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Summary

Abdominal pain in pregnancy is not unusual. However, it can be a disturbing experience, especially for women who are expecting their first baby. The causes of abdominal cramps can be multiple and include constipation, indigestion, round ligament pain, Braxton Hicks contractions, or exercising. There can also be more serious reasons such as ectopic pregnancy, miscarriage, placental abruption and premature labour, which are likely to produce more severe symptoms along with greater discomfort. It can be challenging to diagnose the cause of the pain, and it is highly recommended to visit the doctor immediately for a thorough assessment. However, if the pain resolves within a short span or as soon as one rests, it may not be a cause of concern. Ultrasound and MRI scans are commonly helpful to diagnose the exact cause of pain. The treatment depends upon the cause of pain. There are several self-care measures, which can help in the management of the situation.

  1. What is abdominal pain during pregnancy
  2. Symptoms of abdominal pain during pregnancy
  3. Causes and risk factors of abdominal pain during pregnancy
  4. Prevention of abdominal pain in pregnancy
  5. Diagnosis of abdominal pain during pregnancy
  6. Treatment of abdominal pain during pregnancy
  7. Prognosis and complications of abdominal pain during pregnancy

Abdominal pain is commonly reported by women during pregnancy. It refers to the feeling of discomfort anywhere in the abdominal area due to the growing baby and bodily changes associated with pregnancy. For a woman who has conceived for the first time, these experiences may be a cause of worry. Hence, it is essential to make oneself aware of the symptoms, which need to be looked out for as compared to those, which may be simply a pregnancy-related discomfort. Abdominal pain in pregnancy can be slightly more for a woman carrying twins.

Abdominal pain during pregnancy can be felt anywhere in the belly area. The symptoms that may accompany abdominal pain include:

Causes

The causes of abdominal pain during pregnancy include the following:

  • Constipation
    Constipation tends to be a common feature during pregnancy due to the high levels of progesterone and the pressure of the growing baby in the abdomen. As the level of the hormone increases, the process of digestion slows down. Gas and constipation can lead to mild abdominal pain.
  • Round ligament pain
    The round ligament pain is caused due to the growth of the uterus. As the uterus grows, it places pressure on the two broad ligaments which run from the womb to the groin. These ligaments get stretched as the pregnancy progresses thereby leading to pain and discomfort in the lower belly, groin and hip area. The pain tends to dull and turn achy when resting. While changing positions or making a sudden movement, there can be a sharp pain. Typically, this pain subsides on sitting or lying in a position, which doesn’t stretch these ligaments.
  • Practice contractions
    Practice contractions are also known as Braxton Hicks contractions. They feel like a tightening sensation in the stomach. One may find their abdomen feels hard instead of the usual soft consistency. These are known as practise contractions since they are often confused with the actual birthing contractions. However, Braxton Hicks contractions are not so painful as real labour pain contractions. They may be prompted by dehydration.
  • Other health issues
    Sometimes, the abdominal pain during pregnancy may not be caused by pregnancy itself. The pain could be related to other health conditions such as appendicitis, kidney stones, ovarian cysts or problems with the gallbladder.

Some of the serious causes of abdominal pain in pregnancy can be:

  • Premature labour
    Labour pains which occur before term, i.e., before 37 weeks are considered as early labour stimulations. This kind of abdominal pain can cause significant discomfort along with cramps. If not attended to in time, it might proceed to a premature delivery of the baby.
  • Placental abruption
    Placental abruption occurs when the placenta detaches early from the wall of the womb resulting in bleeding. The bleeding is usually accompanied by severe abdominal pain which remains constant for hours. This condition needs immediate medical attention.
  • Urinary tract infection
    Urinary tract infections are quite common during pregnancy. The presence of a UTI may cause mild to moderate pain. However, this pain does not seem to spread and remains localised to one part of the lower abdomen or the back region or near the urine outlet (urethra). UTIs also cause pain during urination.
  • Miscarriage
    Experiencing severe cramps along with bleeding can be a sign of miscarriage, medically termed as spontaneous abortion. Other symptoms seen with miscarriage are moderate to heavy vaginal bleeding, and expulsion of tissue from the vagina.
  • Preeclampsia
    High blood pressure during pregnancy (known as preeclampsia) may lead to persistent and severe pain on the right side of the stomach and under the ribs. Other indications of preeclampsia are a headache and vision disturbances. It needs immediate medical attention. 

