Abdominal Pain During Pregnancy
Diagnosis & Treatment Options

Abdominal pain during pregnancy can either be normal or the body’s alert system. The key is having a way of determining if the discomfort you feel is good pain or bad pain.


Pregnant belly black and white

Abdominal pain during pregnancy is a common occurrence that affects most pregnant women. Over the course of three trimesters, pregnant women adjust to shifting organs, a growing uterus, and stretching ligaments to make room for baby and prepare Mum’s body for delivery. For many pregnant women, the aches and discomfort last throughout their pregnancies.

However, mums-to-be must also be vigilant to ensure any abdominal pain they experience is part of the natural progression of a normal pregnancy. Problems like severe abdominal pain, cramping, persistent lower back pain, or low back pain that intensifies over a period of days or hours can mean trouble with the pregnancy.

Abdominal pain during pregnancy can either be normal or the body’s alert system. The key is having a way of determining if the discomfort you feel is good pain or bad pain.

Common Causes of Upper Abdominal Pain During Pregnancy

One common source of abdominal pain during pregnancy is upper abdominal pain, located in the area above the navel. There are several common causes of non-threatening upper abdominal pain during pregnancy. 

Acid Reflux 

Acid reflux occurs when the muscles that closes the esophagus after you swallow food is too weak (often due to pregnancy hormones) to fully close. This opening allows stomach contents (and stomach acids) to push back up into the esophagus. Symptoms of acid reflux include burning sensation in the upper abdomen, behind the breast plate (sternum). Sufferers may also have a sour or metallic taste on their tongues. Symptoms tend to be worse at night or when lying flat. 
To relieve acid reflux, avoid eating heavy meals and eating right before bed. Consider sleeping on  pillows with your head slightly elevated. There are also over-the-counter medications that help relieve the burning such as Gaviscon and in severe cases, Losec.

Gastritis 

Gastritis is the inflammation of the lining of the stomach wall. Gastritis can be caused by too much acidity, severe stress, infection, medications like ibuprofen or diclofenac (drugs referred to as NSAID), or direct irritation of the stomach lining from alcohol or eating spicy foods. Gastritis presents as upper central abdominal pain, nausea, bloating, burning, a stabbing feeling, or heaviness just below the chest. It could spread through the upper abdomen to the back. These symptoms could be made worse by eating, and relieved by taking antacids or other medications used to treat gastritis, reflux and heartburn or dyspepsia:

  1. Gaviscon Advance chewable tablets - Chew one or two tablets after meals and at bed time.
  2. Omeprazole (Prilosec) - Usual dose is 10mg once a day; can increase to 20mg once a day.
  3. Ranitidine (Zantac) - Take with above two medications if symptoms persist. Usual dose is 150mg once a day. The above medications are safe in pregnancy. Please always consult your doctor.
Acute Pancreatitis 

Acute pancreatitis This is inflammation of the pancreas. The pancreas is the gland that sits in a loop at the beginning of the small bowel. The pancreas produces enzymes to help the body further break down foods; it is also the gland that produces insulin to help regulate blood sugar.

Pancreatitis tends to occur in pregnant women with gallstones. It causes severe upper abdominal pain, piercing into the back.  Pancreatitis will require medical treatment, in part for pain management. You can read more about pancreatitis here.

Gallstones 

Gallstones are hard deposits in the gallbladder that cause ongoing pain in the upper right abdomen. The pain associated with gallstones is often brought about beating rich, fatty meals. There may be associated vomiting or fever if the inflammation caused by gallstones leads to infection, a condition called cholecystitis. Without an infection, gall bladder stone pain is called billiary colic.

Kidney Stone 

Abdominal pain due to hardened deposits in the kidneys can occur at any time in anyone. Kidney stones usually start as sudden upper abdominal pain on the side of the body. Kidney stones are very painful and the pain comes in intermittent waves that spread from the upper side of the flank towards the groin or lower abdomen. Those who suffer with kidney stones describe the pain as the most severe pain they've ever felt. 

Lower Abdominal Pain During Pregnancy

Whereas upper abdominal pain during pregnancy is usually not related to the pregnancy itself, lower abdominal pain is more often pregnancy-related. Pregnancy-related causes of lower abdominal pain should be monitored at home and taken very seriously. If the pain is severe, accompanied by vaginal bleeding, spreads to the back, or lasts for several days, it should be taken very seriously. Seek the advice of your doctor to rule out the following serious causes of lower abdominal pain during pregnancy:

Ectopic Pregnancy 

An ectopic pregnancy is one that occurs outside the uterus. It causes a right or left lower abdominal pain during the first 5 to 10 weeks of pregnancy. Other indicators of an ectopic pregnancy are vaginal bleeding, or spotting. In severe cases, there will also be abdominal bloating or distention with shoulder pain and possibly fainting. Ecotpic pregnancies  are dangerous for both the mother and the fetus. A fertilized egg cannot survive outside the uterus, and if left to grow, the fetus can damage nearby organs and cause internal bleeding.

