The evaluation of abdominal pain during pregnancy is similar to the evaluation of stomach pain when you are not pregnant, but the evaluation has additional challenges. For example, your physician has to consider the normal changes that occur specific to pregnancy that can cause abdominal pain, while always keeping in mind the well being of your baby and your gestational age.
Is it normal to feel abdominal pain in pregnancy?
Pains, aches and cramps in your belly while you're pregnant are normal. They're usually nothing to worry about, if all is otherwise well.Carrying a baby puts a lot of pressure on your muscles, joints and veins. This can make you feel uncomfortable around your stomach area.
Throughout your pregnancy, the tough, flexible tissues (ligaments) that connect your bones stretch to support your growing uterus (womb). So when you move around, you may feel mild pain on one or both sides of your body.
As your baby grows, your uterus (womb) tends to tilt to the right and the ligament may spasm or contract. So you may feel cramping pain more often on your right side.
How can I ease pregnancy abdominal pain?
Resting when the pain happens usually eases cramping, along with taking these steps:- Try sitting down for a while.
- Lie down on the side opposite to where the pain is, and put your feet up.
- Have a warm bath.
- Use a hot water bottle or wheat bag on the painful areas.
- Try to relax.
Sometimes, having s'x and reaching org'sm can give you cramps and a slight backache. An org'sm makes pulsations ripple up through your v;gina and uterus, which can leave a feeling of cramp afterwards.
Having s'x when you're pregnant can make these ripples feel more like contraction cramps, particularly in the third trimester. But don't worry, there's no evidence that org'sm sets off labour, even at term.
You could ease potential cramps by taking s'x soft and slow. A gentle back massage afterwards may help, too.
What if I feel unwell and have abdominal pain?
Abdominal pain could be a sign of something that's not related to pregnancy. Appendicitis, an ovarian cyst, kidney stones, a urinary tract infection (UTI), or gall bladder problem can cause abdominal pain.Your pregnancy may even have triggered a problem. Fibroids in your uterus that didn't bother you before you conceived may feel uncomfortable now that you're pregnant.
Keep a note of what you're feeling and tell your midwife or doctor about it. They can work out whether there is more to your discomfort than pregnancy aches and pains. However, don't wait to get help if the pain doesn't go away after several minutes of rest, or if you feel cramping along with:
- pain or burning when you wee
- unusual v;ginal discharge
- spotting or bleeding
- tenderness and pain
- vomiting
- fever
- chills
When is abdominal pain a worry in the first trimester?
Abdominal pain is usually nothing to worry about in early pregnancy. But if you're having other symptoms, you may need to get help.Early miscarriage
Sadly, early miscarriage is fairly common. It usually happens because a baby isn't developing properly. You'll have cramps, bleeding and pain in the centre of your lower belly at some time in the first 12 weeks of your pregnancy. Call your doctor, midwife or hospital, and then lie down or sit with your feet up.
If you have heavy bleeding, and are soaking more than one pad an hour, go straight to the accident and emergency department (A&E) of your nearest hospital. You may be able to go straight to an early pregnancy assessment unit, if there's one in your area.
Ectopic pregnancy
An ectopic pregnancy develops outside the uterus. Unfortunately, the pregnancy can't be saved. It's a serious condition, so you'll need swift treatment. Just over one per cent of pregnancies in the UK are ectopic.
You'll feel painful cramping with tenderness that usually starts on one side and spreads across your stomach. You may also have bleeding that is dark and watery. It usually happens between five weeks and 10 weeks of pregnancy. Call your doctor or go to A&E immediately, as an ectopic pregnancy needs treating quickly.
When is abdominal pain a worry in the second trimester?
Abdominal pain on its own in the second trimester is probably nothing to worry about. There's a very slight chance of it signalling a late miscarriage, but only if you have bleeding as well.Bear in mind that late miscarriages are far less common than early miscarriages. Only about one in 100 miscarriages happens later in pregnancy.
If you're having a late miscarriage, you'll feel cramps with heavy bleeding after 12 weeks and before 24 weeks of pregnancy. If you have light v'ginal bleeding or discharge, call your doctor or midwife for advice. If you have heavy bleeding, go straight to your nearest A&E or maternity department.
When is abdominal pain a worry in the third trimester?
By the third trimester, abdominal pain could mean your body is limbering up too soon for birth, so the main worry is premature labour.Going into premature labour doesn't always mean that your baby is going to be born there and then. Sometimes, as long as your waters haven't broken, it's just a false alarm.
If you're in premature labour, you'll feel pain in your pelvic or lower tummy area, backache, mild tummy cramps and diarrhoea. You may feel your waters breaking, and regular contractions, or your uterus tightening, often painlessly. This could happen any time between 24 weeks and 37 weeks of pregnancy.
