during pregnancy. "An increase in these hormones causes the pelvic ligaments to become more relaxed and soft, and the joints start to become more mobile," says Heba Shaheed, a physiotherapist in Sydney, Australia, who specializes in women's and pelvic health.

A joint in front of your pelvis—called the symphysis pubis—can become unstable, causing pain. It may start happening soon after conception, and gets worse toward the end of pregnancy. Some people use support belts to stabilize the area.

Accommodation pain

This cramp-like pain tends to occur 8 to 12 weeks into pregnancy, and can feel like you're getting your period. As long as there's no bleeding, it's probably just your uterus expanding. You're less likely to feel this in your first pregnancy than in subsequent pregnancies, experts say.

Round ligament pain

In your second trimester, you may feel a sharp, stabbing, or aching pain in your side. This pain can happen when your baby's growth stretches a ligament that goes from your uterus to your groin.

When you walk or get up from a chair, for example, "the uterus tilts and pulls on the ligament," says Suzanne Merrill-Nach, M.D., an OB-GYN in San Diego. Lying down on the side that's bothering you can make the pain disappear (alternate sides if both hurt). Most round ligament pain resolves by 24 weeks.

Diastasis recti

Diastasis recti is extremely common during and after pregnancy and can sometimes feel like SPD. The condition occurs when your rectus abdominis muscles (those responsible for six-pack abs) separate, and may create a bulge in the stomach (though this bulge is most noticeable postpartum).

"The muscles of your abdomen attach from your breast bone down to your pubic bone, and pubic muscles are being stretched by hormone changes," explains Shaheed. If you develop diastasis recti and it doesn't resolve on its own after your baby is born, your health care provider can suggest an exercise plan; more severe cases may warrant surgery.

Pressure from baby's weight

In the third trimester, you may experience pressure in your pelvic region as the weight of your rapidly growing baby presses down on nerves that run from your vagina into your legs. "This pain typically occurs with movement, such as when you walk or ride in a car, because the baby bounces," says Dr. Merrill-Nach. To help relieve the pressure, lie down on one side and rest.

Ovarian cysts

Ovarian cysts form when there are changes in the way your ovaries make or release eggs. They are common, noncancerous, and generally harmless, but can grow larger during pregnancy. Let your OB-GYN know if you've had cysts before or think you do now. They can use an ultrasound to look for them.

Being pregnant with an ovarian cyst can be painful, in part because your growing uterus puts pressure on your ovaries. If a cyst ruptures, that pain gets worse. In rare cases, a cyst can grow larger and cause an ovary to twist in on itself (a condition known as ovarian torsion), which produces sharp, severe, abdominal pain with possible nausea, vomiting, and sweating. If you have these symptoms, call your provider.

Braxton hicks contractions

These "practice contractions" are usually not painful; they tend to feel like pressure or tightening in the pelvis, and come and go more sporadically than labor contractions. Braxton Hicks first occur in the second or third trimester and can be triggered by dehydration, so drink plenty of water. They should disappear on their own, but if you have more than four contractions an hour for two hours, call your provider—you could actually be in labor.

Urinary tract infection (UTI)

As in your pre-pregnancy life, getting a UTI during pregnancy can give you a sudden urge to urinate, and you may experience a burning sensation with urination and even some blood in your urine. Some people also have abdominal pain, says Linda Chambliss, M.D., an OB-GYN and maternal-fetal medicine specialist in Phoenix. The difference is that with pregnancy, untreated infections can create serious complications for you and your baby.

"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," explains Dr. Chambliss. Your baby's birth weight may also be affected. This is one reason that your OB-GYN tests your urine every visit: to check for signs of bacteria that can lead to a UTI. If caught early, the infection should be easy to treat with antibiotics.

Constipation

Up to 40% of people experience constipation when they're expecting, according to experts at the Cleveland Clinic. Common culprits include an increase in pregnancy-related hormones or taking iron supplements that slow down your digestive tract, leading to pelvic discomfort.

Stay hydrated, and eat fiber-rich foods such as raw fruits and vegetables. Exercising more or changing your prenatal vitamin (if it contains iron) may also lessen symptoms. If that doesn't help, ask your prenatal health care provider about over-the-counter treatments such as fiber supplements, stool softeners, non-stimulant laxatives, or glycerin suppositories.

Vulvodynia

Vulvodynia is a condition that produces chronic pain in the vulvar and vaginal area, but has no obvious cause. It's not triggered by infection, obvious trauma, or injury—and yet the pain can be severe. It's hard to diagnose, and even when a provider properly diagnoses it, it can be difficult to get the treatment you need. If you have it, an epidural can help with labor and delivery pain.

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Can Pelvic Pain During Pregnancy Be Serious?

In short, yes. If your pain is coupled with certain symptoms, such as fever and bleeding, call your health care provider right away. The following are serious causes of pelvic pain during pregnancy.

Miscarriage

When someone experiences abdominal pain in the first trimester, "you always have to be concerned about miscarriage," says Patrick Duff, M.D., associate dean of the department of obstetrics and gynecology at the University of Florida, in Gainesville. It is estimated that up to 26% of all pregnancies and up to 10% of known pregnancies end in miscarriage. Symptoms of miscarriage include bleeding and cramping that can be rhythmic or resemble menstrual cramps.

