What Causes Abdominal Pain in Pregnancy (and How to Find Relief)
February 26, 2020
My most visceral bout of abdominal pain in pregnancy woke me in the middle of the night. I was 3,000 miles from home on vacation, six months pregnant with my first child and unable to go back to sleep after two excruciating stabs of pain hit my right side. It felt like something inside was ripping, although it only lasted for a second or two.
I caught my breath—my husband was snoring beside me—and sat there expectantly, waiting for more. I wasn’t bleeding, I didn’t have a fever or headache or any other symptoms. With the pain gone as quickly as it had come and no healthcare provider handy to call, I did my best to relax.
It wasn’t until my next OB appointment a couple weeks later that I learned I experienced round ligament pain, a common pregnancy discomfort that strikes as the uterus expands. By itself, ligament pain isn’t worrisome. But what about other abdominal pain during pregnancy? Cramping or severe tenderness that’s accompanied by nausea, bleeding, headaches or a host of other symptoms could indicate a condition that you need to get checked for. Read on to learn more about what can cause abdominal pain in pregnancy and what to do about it.
In this article:
Common causes of abdominal pain in pregnancy
Serious causes of abdominal pain in pregnancy
When to call the doctor about abdominal pain in pregnancy
How to ease abdominal pain during pregnancy
Ligament pain, marked by sharp pain in your stomach, hips or groin, occurs as the ligaments that support your uterus stretch and thicken, usually during the second trimester. It’s one of the most common causes of abdominal pain in pregnancy and it can be absolutely excruciating, sometimes made worse with prolonged sitting or standing. “Your uterus goes from being the size of a lemon to the size of a watermelon—that hurts,” says Meredith Alston, MD, an associate professor at the University of Colorado School of Medicine and ob-gyn at Denver Health Medical Center.
Other common causes of stomach pain in pregnancy include:
• Constipation. Due to the way that progesterone slows down your GI tract, constipation can be made worse by pregnancy, says Alston. You’ll probably know what it feels like: persistent stomach cramps and having fewer than three bowel movements a week.
• Heartburn. GERD, or gastroesophageal reflux disease, is also caused by your system slowing down and your growing uterus pushing on the stomach, especially in the third trimester. Your stomach might feel sour and you’ll have the telltale burn in your chest as acid is pushed up into your esophagus.
• Gastroenteritis. Pregnancy doesn’t make you immune to stomach bugs. If nausea, vomiting and/or diarrhea accompanies your stomach pain, call your provider. Untreated symptoms could lead to dehydration or preterm labor.
Pregnancy-specific conditions that show up with stomach pain in pregnancy are scary to read and think about, but thankfully most are rare. They can include:
• Ectopic pregnancy. Generally diagnosed early in pregnancy, ectopic pregnancies are those that occur outside the uterus, usually in the fallopian tube. According to Alston, it’s marked by pelvic pain and increasing abdominal pain with light or heavy vaginal bleeding.
• Miscarriage. Abdominal cramping or pain in your lower abdomen with spotting could signal a miscarriage, which occurs before the 20th week of pregnancy.
• Placental abruption. The pulling away of the placenta from the side of the uterus can happen because of trauma—falling down, a car accident—but it can also just occur, Alston says. It can prompt abdominal pain in pregnancy, possibly accompanied by back pain or contractions.
• Preeclampsia. Alston warns that sudden, severe indigestion with pain in your upper right quadrant could signal preeclampsia, a disorder characterized by high blood pressure.
• Preterm labor. Abdominal pain during pregnancy could be the start of contractions. “You’ll get a waxing and waning pain—that’s what contractions do,” says Alston. “We worry when patients are having a feeling like their uterus is getting hard, coming and going, if they are before 37 weeks.” You may also have bleeding or leaking of fluid.
• Cholestasis. If you’ve got intense itching without a rash—and maybe a nauseous stomach and pain in the upper right belly—you could have cholestasis of pregnancy, a liver problem. It’s rare and more likely to occur in the third trimester.
• Triple-I infection. Intrauterine infection (chorioamnionitis) occurs when bacteria make their way from the vagina to the uterus and infect the membranes around the fetus, explains Carrie Terrell, MD, division director for obstetrics, gynecology, midwifery and family planning at the University of Minnesota. Symptoms include fever, a tender-to-the-touch stomach and rapid heartbeat.
There are some other non pregnancy-specific conditions that can prompt stomach pain during pregnancy, such as:
• Appendicitis. It occurs in about one in 1,500 pregnancies, according to a 2011 study, usually during the first two trimesters. Symptoms are the same as for non-pregnant women: sudden pain on the right side of your lower abdomen or around your navel that may worsen if you cough or walk; nausea and vomiting; loss of appetite and a low-grade fever.
• Kidney infection. Fever, chills and groin, back and stomach pain in pregnancy could indicate a kidney infection, which if untreated increases your risk of delivering a low-birth weight baby.
• Ovarian torsion. It’s rare, but a sudden coming-and-going pain on one side of your lower abdomen could indicate that one of your ovaries is twisted, cutting off its own blood supply.
While musculoskeletal growing and stretching can be extremely painful in your body’s lower half, it’s not uncommon and there’s not much a visit to your doctor’s office will do to bring about relief. Still, you should never hesitate to call your doctor or midwife about any abdominal pain during pregnancy.
“Generally, in all trimesters, we take abdominal pain pretty seriously,” says Terrell. “It can be a sign of something underlying or other ongoing issues and we want to get people evaluated.”
Your provider needs to know if your abdominal pain is severe, persistent and comes with any vaginal bleeding or fever above 100.4, says Rhonia Gordon, MD, an ob-gyn and clinical assistant professor in the department of obstetrics and gynecology at NYU Langone Health in New York City. Finding out that your pain isn’t indicative of anything serious after you’re examined is way better than leaving a potentially acute condition untreated, which could harm you and baby in the long run.
“You’re carrying around this watermelon and your back and abs tend not to like it all that much,” says Alston. For the run-of-the-mill growing pains that can strike at any time—usually in the second or third trimester when your bump is bigger—you may find some relief from taking a warm bath, applying a heating pad to your belly or sides or taking Tylenol (once you’ve been cleared by your provider), she says. Staying active—walking or doing other light exercise—may help ease abdominal pain in pregnancy as well.
Updated February 2020
Meredith Alston, MD, is an associate professor at the University of Colorado School of Medicine and ob-gyn at Denver Health Medical Center. She earned her medical degree from Emory University School of Medicine in 2003.
Carrie Terrell, MD, is an ob-gyn and the division director for obstetrics, gynecology, midwifery and family planning at the University of Minnesota. She earned her medical degree from University of Minnesota Medical School in 1995.
Rhonia Gordon, MD, is an ob-gyn and clinical assistant professor in the department of obstetrics and gynecology at NYU Langone Health in New York City. She earned her medical degree from Ohio State University in 2015.
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