Is it normal to have abdominal pain during pregnancy?
Occasional aches throughout the abdomen are a common symptom of pregnancy, and although they are generally harmless, it is best to consult your doctor if they are accompanied by other symptoms.
If you experience pain or cramping along with spotting, bleeding, fever, chills, vaginal discharge, fainting, discomfort when urinating, or nausea and vomiting, or if the pain does not subside after several minutes of rest, contact your doctor.
What can intense and persistent abdominal pain mean?
Ectopic pregnancy
An ectopic pregnancy happens when a fertilized egg implants outside the uterus, usually in one of the fallopian tubes. If left untreated, it can be life-threatening. Call your doctor right away if you have any of the following symptoms: severe pain or tenderness that gets worse with physical activity, heavy bleeding or a racing heart, dizziness, or feeling faint.
Miscarriage
A miscarriage is the loss of a pregnancy before the fetus becomes viable, that is, depending on the definition used, before 20 to 24 weeks. Vaginal spotting or bleeding is generally the first symptom, followed by abdominal pain a few hours to a few days later. The bleeding may be light or heavy. The pain you may feel is like a persistent cramp, mild or sharp. Call your doctor if you have symptoms of a miscarriage. If you have severe pain or heavy bleeding, you should be seen right away.
Preterm labor
Preterm labor can occur before the 37th week of pregnancy when contractions begin or the cervix starts to dilate. Contact your doctor or midwife immediately if you experience any of the following symptoms in your second or third trimester (before 37 weeks):
- Increased vaginal discharge or a change in the type of discharge (mucus that looks pink or blood-tinged)
- Vaginal bleeding or spotting
- Abdominal pain similar to menstrual cramps, or more than four contractions in one hour.
- Increased pressure in the pelvic area
- Lower back pain, especially if you don’t usually have back pain
Placental abruption
Placental abruption is a life-threatening condition in which the placenta separates from the uterus, partially or completely, before your baby is born.
There is a wide range of possible symptoms. Placental abruption may cause sudden bleeding, but in some cases you may have only light bleeding or spotting. You may also notice bloody fluid. You may experience back pain, frequent contractions, or the uterus may contract and remain firm like a cramp.
Preeclampsia
Preeclampsia is a complex pregnancy disorder that causes changes in your blood vessels and can affect a number of organs, such as the liver, kidneys, brain and placenta. Symptoms may include swelling of the face or puffiness around your eyes. You may also notice mild swelling in your hands and excessive or sudden swelling of your feet or ankles. (This water retention can lead to rapid weight gain.) In severe preeclampsia, you may have severe pain or tenderness in the upper abdomen, a severe headache, vision problems (such as blurred vision or seeing spots), nausea and vomiting. If you have symptoms of preeclampsia, call your doctor or midwife right away.
Urinary tract infections
Pregnancy makes you more susceptible to all types of urinary tract infections, including kidney infections. Symptoms of a bladder infection may include pain, discomfort, or burning during urination, pelvic discomfort or lower abdominal pain (often just above the pubic bone), and a frequent or uncontrollable urge to urinate, even when there is very little urine in the bladder. Call your doctor if you have any of these symptoms, because a bladder infection that is not monitored and treated can lead to a kidney infection and preterm labor.
Signs that the infection has spread to your kidneys and that you need medical help immediately include high fever, chills, sweating, pain in the lower back or just under your ribs on one or both sides, nausea, and vomiting. Another concerning sign is the presence of pus or blood in your urine.
Other causes
Many other conditions can cause abdominal pain. Some of the most common causes your doctor will consider include a stomach virus, food poisoning, appendicitis, kidney stones, hepatitis, gallbladder disease, pancreatitis, fibroids, and bowel obstruction. Gallbladder disease and pancreatitis are often the result of gallstones, which are more common during pregnancy. Uterine fibroids can grow during pregnancy and typically cause discomfort. The increasing pressure in the uterus can lead to bowel obstruction, which is more likely to occur in the third trimester.
What are the most common causes of harmless abdominal discomfort?
