Causes of Abdominal Pain During Pregnancy

Learn the causes of abdominal pain in pregnancy, and find out whether your symptoms are normal or require immediate attention from your health care provider.

Some abdominal pain during pregnancy is to be expected. 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 when to call the doctor.

Benign 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 feels intense—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.

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," says Dr. Duff. 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 at a time. 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.

pregnant woman with abdominal pain
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Constipation and Gas

Constipation and gas are often part of the pregnancy package. 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.

Avoiding gas-producing foods, such as sparkling beverages, spicy foods, fried foods, dairy products, and veggis like cabbage, onions, and beans, can help reduce gasiness.

Braxton Hicks Contractions

"Braxton Hicks contractions aren't associated with dilation of the cervix," says Dr. Duff. "They're annoying but totally benign." The trick is differentiating these "practice contractions" from real premature labor. Braxton Hicks contractions will often stop if you change positions and they don't come at regular intervals or with progressively more intense pain like labor contractions do.

"True contractions tend to get closer and closer together," says Dr. Duff. "If someone can carry on a conversation, watch television, or read, then the contractions are probably not real labor." Additionally, 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, abdominal pain can be a symptom of serious pregnancy complications that require immediate attention from your OB-GYN. Some red flags to watch for include bleeding, severe pain, fever, and visual disturbances.

Ectopic Pregnancy

Ectopic or tubal pregnancies are when the egg implants someplace other than the uterus, most often in the fallopian tube. They occur in one out of every 50 pregnancies, according to the March of Dimes, and unfortunately, are not viable.

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 pelvic infection. An abnormally shaped uterus and the use of artificial reproductive techniques also seem to increase the risk.

Ectopic pregnancies require immediate treatment with medication or surgery. 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 right away, 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 pregnant people experience abdominal pain during early pregnancy, "you always have to be concerned about miscarriage," says Dr. Duff. The unfortunate fact is that about 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 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 people 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% of the pregnant people who show up in her triage unit), but it's better to be safe than sorry, especially in this case.

Placental Abruption

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 (around 1 out of every 200 births), the placenta can separate from the uterine wall before delivery. This is a dangerous pregnancy 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.

Sometimes, a pregnant person may go into labor when their placenta separates, in which case their 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. People 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.

Preeclampsia

According to the Preeclampsia Foundation of America, preeclampsia and other hypertensive disorders occur in 5% to 8% of all pregnancies. Preeclampsia can develop after 20 weeks (which is one reason why your doctor checks your blood pressure at every appointment). This condition 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.

Expecting parents with severe preeclampsia might also experience pain in the upper right portion of their 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 13% of expectant parents will get a urinary tract infection (UTI) at some point during their pregnancy. 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 Dr. Chambliss.

"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," says Dr. Chambliss. 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

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 a potentially 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.

Gallstones

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, says Dr. Chambliss. Close to 8% of expecting parents develop gallstones. Depending on the severity of your symptoms, treatment may include surgery, which can sometimes be postponed to after delivery.

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."

In particularl, 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
  • Fever or chills
  • More than four contractions in an hour for two hours
  • Pain during urination, difficulty urinating, or blood in your urine
  • Severe abdominal pain
  • Severe headache
  • Severe swelling of the hands, legs, or face
  • Visual disturbances

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.

  • 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 avoid turning sharply at the waist.
  • Choose fiber-rich foods (including fruits, vegetables, and bran)
  • Drink plenty of water
  • Eat small, frequent meals
  • Exercise regularly, in moderation and with your doctor's approval
  • Empty your bladder often
  • Prenatal massage, acupuncture, or yoga may also provide relief
  • Rest frequently

But remember: If have any concerns or you're experiencing any worrisome symptoms, contact your doctor or midwife right away.

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