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It is quite common for pregnant women to experience abdominal pain, and most of the time doctors hear complaints describing pain in the back and especially abdomen. There are many potential causes of such pain.

Abdominal problems in pregnancy

For starters, it’s well known that round ligament stretching will cause minor or even moderate pain in the lower abdomen during pregnancy. A pregnant woman has to distinguish what is and what is not a cramp. A cramp could easily be confused with a minor contraction, which happens from time to time and is no cause for alarm. It is just a signal that the uterus is preparing itself for the upcoming birth.

There are several potential reasons for cramps and pain in the lower abdomen during pregnancy, but most of the time, it’s nothing serious. So the question for all pregnant women is, whether or not it is normal to experience some abdominal pain during pregnancy, and what serious problems can cause abdominal pain?

The following article explains some of the most common causes of abdominal discomfort, harmless or otherwise.

Causes of abdominal pain during pregnancy

Occasional abdominal discomfort is a common pregnancy complaint [1], but it can also be a sign of a serious problem.

Severe or persistent abdominal pain during pregnancy is never normal. The point when one experiences abdominal pain or cramping along with spotting, bleeding, fever, chills, vaginal discharge, and faintness, is when the doctor must be visited. Symptoms such as discomfort while urinating, nausea, and vomiting, or the pain not subsiding after several minutes of rest, also require a doctor's exam.

Severe causes of abdominal pain during pregnancy

Ectopic pregnancy

This is one of the potential causes of abdominal pain during pregnancy, occurring when a fertilized egg is implanted outside the uterus, typically in one of the fallopian tubes [2].

The problem is usually discovered during the first three months of pregnancy, or before a woman even knows she is pregnant. If ectopic pregnancy is left untreated, it can rupture and become life-threatening, so a woman has to call her practitioner immediately if she has any of the following symptoms [2]:

  • abdominal or pelvic pain or tenderness,
  • vaginal spotting or bleeding (which can be red or brown, copious or scanty, and continuous or intermittent),
  • pain that gets worse during physical activity or while moving bowels or coughing, and
  • pain in the tip of the shoulder, 
  • any sign of shock, such as a racing pulse, pale, clammy skin, or dizziness or faintness

should also be checked by the doctor.

Miscarriage

Bleeding is generally the first symptom of a miscarriage, followed by abdominal pain a few hours to a few days later. The pain can be crampy, similar to menstrual cramps, but it’s often stronger and rhythmic [3].

Some women feel it as a low backache, others as a dull abdominal pain or pelvic pressure, but both refer to the same problem. It is important to know that a pregnant woman should call her practitioner if she has any signs of a miscarriage, such as severe pain or heavy bleeding.[3]

Preterm labor 

A woman has problems with premature labor if she starts having contractions that efface or dilate the cervix before 37 weeks of pregnancy.[4]

Any symptom in the second or third trimester that refers to

  • an increase in vaginal discharge,
  • or a change in the type of discharge,

should be reported to the doctor.

If the discharge is particularly watery, mucus-like, or bloody, and even if it's pink or just tinged with blood, it should be considered as a potential symptom.

In addition, vaginal spotting or bleeding, abdominal pain, menstrual-like cramping, more than four contractions in one hour, an increase in pressure in the pelvic area, or low back pain, especially if there were no previously this kind of pain, should all be checked by the doctor.[4]

Placental abruption 

Placental abruption is the partial or complete separation of the placenta from the uterus, a serious problem if it happens before the baby is born.[5]

There's a wide variation in symptoms of placental abruption. Sometimes a placental abruption can cause sudden and obvious bleeding, but in some cases, bleeding may not be noticeable at first, for example, some women report only light bleeding or spotting. A woman might have uterine tenderness, back pain, or frequent contractions, or the uterus might contract and stay hard, like a cramp or contraction that does not go away. Also, in a case of a perceived decrease in the baby's activity, immediate medical attention is recommended.

