Abdominal Pain During Pregnancy: Common Causes and When to Call the Doctor
Some abdominal pain during pregnancy is normal. After all, your organs are constantly shifting, your uterus is expanding, and your ligaments are stretching—all of which can cause benign aches and pains. On rare occasions, though, abdominal pain can signal something serious. Consult our guide to learn more about the causes of upper and lower abdominal pain during pregnancy, and find out when to call the doctor.
Harmless Causes of Abdominal Pain During Pregnancy
From constipation to round ligament pain, here are some common culprits that cause harmless abdominal discomfort during pregnancy. Keep in mind that if the pain you're experiencing continues—or if you have worrisome symptoms such as bleeding or strong cramping—you should check in with your OB-GYN right away.
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 and smaller meals, exercise regularly, get enough rest, and empty your bladder often.
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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. Round ligament pain usually starts between 18 and 24 weeks (around when you start showing) and typically occurs on one side of your belly, though it can strike both. You may feel it as lower abdominal pain that radiates into the groin; it may be sharp and stabbing or dull and achy, and it usually lasts for just a few seconds. It can be triggered by any movement that causes these ligaments to stretch, like coughing, sneezing, laughing, or getting up suddenly. Round ligament pain usually resolves 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 often part of the pregnancy package, unfortunately. 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 aren't associated with dilation of the cervix," Dr. Duff says. "They're annoying, but totally benign." The trick is differentiating 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 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.
Serious Causes of Abdominal Pain in Pregnancy
For a small number of expecting parents, serious pregnancy complications can develop that require immediate attention from your OB-GYN. Some red flags to watch 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 one out of every 50 pregnancies, according to the March of Dimes. If you have an ectopic pregnancy, you may experience intense pain and bleeding between your sixth and tenth weeks of pregnancy, as the tube becomes distended. The following factors increase the risk of ectopic pregnancy: previous pelvic, abdominal, or fallopian tube surgery; endometriosis; previous ectopic pregnancy; tubal ligation; having 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 can't continue and require immediate treatment. If you had a positive pregnancy test but haven't 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 during early pregnancy, "you always have to be concerned about miscarriage," says Dr. Duff, 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 it's accompanied by persistent backache, you could be having preterm labor. Now isn't the time to wait it out—call your OB-GYN right away. The contractions might come with leaking vaginal fluid or blood or a decrease in fetal movement.
Even experienced pregnant women may not be able to tell if contractions are 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 this happens to about 30 percent of the women who show up in her triage unit), but it's better to be safe than sorry, especially in this case.
Your placenta provides oxygen and nutrients to your baby. It usually implants high on the uterine wall and doesn't detach until after your little one is born. In rare cases (1 out of every 200 births), the placenta can separate from the uterine wall—a dangerous complication that's most common in the third trimester. Dr. Duff describes the discomfort 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 bleeding that doesn't 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 for a vaginal delivery. Women at risk for this condition include those who have a history of placental abruption, as well as those with high blood pressure, preeclampsia, and abdominal trauma.
According to the Preeclampsia Foundation of America, preeclampsia and other hypertensive disorders occur in 5 to 8 percent of all pregnancies. Preeclampsia can develop after 20 weeks (which is partly why your doctor checks your blood pressure at every appointment) and it's 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.
Women with severe preeclampsia might also experience pain in the upper right portion of your abdomen, nausea, headaches, swelling, and visual disturbances like flashing lights. If you suspect 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. The good news is that if a UTI is caught early, it should be easy to treat with antibiotics—and that's one reason why your OB-GYN tests your urine during every visit.
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 curveball." And the delayed diagnosis raises the risk of dying from appendicitis during pregnancy. Although the usual hallmark of appendicitis is pain in the lower right quadrant of your abdomen, you may feel it higher up when you're pregnant. Other symptoms include lack of appetite, nausea, and vomiting.
Stones in the gallbladder are more common in women, especially if they're 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 to Call the Doctor
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
- Fever or chills
How to Ease Abdominal Pain During Pregnancy
Wondering if there's anything you can do to help ease benign abdominal discomfort during pregnancy? Of course, the treatment depends on what's causing the pain, but these tips might be able to help.
- Eat small, frequent meals
- Exercise regularly, in moderation and with a doctor's approval
- Choose fiber-rich foods (including fruits, vegetables, and bran)
- Drink plenty of water
- Empty your bladder often
- Rest frequently
- Change the way you move, especially if you're experiencing round ligament pain. For example, you might try sitting down and getting up more slowly and trying not to turn sharply at the waist.
But remember: If you're experiencing any worrisome symptoms, see the doctor right away.
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