Abdominal Pain During Pregnancy
Diagnosis & Treatment Options

Explaining The Common Causes And Treatment Of Abdominal Pain During Pregnancy In The Different Parts Of The Abdomen

Last updated: 26/10/2012

Abdominal pain during pregnancy is so common, yet could be difficult to diagnose. See common causes of pain in the different parts of the abdomen during pregnancy and steps to deal with them.

Are you in early or late pregnancy? Do you have pain in the upper part of your tummy or just below your navel? Any thoughts in your mind what this pain could be due to?

Abdominal pain during pregnancy is so common that almost every pregnant woman is expected to have one form of pain or the other at some point during pregnancy. If you suffer with abdominal pain, whether in early or late pregnancy, it is not something you should ignore. While most causes of abdominal pain when pregnant do not require treatment other than simple pain killers, some other causes of pain in pregnancy needs close monitoring and treatment, to avert deleterious consequences.

Early diagnosis and prompt treatment is key to ensuring good health for both baby and mother. The following are common causes of stomach pains in pregnancy, taking into account the area of the abdomen involved.

Upper Abdominal Pain During Pregnancy

The upper abdomen refers to the area of the abdomen above the navel or belly button. It is a common area for abdominal pain during pregnancy. The causes of pain in the upper abdomen during pregnancy are not usually pregnancy related, though sometimes, such conditions are made worse because of the changes taking place in pregnancy. The following are the common causes of abdominal pain in this region during pregnancy:

  • Acid Reflux - this is usually due to weakness of the sphincter that prevent the flow of acid from the stomach back to the gullet or esophagus by pregnancy hormones, or the growing uterus pushing up the stomach. The symptoms as described above are those of burning sensation in the upper abdomen behind the breast plate (sternum). There may also be a feeling of sour or metallic taste in the mouth. Symptoms tend to be worse at night or when lying flat.
    Treatment is usually by increasing the number of pillow you sleep on, and the use of antacids like Gaviscon and in severe cases, Losec. Avoid heavy meals and eating late.
  • Gastritis - This is the inflammation of the lining of the wall of the stomach. This can be caused by too much acidity, severe stress, direct irritation of the stomach lining by substances like alcohol or too spicy food, infection, medications like ibuprofen or diclofenac (drugs referred to as NSAID). It presents as upper central abdominal pain or discomfort, burning or stabbing in nature, some have described it as a heaviness just below the chest, and could spread right through the upper abdomen to the back, as if between the shoulder blades. There could be associated feeling of nausea, belching and bloating. These symptoms could be made worse by eating, and relieved by taking antacids. Like heartburn, the following medications could be used in treating 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 persists. Usual dose is 150mg once a day. The above medications are safe in pregnancy. Please always consult your doctor.
  • Acute Pancreatitis - This is inflammation of the gland that sits in a loop at the beginning of the small bowel, a gland called the pancreas. This is what is responsible in producing insulin as well as many of the enzymes that help to digest our meals. Pancreatitis tends to occur in pregnant women with gallstones. It causes severe upper abdominal pain, piercing into the back and the sufferer is usually very unwell. Read more about pancreatitis here.
  • Gallbladder Stone disease in pregnancy would present exactly as in the non-pregnant woman. It comes on as pain in the upper right abdomen. It could be cramping in nature, often brought about by the ingestion of fatty meals. There may be associated vomiting. Fever comes in if the inflammation caused by the stone leads to infection, a condition called cholecystitis. Without an infection, gall bladder stone pain is called billiary colic.
  • Kidney Stone - Abdominal pain due to stone in the kidney can occur at any time in anyone. It usually starts as a sudden flank or upper abdominal pain on the side of the body, often very painful, comes in wave form, spreading from the upper side of the flank towards the groin or lower abdomen. The sufferers usually describe this as the most severe pain they've ever felt. They roll around, looking for a position of comfort and may vomit for feel nauseated.

Lower Abdominal Pain During Pregnancy

Pregnancy related causes of abdominal pain occur more in the lower abdomen. If you are pregnant and have pain in the lower abdomen, it is one that often needs to be taken seriously, until a potentially dangerous cause of abdominal pain during pregnancy is excluded.