Other causes of abdominal pain during pregnancy

Preeclampsia

Preeclampsia is a disease common in pregnancy which causes spasms and other changes in blood vessels. It can also affect a number of organs, including liver, kidneys, brain, and the placenta. Preeclampsia is diagnosed if a woman has high blood pressure and protein in the urine after 20 weeks of pregnancy [6]. It is commonly accompanied by swelling of the face or puffiness around the pregnant woman’s eyes. Slight swelling of the hands or excessive or sudden swelling of the feet or ankles could also happen during preeclampsia. It should be clear this water retention can also lead to a rapid weight gain. When severe preeclampsia happens, a woman may also experience:  

  • intense pain or tenderness in the upper abdomen,
  • a severe headache,
  • visual disturbances,
  • or nausea and vomiting.

Similar to any other problem, preeclampsia requires an immediate doctor's exam.

Read more: Urinary Tract Infections in Women

Urinary tract infections during pregnancy 

Being pregnant makes a woman more susceptible to urinary tract infections of all kinds, including kidney infections. Symptoms of a bladder infection are [7]: 

  • pain, discomfort, or burning when urinating,
  • pelvic discomfort or lower abdominal pain,
  • and frequent or uncontrollable urge to pee, even when there is very little urine in the bladder, 
  • cloudy or foul-smelling urine could also be the sign of a bladder infection.
Since an untreated bladder infection can also lead to a kidney infection and premature labor, these symptoms should not be ignored.

Signs that the infection has spread to the kidneys, and that it’s high time to seek medical attention, may include [8]:

  • a high fever with shaking, chills, or sweats.
  • pain in lower back or inside just under ribs, on one or both sides,
  • nausea, and vomiting,
  • and possibly blood in the urine.

These are all symptoms that should be reported to the doctor.

Many other conditions can cause abdominal pain, whether a woman is pregnant or not. Some of the most common ones that doctors will consider are:
  • a stomach virus or food poisoning,
  • appendicitis,
  • kidney stones,
  • hepatitis,
  • gallbladder disease,
  • pancreatitis.
  • Abdominal pain during pregnancy can often be a result of gallstones, which are more common during pregnancy.
  • Bowel obstruction is also common and may be caused by the pressure of the growing uterus on the previously scarred intestinal tissue. It’s most likely to occur in the third trimester.

What is a cause of harmless abdominal discomfort during pregnancy?

Not all abdominal discomfort is a sign of a serious problem. For example, a pregnant woman may notice a bit of cramping during or right after an orgasm. However, as long as it is mild and short-lived, it is perfectly normal and nothing to be alarmed about. Following are some of the most common causes of harmless abdominal discomfort during pregnancy.
  • Gas and bloating are more likely to occur during pregnancy because of the hormones that slow digestion and the pressure of growing uterus on stomach and intestines.
  • Constipation is another common cause of abdominal discomfort throughout pregnancy, caused by hormones that slow the movement of food through the digestive tract, and the pressure of the growing uterus on the rectum.

Read more: Best Food for Constipation

  • Round ligament pain is generally either a brief, sharp, stabbing pain or a longer-lasting, dull ache that pregnant woman feels on one or both sides of their lower abdomen or deep in the groin. This pain usually starts in the second trimester, when the ligaments that support uterus in the pelvis stretch and thicken to accommodate its growing size. A woman may also feel a short jabbing sensation if she suddenly changes position, such as when she is getting up from a bed or chair, or when she coughs, rolls over in bed, or gets out of the bathtub. It is important to call your caregiver if this discomfort continues even after rest.
  • Braxton-Hicks contractions occur sometime after mid-pregnancy, when a woman may start noticing some tightening in the uterus from time to time. Before 37 weeks, these contractions should be infrequent, irregular, and essentially painless, but still reported to the doctor. It is especially recommended if those symptoms are accompanied by lower back pain, or if the woman feels more than four contractions per hour.[9]

Treatment for abdominal pain during pregnancy

The best advice woman might get is to sit down, put her feet up, and relax when she feels abdominal pain. Resting comfortably should quickly relieve any symptom. Other things a woman could do: avoid quick changes in position, especially turning sharply at the waist; when pain is felt, bend toward the pain to relieve it; walking, doing light housework, or changing position may help relieve some of the symptoms such as gas pains.

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