Abdominal pain in pregnancy

Is it normal to feel abdominal pain in pregnancy?

Pains, aches and cramps in your belly are common. Most mums-to-be have them at some point in their pregnancy (Crafter and Brewster 2014). They’re usually nothing to worry about if all is otherwise well, and they’re not getting worse or accompanied by bleeding or fluid leaking from your vagina.

Carrying a baby puts a lot of pressure on your muscles, joints and veins. This can make your belly feel uncomfortable at times.

Throughout your pregnancy, the tough tissues (ligaments) that connect your bones stretch to support your growing uterus (womb) (Kilpatrick 2018). When you move around, you may feel mild pain on one or both sides of your body (Bastian and Brown 2018).

As your baby grows, your uterus tends to tilt to the right. The ligament that supports that side of your uterus may spasm or contract. So you may feel a cramping pain more often on your right side (Kilpatrick 2018).

How can I ease pregnancy abdominal pain?

Resting usually eases cramping, so if you can, sit down and relax for a while.

To ease ligament pain:

• Lie down on the opposite side to the pain.
• Have a warm bath.
• Use a hot water bottle or wheat bag on the painful areas.
• Get in the habit of standing up and sitting down more gradually, avoiding sudden movements. This may help decrease the spasms.
  (Aguilera 2018)

Doing gentle stretching exercises, such as yoga, may help. Ask your midwife or doctor about antenatal exercise classes in your area.

Sometimes, having sex and reaching orgasm can give you cramps and a slight backache. An orgasm sends pulsations rippling through your vagina and uterus, which can feel more like cramping when you’re pregnant.

Having sex when you're pregnant can make these ripples feel more like contraction cramps, particularly in the third trimester. An orgasm or sex can also set off practice contractions, known as Braxton Hicks contractions (NHS 2018a). But don't worry, having an orgasm won’t trigger labour, even when you're full-term (Hall et al 2012, Lim et al 2013, Omar et al 2013). And it’s perfectly fine to have sex in pregnancy unless your caregiver has told you not to for medical reasons.

Braxton Hicks make the muscles of your womb go hard as they contract. If it feels uncomfortable, lie still until the contractions pass, or try relaxation techniques. A gentle back massage after sex may help.

What causes abdominal pain in pregnancy?

There are many possible causes of abdominal pain. Sometimes, it can be hard for your midwife or doctor to work out whether your pain is serious or normal.

Your caregiver will want to know exactly how the pain feels, so keep a note of what time of day it started, how long it lasted and how intense it was. Was it sharp pain or more of a dull ache? Did it come and go when you moved, or was it a constant pain.

Note down what you're feeling so you can give your midwife or doctor a full run-down.

Don't wait to get help if the pain doesn't go away after several minutes of rest, though, or if you feel cramping along with:

• blood in your wee, or pain or burning when you wee
• unusual vaginal discharge
• spotting or bleeding
• tenderness and pain
• vomiting
• fever
• chills
  (Kilpatrick 2018)

Sometimes, your abdominal pain could be a sign of something that's not related to pregnancy. Appendicitis, an ovarian cyst, kidney problems, a urinary tract infection (UTI) or a gall bladder problem can all cause abdominal pain (Kilpatrick 2018, Penner and Fishman 2017).

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 (Kilpatrick 2018).

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 seek help (Kilpatrick 2018).

Early miscarriage
Miscarriages in early pregnancy are much more common than most people realise. Sadly, one in five pregnancies ends in early pregnancy, usually because the baby isn't developing properly (RCOG 2016a).

The most common sign of early miscarriage is bleeding, which may come and go over several days. You'll probably also have stomach cramps and discharge of fluid and tissue from your vagina (NHS 2018b). Call your doctor, midwife or hospital, and then lie down or sit with your feet up.

If you have bleeding or pain that you feel you can’t cope with, you can get medical help and advice from your nearest hospital emergency department (RCOG 2016b).

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.

About one in 200 pregnancies are ectopic (VDH 2014).

Ectopic pregnancies are most often diagnosed between four and eight weeks of pregnancy, but can happen any time in the first trimester (Ayaz et al 2013).

An ectopic pregnancy can be very serious, so call your doctor or midwife if you have these symptoms:

• pain in your lower abdomen, which may just be on one side
• vaginal bleeding or spotting, which may be darker than your normal period
  (RCOG 2016b)

Go to your nearest hospital emergency department immediately if you’re experiencing all of the following symptoms:

• you have a sharp, intense pain in your tummy and
• you feel sick, dizzy or faint and
• you look pale
  (NHS 2016)

Ovarian hyperstimulation syndrome (OHSS)
If you had fertility treatment to get pregnant, especially IVF, there’s a chance your abdominal pain is caused by the fertility drugs over-stimulating your ovaries.

A third of women who’ve had IVF suffer mild discomfort from OHSS in the days after their egg collection. The discomfort can last a few weeks into the pregnancy.

Call your fertility clinic if your pain isn’t getting better. Get urgent help if you start to vomit or have urinary problems or chest pain (RCOG 2016c).

When is abdominal pain a worry in the second trimester?

Mild abdominal pain on its own in the second trimester is probably nothing to worry about (Kilpatrick 2018).

There's a very slight chance of it signalling a late miscarriage, but only if the pain escalates or you have bleeding (Wells 2016). Late miscarriages are far less common than early miscarriages, and happen between 12 and 20 weeks of pregnancy (RHWS 2013).

The most common signs of late miscarriage are cramps and heavy bleeding. If you have these symptoms, go straight to your nearest hospital emergency or maternity department.

If you have light vaginal bleeding or unusual discharge during pregnancy, call your doctor or midwife for advice.

When is abdominal pain a worry in the third trimester?

Pain and discomfort may be caused by your baby changing position, your uterus getting bigger as your baby grows, or Braxton Hicks starting (Kilpatrick 2018).

If you get a severe pain just below your ribs, call your midwife or doctor straight away (NHS 2018c). This could be a symptom of pre-eclampsia. If you have pre-eclampsia, you may have other symptoms, such as painful headaches, feeling very unwell and a sudden increase in swelling (oedema).

Abdominal pain in the third trimester may mean your body is getting ready for birth too soon. But 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.

Premature labour can happen any time before 37 weeks of pregnancy (DH 2018). You'll feel pain in your pelvic or lower tummy area from the contractions (NHS 2017). You may have a show, when the mucus plug that has sealed the entrance to your uterus comes away (NHS 2017). You may also feel your waters breaking (NHS 2017).

Call your doctor, midwife or the maternity unit 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 full 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.

Resting on the sofa or going for a walk may help ease early labour cramping (Nolan et al 2009).

Check out our photo gallery for tips to get relief from late-pregnancy aches and pains.