The following are common causes of lower abdominal pain during pregnancy:

  • Ectopic Pregnancy - This occurs when a pregnancy is outside the womb. It causes a right or left lower abdominal pain during pregnancy, in the first 5 to 10 weeks of pregnancy. If you are 5 to 10 weeks pregnant, and have pain in one side of your lower abdomen, it is important you see a doctor to exclude the presence of ectopic pregnancy. Apart from the pain, there may also be an associated bleed or spotting from the vagina after the onset of pain. In severe cases where the woman has bled a lot, there will also be abdominal bloating or distention with shoulder tip pain and fainting. The risk of ectopic pregnancy disappears after the 10th to 12th week of pregnancy.
  • Miscarriage - The onset of miscarriage is a very common cause of abdominal pain during early pregnancy, especially in the first twelve week of pregnancy. It often starts with a vaginal bleed. This could be a few spotting initially, and then followed by increasing amount of blood lose. Then comes a cramping pain which starts like menstrual pain at first, but soon becomes more severe, if the pregnancy is certainly going to go. Sometimes, a miscarriage stops half way and the pregnancy continues successfully. This is called a threatened miscarriage. If you suspect you are having a miscrriage, please contact your healthcare provider now.
  • Ligament Pain - There are a number of big ligaments that hold and support the pregnant womb in place. As the pregnancy grows and become bigger, the weight and pull on these ligaments increases, causing lower abdominal and lower back pain in pregnancy. Pain due to ligament stretch tends to start at the end of the first trimester (after 12 weeks of pregnancy) and beyond. Rest, the use of simple pain killers like paracetamol (acetaminophen) up to 1g four times a day for a few days gives relieve.
  • Urine Tract Infection - this could be due to cystitis (bladder infection) or kidney infection. It is certainly one of the most common causes of lower abdominal pain in pregnancy, at any stage of pregnancy. It 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, poor appetite, and feeling hot and cold (fever).
    Treatment usually involve a choice of antibiotics carefully selected, that are safe to take in pregnancy. They include the use of any one of the following: Amoxicillin Capsules Take 500mg three times a day for 7 days (Amoxyl). THIS IS A PENICILLIN based antibiotic. DO NOT USE IF YOU HAVE PENICILLIN ALLERGY. Use ERYTHROMYCIN instead. Cefalexin. 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. Please consult your doctor to find out if you have had this medication in the past. Erythromycin. Take 500mg Four times a day for five days. It Is not known to be harmful in pregnancy, and it is not a penicillin. Other antibiotics that can be taken for urine infection in pregnancy include nitrofurantoin.
  • 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. Treatment is with the use of medications like Movicol or Lactulose. Both lactulose and Movicol are safe for use in pregnancy.
  • Braxton Hicks Contractions - This is false labour. It is a mild lower abdominal cramps common after the 16th week of pregnancy, but more common towards the 24th to 40th week. If you are having a cramping lower abdominal pain after the 16th week of pregnancy, take a walk if you are resting, or rest if you are active, and this is usually enough to make Braxton Hicks contraction go away. A warm bath and paracetamol is almost certain to abort severe episode of Braxton Hicks contractions.
  • Symphysis Pubis Dysfunction (SPD) - This is more a problem after the end of the second trimester (24th to 40th week of pregnancy). It is due to lax and over stretched ligaments in the front of the pelvic bones. It causes severe lower abdominal pain just above the genitalia, spreading to the top of the thighs, and worsened by movement. Most women with SPD walk with a waddling gait, described like the steps of a duck.Treatment is usually centered around adequate rest and simple pain killers
  • Fibroid - Fibroid tends to grow with pregnancy, and any time from the 12 to 20th week, they tend to 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 fibroid. Fibroid are an abnormal growth of the muscle of the uterus, often budding out and out growing its blood supply, leading to red degeneration.
    They are more common in the Afro-Caribbean woman, but also in woman of any race. They presents as abdominal cramps in pregnancy. The pointer to the presence of fibroid in pregnancy, for a woman who does not know of their existence is a womb size bigger than that expected for that age of pregnancy, with associated cramping abdominal pain. If suspected, a scan will help in clinching the diagnosis and treatment is usually with simple pain killers, until delivery.

Other causes of lower abdominal pain during pregnancy include problems with ovarian cysts, placenta abruptio, early preterm labour and polyhydramnios.

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