Call your doctor, midwife or the delivery suite of your nearest hospital immediately. If you think your waters have broken, call the maternity unit first.
Having cramps once you're past 37 weeks may mean you're in the early stages of labour. At this stage your pregnancy has reached term, so the cramps are a normal part of your body gearing up to give birth. You may also feel constant lower backache, caused by the increased pressure on your pelvis and back passage.
Early labour cramping is usually much less severe than the contractions you'll have during active labour. You may find that resting on the sofa helps, or try going for a walk. Finding your own way to cope with any discomfort now will help to prepare you for active labour.
Normal Changes in Pregnancy that can Cause Abdominal Pain
The enlarging uterus as it raises out of the pelvis places pressures on the lower back and abdomen and produces pain. The enlarged uterus may also compress the ureter, (the tube between the bladder and the kidney) making it difficult for urine to pass down the ureter causing intermittent severe lower abdominal pain. This pain can mimic the pain associated with passing a kidney stone, or bladder infection.
The ligaments that hold the uterus in place can also be stretched from the enlarging uterus causing sudden onset of sharp lower abdominal pain. This is called round ligament pain.
In addition, the hormonal changes during pregnancy can decrease lower esophageal sphincter tone (esophageal reflux) causing symptoms of indigestion and dyspepsia. The normal increases in progesterone seen in pregnancy can influence many organs. The progesterone will decrease the peristalsis of the bowel and cause constipation and pain. The gallbladder is also affected by the increased pregnancy hormones. The gallbladder cannot secrete its digestive enzymes correctly with the increasing pregnancy hormones, thus slowing down the gallbladder function and this can mimic the pain associated with gallstones.
All of these are just a few of the normal pregnancy changes that can result in abdominal pain.
The ligaments that hold the uterus in place can also be stretched from the enlarging uterus causing sudden onset of sharp lower abdominal pain. This is called round ligament pain.
In addition, the hormonal changes during pregnancy can decrease lower esophageal sphincter tone (esophageal reflux) causing symptoms of indigestion and dyspepsia. The normal increases in progesterone seen in pregnancy can influence many organs. The progesterone will decrease the peristalsis of the bowel and cause constipation and pain. The gallbladder is also affected by the increased pregnancy hormones. The gallbladder cannot secrete its digestive enzymes correctly with the increasing pregnancy hormones, thus slowing down the gallbladder function and this can mimic the pain associated with gallstones.
All of these are just a few of the normal pregnancy changes that can result in abdominal pain.
Less Common Pregnancy Related Causes of Abdominal Pain
- Miscarriage - Occasionally lower abdominal pain is a sign of a pending miscarriage. Symptoms of miscarriage typically include bleeding that is light or heavy and menstrual like cramping that gradually increases in intensity. Other women experience back pain. If you confirm a pregnancy then experience spotting, bleeding and cramping, be sure to contact your doctor right away.
- Placental abruption — The separation of the placenta from the uterine wall prematurely can cause bleeding and severe lower abdominal pain in pregnancy. Placental abruption not only results in severe abdomen pain, but fetal distress for the unborn child. Delivery is immediately needed to avoid fetal death and serve maternal hemorrhage.
- Uterine rupture — Uterine rupture can cause abdominal pain in pregnancy. Most uterine ruptures occur in childbirth while having a v'ginal birth after cesarean section (VBAC). The previous cesarean section scar on the uterus opens up and allows the head of the baby to float in the abdomen. Not only is an uterine rupture associated with abdominal pain, it causes fetal distress, and heavy vaginal bleeding leading to shock.
- Ectopic Pregnancy - This is a serious condition that occurs in early pregnancy when a fertilized egg attaches outside of a woman's uterus. Normally the egg attaches to a fallopian tube. Typically this condition is caught in the first few weeks of pregnancy. When not treated an ectopic pregnancy is very serious and may result in rupture of the fallopian tubes. Signs and symptoms of an ectopic pregnancy include spotting, abdominal pain and tenderness, bleeding, back pain , shoulder pain, dizziness or faintness. If you suspect an ectopic pregnancy contact your doctor immediately!
- Severe Preeclampsia and HELLP syndrome — Severe Preeclampsia results in upper right and mid quadrant abdominal pain. Preeclampsia refers to a syndrome characterized by high blood pressure, headache and protein in your urine. Severe preeclampsia will cause swelling around the liver which causes the upper abdominal pain. The HELLP syndrome is a more severe form of preeclampsia that's most common presentation is severe pain in the upper abdomen.
- Amniotic Fluid Infection — Infection of the amniotic fluid and sac the baby sits in can cause fever, abdominal pain, contractions and labor. It is commonly seen with premature rupture of the membranes.
