Abdominal Pain In Pregnancy

Understanding Pregnancy And Non-Pregnancy Related Causes of Abdominal Pain During Pregnancy

Abdominal pain in pregnancy is so common, that every pregnant woman is expected to have one form of pain or the other during this most exciting, yet challenging time of life. We bring you a list of common causes of abdominal pain during pregnancy and how to narrow down the most likely causes of such pain.

Right Side Abdominal Pain In Pregnancy

Changes in the types and actions of pregnancy hormones, the increasing size of the womb (uterus) and the placenta as well as the position and size and movements of the growing foetus , all could lead to conditions that bring about abdominal pain in pregnancy.

The pregnant woman is of course not immune to the other usual causes of abdominal pain in the non pregnant woman, man and child.

Thankfully, most common causes of pains in pregnancy (in the abdomen) are not dangerous. With the use of mild pain killers, or other specific medicines, or even with the passage of time, they resolve on their own. Such pregnancy related abdominal pain include pregnancy induced acid reflux, ligament pain, Braxton hicks contractions, and symphysis pubis dysfunction (SPD - causing pain in the middle of the front of the lower pelvis).

For some other causes of abdominal pain in pregnancy, a delay or failure of prompt recognition and intervention or treatment could lead to distress and possibly injury to both the unborn baby and the mother. It is therefore important that any pregnant woman complaining of pain in the abdomen of any severity, lasting for more than an hour or less, should be taken seriously, and the possible cause of pain should be sought in a methodological pattern.

Common Causes Of Abdominal Pain During Pregnancy

The likely causes of pain in the abdomen during pregnancy could vary depending on the stage of pregnancy. The following are the common causes of abdominal or "stomach" pains in pregnancy at each stage or trimester of pregnancy and how to recognise them.

Early Pregnancy - 4th To 12th Week

The first trimester is that time from conception till the end of the twelfth week (or third month). This is the most uncertain period or times during pregnancy in terms of the possibility of progression of the pregnancy. The presence of pain in the abdomen during this time naturally feels the expectant mother with fear. Fear of a possible miscarriage or ectopic pregnancy. Yes. Those are the two conditions most feared for lower abdominal pain in pregnancy. But there are more. We list the common causes of abdominal pain in early pregnancy. They include:

  • Miscarriage - this usually starts with passage of small amount of blood from the vagina, and may be followed later with varying degree of cramping lower abdominal pain. Sometimes it stops on its own and the pregnancy continues, or it may lead to lose of the pregnancy. The rate of miscarriage is highest in the first 12 weeks of pregnancy
  • Ectopic Pregnancy - this means pregnancy occurring outside the womb. It is unfortunately a very common condition. It causes lower abdominal pain in one side of the abdomen. This might be followed later by vaginal bleed. It is a very common cause of right or left lower side abdominal pain in the first 5 to 10 weeks of pregnancy. It is potentially a serious or life threatening condition if not diagnosed on time. See your doctor now if you have any of these symptoms.
  • Gestational Trophoblastic Disease - This is a form of tumour of the placenta, with loss of the baby. It is another potential cause of lower abdominal pain in early pregnancy with bleeding or passage of grape-like materials and a uterus larger than what is expected for that stage of pregnancy.
  • Twisted, Ruptured, or Bleed Into An Ovarian Cyst (Corpus Luteum Of Pregnancy). After fertilization, the "empty" sac of egg from the ovary that helps produce hormones to protect and the developing baby may become enlarged, and have blood collecting inside it, causing a right or left lower abdominal pain in early to mid pregnancy.
  • Pain From A Pre-existing Fibroid
  • Constipation
  • Acid Reflux
  • Gastritis following excessive vomiting - hyperemesis gravidarium. This usually presents as a upper abdominal pain with bloating. The pain may spread to the center of the back. Gaviscon, pain killers and tablets like losec may help.
  • Urine Tract Infection
  • Acute Appendicitis
  • Acute Pancreatitis
  • Gastritis
  • Hiatus hernia
  • Stomach Ulcer
  • Duodenal Ulcer
  • Gallstones
  • Bowel Obstruction
  • Food poisoning
  • Trapped wind
  • Kidney stone
  • Severe Diabetes (DKA)

And all other other normal causes of abdominal pain in the non-pregnant woman.

Mid Trimester 12th To 24th Week

This is the time of pregnancy some stability is established, and miscarriage is less likely, and an ectopic pregnancy can almost certainly not be an issue. The causes of abdominal pain at this stage of pregnancy is usually due to things like:

  • Round Ligament Pain, causing a dull dragging lower abdominal pain that spreads to the back. It could also cause a sharp dragging right or left sided abdominal pain during this stage of pregnancy
  • Fibroid. 1 in every 5 pregnant woman may have a fibroid, and they tend to grow with pregnancy, causing pain and discomfort - "red degeneration" often between the 12th to 20th week of pregnancy. They typically cause lower abdominal pain in pregnancy, depending on their position in the womb
  • Acid Reflux - this is the time in pregnancy most women begin to feel a burning or sharp pain in the upper abdomen between the breast, or just below that point. It is commonly due to acid burn from the stomach
  • Braxton Hicks Contraction. Too early you thought? No. Braxton Hicks himself described these contractions or "false labour" to start from the 16th week of pregnancy. Read more about Braxton Hicks here.
  • Placenta Abruption or Abprutio Placentae - commonly following injury, like blow, kick or direct trauma to the pregnant abdomen. It causes severe abdominal pain with very hard uterus and difficult to feel foetal parts
  • Pre-Eclampsia and Eclampsia - this typically starts after the 20th week of pregnancy, and occurs in women with raised blood pressure, swollen legs and high amount of protein in their urine. The pain is usually in the upper abdomen and this is an emergency that needs to be attended to immediately to prevent fits and foetal and maternal death
  • Miscarriage And Early Preterm Labour - Though less common, the lose of pregnancy can still occur after the 12th week of pregnancy. If you have a lower cramping abdominal pain in pregnancy at any time, it is always good to get checked by your healthcare provider as soon as possible
  • PolyHydramnios - this simply means too much fluid around the baby. This can cause the uterus to be larger than it should be for that age of pregnancy, stretching it and causing abdominal pain during middle to late pregnancy. It can easily be diagnosed with a scan.

The other causes of abdominal pain in any non pregnant woman can also cause pain at this stage of pregnancy.

Late Pregnancy - 24th To 40th Week

There are conditions that causes abdominal pain exclusively after the 2nd and during the third trimester or late pregnancy. They include:

  • Symphysis Pubis Dysfunction (SPD) Pain - As pregnancy continues and the body prepares for the birth of the baby, the ligaments around the pelvis and hip bones loosen up and becomes lax. Sometimes, the weight of the uterus puts excessive pressure on the lax ligament holding the two side of the pelvic bones together in the middle. This causes severe pain in the front of the pelvis, and this pain could spread to the upper thighs and around the genital region and anus, worsened by movement. Women suffering with SPD often walk with what doctors call waddling gait - like the steps of a duck.
  • Braxton Hicks Contractions - This could start as early as the 16th week, but in most women, it is more noticeable in the third trimester or late pregnancy
  • Acid Reflux - Even more common at this stage of pregnancy
  • Rupture of The Uterus
  • PreTerm Labour
  • Urine Infection
  • Acute Appendicitis
  • Constipation

And all other causes of abdominal pain as described in the non-pregnant woman.

For more information on recognition and treatment of specific common causes of abdominal pain in pregnancy, please see here

Abdominal Pain in Pregnancy - Questions & Comments

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