Pelvic pain or discomfort is common during pregnancy. After all, ligaments are stretching, hormone levels are changing, and organs are shifting around to make room for your growing uterus. But sometimes pain is a red flag that something more serious is wrong. 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.
From relaxed pelvic joints to pressure from your growing baby's weight, here are the common culprits of benign pelvic pain during pregnancy. If the pain you're experiencing doesn't go away, or if you have symptoms such as bleeding, an unusual discharge, or strong cramping, call your Ob-Gyn.
Symphysis Pubis Dysfunction (SPD)
Levels of estrogen, progesterone, and relaxin (which helps your ligaments stretch for childbirth) 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 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 pubis – may become especially stretchy and unstable, leading to pelvic pain. Shaheed says the pain can start soon after conception, but it tends to get worse toward the end of your pregnancy. Some women like to use pelvic support belts, which can help stabilize the area. Note that symphysis pubis dysfunction (SPD) may also be called pelvic girdle pain.
From 8 to 12 weeks of pregnancy, you may experience cramp-like pain that feels like your period is coming on. 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, says Stanley Greenspan, M.D.
Round Ligament Pain
As you start your second trimester, you may begin to feel pain in your side as the ligament that goes from the top of the uterus down to the groin stretches. "Women tend to feel this when they're walking or getting up from a chair," says Suzanne Merrill-Nach, M.D., an obstetrician in San Diego. "The uterus tilts and pulls on the ligament." Lying down on the side that's bothering you can make the pain disappear – and it should disappear for good by about 24 weeks.
Diastasis recti, which happens when your rectus abdominis muscles separate during pregnancy, can also cause pelvic pain similar to SPD. “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. Diastasis recti is extremely common during pregnancy. If you develop it, your doctor will likely suggest an at-home exercise plan after you give birth. Rarely, severe cases of diastasis recti may require surgery.
Pressure From Your Baby's Weight
Once you're in your third trimester, you may start to experience pressure in your pelvic region as the weight of your rapidly growing fetus presses down on the 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," Dr. Merrill-Nach says. To help relieve the discomfort, lie down on one side and rest.
Functional ovarian cysts, which form due to changes in the way your ovaries make or release eggs, are very common, noncancerous, and generally harmless. They can grow larger during pregnancy, and the pressure that your growing uterus puts on your ovaries can cause persistent pain. If the cyst ruptures, the pain may suddenly get worse. Be sure to tell your Ob-Gyn if you have a history of ovarian cysts, or if you think you've developed them during your pregnancy. She can do an ultrasound to help ensure that the cysts haven't grown too large.
In rare cases, a cyst can twist (called torsion) – a serious condition that usually happens after sudden or rigorous activity such as running to catch a bus or having intercourse. "A patient with torsion is usually inconsolable," Dr. Greenspan says. "The pain is very sharp, severe, and constant, and there may be nausea, vomiting, and sweating." If you suspect that you are experiencing torsion, call your Ob-Gyn right away.
Braxton Hicks Contractions
Pressure or tightening in the pelvis that comes and goes could be contractions, but if they're sporadic and generally not painful, they're most likely practice contractions, called Braxton Hicks, instead of true labor contractions. These "practice" contractions tend to occur at around 20 weeks and can be triggered by dehydration, so be sure to drink plenty of water. (You'll know it's a contraction if you lie down and feel your belly; your uterus will become hard, and then relax.) They should disappear on their own but if you have more than four contractions an hour for two hours, call your doctor. "When we are talking about preterm labor generally before 37 weeks, we are looking for contractions every 15 minutes or closer that persist over two hours even if the patient has an empty bladder and is lying down," Dr. Merrill-Nach says.
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, says Linda Chambliss, M.D., chief of obstetrics at St. Joseph's Hospital and Medical Center in Phoenix. "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.
Constipation, a common complaint during pregnancy, can cause some pelvic pain or discomfort. (Hormones slow down the digestive tract, as do the iron supplements your Ob-Gyn may recommend.) Drink plenty of water, and eat fiber-rich foods such as raw fruits and vegetables. If that doesn't help, ask your Ob-Gyn if you can try a stool softener or a glycerin suppository, Dr. Greenspan suggests.
Vulvodynia During Pregnancy
Vulvodynia is a condition that causes chronic pain in the vulvar and vaginal area, but has no obvious source. It's not caused by infection, obvious trauma, or injury – and yet the pain can be really bad. It's hard to diagnose and even when a doctor does properly diagnose it, many women are treated ineffectively and disrespectfully, because the source of pain isn't anything doctors can see or test. If you have vulvodynia, an epidural can help with labor and delivery pain.
When women experience abdominal pain in the first trimester, "you always have to be concerned about miscarriage," says Patrick Duff, M.D, professor and residency program director in the department of obstetrics and gynecology at the University of Florida, in Gainesville. That’s 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 a persistent backache and pelvic pressure that comes and goes, 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 lain down, you should come in to be checked," Dr. Merrill-Nach says. If these symptoms occur before 37 weeks, it's considered preterm labor.
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.
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 bleed 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.
Uterine fibroids are noncancerous growths of the uterus. They're most common during your childbearing years, and pregnancy can stimulate fibroids to get larger; they may or may not hurt. "When a fibroid grows rapidly it can outgrow its blood supply and degenerate, causing pain," Dr. Greenspan says. "Most of the time, we just observe them in pregnancy, but once in a while, they have to be surgically excised to allow the pregnancy to continue."
It's rare, but it's possible for the uterus to tear open, especially if you have a scar from a previous cesarean section or other abdominal surgery. If it does happen, it feels like "sudden severe tearing pain in the midline, where a prior scar exists," and it can be disastrous and potentially fatal for the mother and child, Dr. Greenspan says. Ruptures that show up outside of labor usually follow some sort of trauma to the abdomen. "There is no way to prevent uterine rupture," Dr. Greenspan says. "However, if the patient has a risk factor for rupture, then she should be closely followed by her provider and her symptoms should be taken seriously, especially if pain develops in the later in the pregnancy and is getting worse."
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.
Another unlikely but serious cause of pain: Your ovaries can become twisted. This can happen at any point, but is more likely to occur during the early stages of pregnancy. "The ovary is like a hammock or spindle, so it can flip over on itself and cut off its own blood supply," Dr. Greenspan says. A risk factor for ovarian torsion is induction of ovulation because it can cause enlarged ovaries. Symptoms include lower abdominal pain, nausea, and fever.
You can experience inflammation of the appendix even if you're pregnant. Generally you would feel pain in the lower right part of your abdomen. "Appendicitis can be sneaky during pregnancy because as you get further along, the appendix is pushed up higher in the abdomen," Dr. Merrill-Nach says. Appendicitis requires emergency surgery to remove the appendix to avoid the risk of rupturing.
If you feel severe waxing and waning pain progressing down your side, you may have a kidney stone. "Usually we make women more comfortable and just wait for the stone to pass," Dr. Merrill-Nach says. Talk to your doctor if you suspect that you have kidney stones.