Preterm labor

If you're experiencing a persistent backache and pelvic pressure that comes and goes in waves, you may be in labor. "My rule is that if you have four or more contractions an hour and they continue for two hours, even after you have urinated and laid down, you should come in to be checked," says Dr. Merrill-Nach. When you have these symptoms before the 37th week of pregnancy, it's considered a possible sign of preterm labor.

Ectopic pregnancy

Ectopic or "tubal" pregnancies occur when a fertilized egg implants somewhere other than the uterus—usually in the fallopian tube. This can happen in 1% to 2% of pregnancies. 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.

People who have had one ectopic pregnancy are more likely to have another. The risk is further increased for those who've had endometriosis, tubal ligations, pelvic infections, and prior pelvic, abdominal, or fallopian tube surgeries, as well as those who had an intrauterine device (IUD) in place at the time of conception. Anyone with an abnormally shaped uterus also has a higher chance of an ectopic pregnancy, as does anyone who used artificial reproductive techniques to become pregnant.

Ectopic pregnancies are not viable and require immediate medical attention. If you are experiencing severe abdominal pain after a positive pregnancy test, but haven't had the pregnancy officially confirmed via ultrasound, visit your OB-GYN ASAP, says Dr. Chambliss. They can do an ultrasound to examine you.

Placental abruption

Around 1% of pregnant people experience a placental abruption, typically in the third trimester. This too-early separation of the placenta from the uterine wall can generate "severe, constant, progressively worsening lower abdomen pain," says Dr. Duff. Your uterus may become rock hard (if you press on your abdomen, it won't indent), and you may bleed dark, red blood with no clots.

In milder cases, a health care provider may choose to simply monitor your pregnancy, though they could decide to induce labor and deliver the baby vaginally. If the condition itself triggers labor, an emergency Cesarean section may be necessary. People who've had a previous placental abruption, or those who have experienced abdominal trauma, preeclampsia, or high blood pressure are most at risk.

Uterine fibroids

These noncancerous growths are common during the childbearing years, but pregnancy further stimulates them. If they grow too fast, they can outpace their own blood supply and start to degenerate, which causes pain. Sometimes they must be surgically excised for the pregnancy to continue.

Uterine rupture

While rare, it is possible for the uterus to tear open during pregnancy, especially if you have a scar from a past Cesarean section or other abdominal surgery. You'll feel a sudden, severe, tearing pain around the area of the trauma.

While there's no way to prevent it, let your health care provider know if you've ever had injuries in that region, and have them monitor your condition. Call them immediately if pain develops later in pregnancy and gets worse.

Preeclampsia

Preeclampsia is a frequently painful condition that affects 5% to 8% of pregnant people and can begin anytime after the 20th week of pregnancy. Symptoms include the constriction of blood vessels around the uterus (which can seriously diminish the supply of oxygen and nutrients to your baby), the sudden onset of high blood pressure, and potential kidney or liver damage.

Preeclampsia also increases the risk of placental abruption. When the condition is severe, it can be accompanied by pain in the upper right portion of your abdomen and trigger nausea, headaches, and visual disturbances (such as flashing lights). For many people, high blood pressure and abnormal swelling in the face, hands, and feet are the first indications that something is wrong. If you suspect you have preeclampsia, call your prenatal health care provider immediately.

Ovarian torsion

In rare cases, abdominal pain, nausea, and fever are brought on by ovarian torsion, which happens when an ovary twists around its attached ligaments and cuts off its own blood supply. It can take place at any time during pregnancy but is most common in the early stages. You may be more at risk if you have ovarian cysts or have undergone ovulation induction, which can cause enlarged ovaries.

Appendicitis

Yes, this inflammation of the appendix happens to pregnant people, too. You'll generally feel it in the lower right part of your abdomen, though it may move: "Appendicitis can be sneaky during pregnancy because as you get further along, the appendix is pushed up higher in the abdomen," says Dr. Merrill-Nach. In the case of appendicitis, emergency surgery is often needed to remove the appendix before it ruptures.

Kidney stones

Do you feel severe pain progressing down your side? Is it waxing and waning? If so, you may have a kidney stone, for which the solution tends to be surprisingly low-tech: "Usually we make women more comfortable and just wait for the stone to pass," says Dr. Merrill-Nach. If you think you have a kidney stone, visit your health care provider, who can confirm it with blood, urine, and/or imaging tests.

How to Relieve Pelvic Pain During Pregnancy

For run-of-the-mill pelvic discomfort during pregnancy, try these tips:

  • Take a warm—not hot—bath or stand in the shower and let the water hit your back.
  • Get a prenatal massage from a certified massage therapist.
  • Try a pelvic support garment, which can keep your uterus from pushing down on your pelvis.
  • Wear low-heeled shoes with good arch support.
  • Avoid quick movements and sharp turns at the waist.
  • Exercise regularly.

When to Call the Doctor

Never hesitate to contact your health care provider if you feel like something's not quite right. Your doctor or midwife would much rather have you call and determine that there is nothing to worry about than not call and risk a serious issue.

If you have any of the following symptoms, call your doctor or midwife immediately:

  • Pelvic pain that you can't walk or talk through
  • Fever and/or chills
  • Any bleeding
  • Severe headache
  • Dizziness
  • Sudden swelling of the face, hands, and/or feet
  • Persistent nausea and/or vomiting
  • Fewer than 10 fetal kicks in one hour (any time between 28 weeks and delivery)
  • More than four contractions an hour for two hours
  • Watery, greenish, or bloody discharge
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