Abdominal discomfort is not always a sign of a serious problem during pregnancy. For example, you may notice cramping during or right after orgasm. As long as it is mild and short-lived, it is completely normal and nothing to worry about.
Here are some other common causes of abdominal discomfort.
Gas and bloating
It is very likely to experience gas-related pain during pregnancy due to hormones that slow down digestion and the increasing pressure of your uterus on your stomach and intestines.
Constipation
Constipation is another common cause of abdominal discomfort throughout pregnancy, again due to hormones that slow the movement of food through your digestive system and the increasing pressure of the uterus on your rectum.
Braxton Hicks contractions
At some point after the second trimester, you may begin to notice your uterus tightening. Before 37 weeks, Braxton Hicks contractions should be infrequent, irregular, and essentially painless.
Call your doctor if the contractions are accompanied by lower back pain, if you feel more than four contractions in an hour (even if they don’t hurt), if they come at regular intervals, or if you have any other symptoms of preterm labor.
Is there anything I can do to ease abdominal pain?
Here are some tips for managing abdominal discomfort that is not caused by something serious:
- Move around or do some gentle exercises to relieve pain caused by gas.
- Take a warm (not hot) bath or shower, or place a warm water bottle wrapped in a towel on the painful area.
- Lean toward the side of the pain for relief.
- Drink plenty of fluids because dehydration can trigger Braxton Hicks contractions.
If Braxton Hicks contractions cause the pain, it may help to lie down and rest.
Lower abdominal pain by month of pregnancy
Lower abdominal aches in early pregnancy (1st to 3rd month). Mild, period-like cramps are very common, as the uterus grows and blood flow increases. Light spotting around the time of implantation is also common. Severe pain on one side with bleeding or dizziness needs urgent evaluation for ectopic pregnancy or miscarriage.
Lower abdominal pain in the 5th and 6th month. This is the time of round ligament pain: sharp, stabbing pains in the groin, more often on the right, when you change position or cough. Mild, irregular Braxton Hicks contractions may also begin. Persistent pain with burning when urinating points to a urinary tract infection.
Lower abdominal pain in the 8th month. Pressure from the baby's head on the pelvis and Braxton Hicks contractions are expected. Contractions that come regularly and get stronger before 37 weeks, leaking fluid or bleeding need an urgent check for preterm labor.
Pain on the right, on the left or in the upper abdomen
- Lower left: often from constipation, gas or the left round ligament. In the first trimester, if it is severe, ectopic pregnancy must be ruled out.
- Lower right: round ligament, urinary tract infection, an ovarian cyst and, less often, appendicitis, which causes worsening pain, fever and nausea.
- Upper abdomen: heartburn and pressure from the uterus in the third trimester. Pain in the upper right abdomen under the ribs with a headache or blurred vision may be a sign of preeclampsia and needs urgent evaluation.
You can read about how the body and belly change month by month in our guide to stages of pregnancy.
Less well-known causes of abdominal pain in pregnancy
Ovarian torsion
An ovary with a cyst, or an ovary enlarged after fertility treatment, can twist around its axis and cut off its own blood supply. It is more common in the first trimester. The pain is sudden, very severe, on one side, and often comes with nausea and vomiting. It needs emergency evaluation, because prompt surgery saves the ovary. More about ovarian cysts and their treatment can be found on the related page.
Fibroid degeneration
A fibroid that grows quickly during pregnancy can "outgrow" its blood supply. The result is localized, severe pain over the fibroid, sometimes with a low-grade fever, usually in the second trimester. It is most often treated conservatively, with rest and pain relief that is safe in pregnancy.
Ovarian hyperstimulation syndrome after IVF
If the pregnancy was achieved through in vitro fertilization, bloating and pain in the first weeks may be due to ovarian hyperstimulation. Rapid weight gain, marked swelling of the abdomen, passing little urine or shortness of breath require immediate contact with the center that is monitoring you.
Abdominal pain after a fall or blow
After 20 weeks, even a seemingly minor blow to the abdomen, such as a fall or a car accident while wearing a seat belt, needs evaluation, even if you feel fine. The reason is that placental abruption can appear hours later.