- Preterm Labor - Some women experience lower abdominal pain or cramping further along in their pregnancy. This may be a sign of premature labor. Preterm labor is typically characterized by regular abdominal contractions that start dilating and effacing the cervix. You may experience v'ginal discharge that is a bloody mucous accompanied by cramping, or low back pain. Be sure you contact your doctor immediately to rule out premature labor. In many cases early labor can be stopped effectively allowing mothers to carry their baby to term.
Non Pregnancy-Related Causes of Lower Abdominal Pain
- Acute appendicitis — Appendicitis is the most common cause of right quadrant, lower abdominal pain that requires surgery during pregnancy. The most symptom of appendicitis, is low grade fever and right lower quadrant pain.
- Gallbladder disease —Pregnancy does increase the risk of developing gallstones. When the gallstones interfere with the gallbladder function the result is gallbladder disease. The symptoms of a poorly functioning gallbladder is a deep and gnawing pain that is intermittently sharp and severe. The abdominal pain is located in the right upper quadrant and may come and go.
- Bowel obstruction — As the uterus increases in size during pregnancy the chance of bowel obstruction also increases. Previous scar tissue (adhesions) are the most common reason for bowel obstruction in pregnancy. Bowel obstruction will cause crampy abdominal pain with vomiting. Previous surgeries are the leading cause of adhesions that result in bowel obstructions .
- Inflammatory bowel disease — The abdomen pain associated with inflammatory bowel disease is in the lower quadrants and usually associated with loose, bloody, mucous stool.
- Pancreatitis — Rarely an inflamed pancreas can cause persistent upper abdominal pain. This pain typically radiates straight through to the back.
Diverticulitis — When pouches or sacs in the wall of the colon become inflamed ( Diverticulitis) this results in lower abdominal pain. Diverticulitis is also associated with loose and bloody stools. - Perforated ulcer —Despite peptic ulcer disease getting better in pregnancy, sometimes a peptic ulcer will perforate. The abdomen pain will evolve over the first few hours after perforation. The pain will become very severe.
- Nephrolithiasis — Kidney stones usually present in the second and third trimesters of pregnancy. The pain is in the flank and then travels to the lower abdomen. Blood is also present in the urine in most cases. Usually a kidney infection is associated with the stones.
- Trauma — Motor vehicle accidents are the cause of two-thirds of trauma that causes abdominal pain in pregnancy. The pain can be associated with either blunt or penetrating trauma.
- Sickle cell crisis — The vasomotor crisis seen with sickle cell disease can causes severe abdominal pain. The pain is difficult to distinguish from appendicitis or gallbladder disease.
- Pneumonia — The lower lobe pneumonias commonly cause abdominal pain syndromes, specifically the right side. Abdominal pain can be the sole symptom in pregnancy with a lower lobe pneumonia.
- Gastroenteritis — Severe abdominal pain results from maternal gastroenteritis and inflammation of the abdominal lymph nodes (mesenteric adenitis).
- Thrombosis — Blood clots in the pelvic veins, liver and abdominal cavity (mesenteric veins) can cause poorly localized abdominal pain.
The good news is most women will experience mild abdominal discomfort throughout their pregnancy that occasionally occurs from the uterus stretching, from gas or even from constipation.
Is there anything I can do to help ease abdominal discomfort during pregnancy?
- Eat small, frequent meals
- Exercise regularly, in moderation
- Choose fiber-rich foods (including fruits, vegetables, and bran)
- Drink plenty of water
- Empty your bladder often
- Rest as often as you can
Warnings
Lower stomach pain accompanied by bleeding may be a serious medical situation, according to the March of Dimes. Dizziness or fainting also do not accompany ordinary pregnancy pains; check with a medical professional immediately, especially if the blood seems clot-like.
Time Frame
Usually, serious pregnancy problems related to lower stomach pain happen during the first months of pregnancy, according to the March of Dimes. Miscarriages, if they happen, usually occur during the first weeks of pregnancy; ectopic pregnancies are usually identified within the first three months. You may also experience the stomach pain, nausea and perhaps vomiting commonly referred to as "morning sickness" during the first few months of pregnancy. Later in pregnancy, lower stomach pain and cramps may indicate the onset of labor. Once the contractions are close together, you may be getting ready to deliver your new child into the world.
Prevention/ Solution
Not all pregnancy side effects, especially lower stomach pain, can be fully prevented or treated, according to the March of Dimes. Eating right before getting out of bed can reduce or eliminate the pains and other discomforts associated with morning sickness. Also, changing positions or walking may help reduce cramps once they begin. Don't take any medicines without talking to a doctor first.