Miscarriage

The onset of miscarriage is a very common cause of abdominal pain during early pregnancy, especially in the first twelve weeks. Miscarriages often starts with vaginal bleeding, which could be very little initially, followed by increasing amounts of blood loss. Though one in four women will have some spotting during their pregnancy, if it is accompanied by cramping that feels like menstrual pain and becomes more severe as the days progress these are key indicators the pregnancy may be in trouble. If the miscarriage symptoms stop and the pregnancy continues successfully, this is called a threatened miscarriage. Any sign of potential miscarriage is cause for a pregnant woman to go to the hospital.

Ligament Pain 

Ligaments support the pregnant womb and hold it in place. As the pregnancy progresses and the womb gets bigger and heavier, the weight and pull on these ligaments increases, causing lower abdominal and lower back pain in pregnancy. Pain due to stretching ligaments begins around 12 weeks of pregnancy and continues throughout the pregnancy. Up to 1g of acetaminophen (Tylenol) four times a day for a few days is safe for an expecting mum and provides relief.

Urinary Tract Infection (UTI)

A urinary tract infection is an infection in the bladder or kidneys and is a common problem for pregnant women, in part because the position of the growing uterus (which sits on top of the bladder) makes it more difficult for bladder to drain. The result is often a bladder infection. UTI causes lower abdominal pain in pregnancy, and can happens at any stage of pregnancy. A urinary tract infection during pregnancy usually starts as a lower abdominal pain around the bikini line, or around the side of the abdomen (loin pain). There may be associated increased frequency of passing urine, with or without a burning sensation on passing urine. Other indicators of a urinary tract infection are poor appetite, and feeling hot and cold (fever). 

Treatment usually involves a choice of antibiotics that are safe to take during pregnancy. They include:

 Amoxicillin Capsules (affiliate link) - Take 500mg three times a day for seven days (Amoxyl). This is a penicillin-based antibiotic. DO NOT USE IF YOU HAVE PENICILLIN ALLERGY. Instead, use erythromycin.

Erythromycin (affiliate link) - Take 500mg four times a day for five days. Erythromycin is safe to take during pregnancy for women who may be allergic to penicillin products. You can also take an antibiotic called nitrofurantoin for a urinary tract infection in pregnancy.

Cefalexin (affiliate link) - Take 500mg three times a day for seven days. This is NOT a penicillin based medication, though a few persons who are allergic to penicillin will also be allergic to this medication.

Constipation

Constipation is a common cause of lower abdominal pain during pregnancy. If you have not opened your bowels properly for three or more days, or are passing very hard stools in last few days and now have a right or left lower abdominal pain during pregnancy, it is important to see your doctor to exclude constipation. Constipation is treated with the use of medications like Movicol or Lactulose. Both lactulose and Movicol are safe for use in pregnancy.

Braxton Hicks Contractions 

Braxton Hicks Contractions are often referred to as false labour. They present symptoms that can seem very much like the start of actual labour and fool even seasoned mothers. Braxton Hicks feel like mild lower abdominal cramps and they usually start at the beginning of the second trimester, though they tend to manifest for first-time mothers later than they do for pregnant mothers who have already had children. Braxton Hicks Contractions can be mild or several, but will usually subside when the mother changes positions, walks around, lies down, drinks water (Braxton Hicks can be brought on by dehydration), or lays on her left side. A warm bath and paracetamol can help alleviate the pain of false labour, or stop it altogether.

Symphysis Pubis Dysfunction (SPD)

Symphysis Pubis Dysfunction can be a painful condition that occurs when the ligaments that stabilize the pelvis during pregnancy become too soft. SPD typically starts to be a problem at the start of the third trimesters (24th to 40th week of pregnancy) when lax and over-stretched ligaments in the front of the pelvic bones allow the pelvis shift. The shift causes severe lower abdominal pain during pregnancy just above the genitalia, spreading to the top of the thighs. The pain gets worse with movement. Most women with SPD walk with a waddling gait. The treatment for SPD is rest and over-the-counter pain killers. 

Fibroids

Fibroids are an abnormal growth of the muscle of the uterus, often budding out and out growing its blood supply, leading to red degeneration. They aren’t typically dangerous, but they can cause lower abdominal pain when they undergo what is called a red degeneration. An agonizing lower abdominal pain in pregnancy can be caused by the presence of uterine fibroids. 

Fibroids are more common in Afro-Caribbean women, but also in women of any race. They present as abdominal cramps during pregnancy. A key indicator that uterine fibroids are present is having an oversized uterus that seems to be outpacing the actual age of the pregnancy. Uterine fibroids can be diagnosed with a simple ultrasound and treated with pain killers if they are painful. 

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