- The evaluation usually includes an examination, an ultrasound and, after 24 to 26 weeks, cardiotocography for several hours.
- If your blood type is Rhesus negative, you may need an anti-D injection.
- In the car, the lap part of the seat belt goes under your belly, across your hips, and the diagonal part between your breasts and the side of your belly. Never over the uterus.
Painkillers for abdominal pain in pregnancy: what is allowed
- Paracetamol (acetaminophen): it is the first-choice painkiller, at the lowest effective dose and for the shortest possible time.
- Ibuprofen, diclofenac and other anti-inflammatory drugs: are avoided, especially after 20 weeks, because they can affect the baby's kidneys, the amniotic fluid and, later, the baby's heart circulation.
- Low-dose aspirin: given only when recommended by your doctor, to prevent preeclampsia, and not as a painkiller.
- Antispasmodics and medications for gas: only after talking with your doctor.
Most importantly: a painkiller should not "mask" pain that has not been explained. If you need pain relief to cope, the pain needs to be examined.
What happens when you go for a pain assessment
When you visit the office or the maternity hospital for abdominal pain, the evaluation is usually quick and organized:
- questions about when the pain started, where it is, whether it comes in waves, and whether there is bleeding or leaking fluid,
- measurement of blood pressure, pulse and temperature,
- palpation of the abdomen and, when needed, a vaginal examination,
- urinalysis and, depending on the picture, blood tests,
- ultrasound and, in the third trimester, monitoring of contractions and the baby's heart rate.
Bring your pregnancy file with your test results and the obstetric ultrasound reports you have had. It helps a lot with a quick assessment.
For a personalized assessment of your case, book an appointment with Dr. Panagiotis Polyzos at his office in Athens or Volos.
Frequently Asked Questions
Is lower abdominal pain normal in early pregnancy?
Mild pulling sensations and period-like cramps are common in the first weeks, as the uterus grows. If the pain is severe, one-sided or comes with bleeding, it needs to be checked right away for ectopic pregnancy.
What is round ligament pain?
Sharp, brief pain in the groin, usually in the second trimester, when you change position, cough or stand up suddenly. It is harmless and goes away with rest.
How can I tell aches from contractions?
Contractions harden the whole belly, come in a regular rhythm and do not ease when you change position. Before 37 weeks, regular contractions mean you should contact your doctor right away.
What can I do to feel better?
Rest on your side, a warm (not hot) shower, slow changes of position, plenty of fluids and a pregnancy support belt. Painkillers only on your doctor's advice.
When should I see a doctor right away?
If the pain is severe or constant, or if it comes with bleeding, fever, vomiting, pain when urinating, a hard belly or reduced baby movements. See also the warning signs in pregnancy.
Is lower abdominal pain normal in the 5th month?
Usually yes. These aches are mainly due to stretching of the round ligaments and ease with rest. If the pain is constant, rhythmic or comes with bleeding or fever, tell your doctor.
What does lower right abdominal pain mean in pregnancy?
Most often it comes from the right round ligament or the bowel. If it gets worse or comes with fever, nausea or pain when urinating, you need an examination for a urinary tract infection, a cyst or appendicitis.
Can my belly hurt when the baby kicks?
Yes, in the third trimester strong movements, especially under the ribs or toward the bladder, can cause brief pain. This is harmless. What is worrying is the opposite: a noticeable decrease in the baby's movements, which needs to be checked the same day.
Is abdominal pain after sex during pregnancy dangerous?
Mild cramps or tightening of the uterus after sex and orgasm are common and pass within a few minutes with rest. If the pain persists, becomes rhythmic, or there is bleeding or leaking fluid, contact your doctor.
What does abdominal pain with diarrhea mean in pregnancy?
It is usually gastroenteritis or a food intolerance. The most important thing is to drink enough fluids, because dehydration can trigger contractions. If there is fever, blood in the stool, inability to keep fluids down, or rhythmic pain in the third trimester, you need an examination.