Risk factors

 There are certain factors which can trigger the round ligament pain, like

  • Coughing.
  • Sneezing too hard.
  • Changing the body position suddenly.
  • Standing up suddenly from a sitting or lying down position. 

There are certain factors, which tend to increase the risk of having constipation in pregnancy, such as

  • Stress
  • Lack of physical activity.
  • A low intake of fluids and dietary fibre.
  • Intake of iron supplements (in some cases).

Some of the triggers for Braxton Hicks contractions include:

  • Increased physical activity.
  • Dehydration.
  • A full urinary bladder.
  • Touching the mother’s belly too frequently.

Risk factors for more serious causes of abdominal pain such as miscarriage include:

Risk factors for a urinary tract infection that can cause abdominal pain include:

  • Kidney stones.
  • Poor bladder emptying due to the pressure of the baby on urinary bladder.
  • Diabetes.
  • Poor immunity due to conditions like AIDS or cancer or while on immunity suppressing medicines.

Specific measures can be undertaken to prevent abdominal pain during pregnancy:

  • Stay hydrated at all times. Drink plenty of water throughout the day. Water intake should be around 2.5 to 3 litres each day.
  • Get adequate rest.
  • Engage in regular yet mild exercise.
  • Avoid lifting heavy objects.
  • Avoid climbing the stairs too fast.
  • Practise deep breathing as a relaxation technique.

In the case of round ligament pain, there are no specific diagnostic tests which are used. However, the doctor will be able to pinpoint the cause as round ligament pain from your description of the symptoms. A physical examination is the most important first step in an accurate diagnosis. Women who are expecting for the second time will most likely be familiar with the pain. 

Most of the routine and non-life-threatening causes of abdominal pain in pregnant women are easily diagnosed by the doctor through a physical examination. However, in the presence of the following symptoms, blood tests and imaging tests might be needed to confirm the diagnosis.

  • Heavy bleeding.
  • Intolerable, worsening, and unrelenting pain.
  • Fever and chills.
  • Severe vomiting.
  • Severe nausea.
  • An unusual vaginal discharge, which is blood-stained or yellow-green in colour.
  • Pain or burning while urinating. (Read more - Painful urination causes and treatment)

These tests include:

  • Ultrasound & MRI scan
    These scans help to assess the development of the baby and look for other abnormalities. Ultrasound, as well as magnetic resonance imaging, are safe to be used during pregnancy. These tests also help in determining any causes, which are not related to pregnancy directly but might be causing the abdominal pain e.g. gallstones, appendicitis.
  • Blood tests
    Blood tests can be done to determine the level of hormones in the blood as well as for diagnosing infections. The urine pregnancy test also helps in determining the cause of an abdominal pain. In some cases, one may be required to go through the blood tests 48 hours apart to check the level of hormones, or enzymes like amylase, and lipase that are elevated during pancreatitis (swelling of the pancreas).

The treatment of the abdominal pain in pregnancy depends upon the underlying cause.

  • If the pain is triggered due to constipation and gas, then most often, the pain will resolve by itself or with some dietary changes. Lifestyle changes prove to be helpful in preventing any further episodes. Consuming a fibre rich diet and having plenty of water throughout the day helps to resolve constipation.
  • In severe cases, laxatives or other medicines may be recommended by the doctor to ease the bowel movements and treat constipation. However, these medicines cannot be taken without prior medical consultation. The use of regular over-the-counter laxatives is to be strictly avoided in pregnancy without consultation with a doctor.
  • The treatment for round ligament pain involves making changes in the body posture to reduce and prevent the pain from recurring. 
  • If the abdominal pain is due to Braxton Hicks contractions, then the treatment usually involves self-care. However, if the pain seems to get more intense and prevents one from doing any activity, then the doctor may prescribe pain-relieving medication or sedatives to relax the muscles of the uterus. In case the contractions have been triggered by severe dehydration, the doctor may administer fluids through an IV (fluids administered directly into the veins through a drip).
  • Other serious causes of abdominal pain during pregnancy need immediate medical attention, and treatment varies based on the stage and severity of the condition.
  • For an ectopic pregnancy, surgical removal of the foetus is needed.
  • For a miscarriage, depending on the extent, either complete bedrest with hormonal therapy or dilatation and curettage to clean the uterus of the remnants of the foetal tissues might be performed.

Lifestyle management

  • Management of round ligament pain
    It can be managed at home as recommended by the doctor. In the case of round ligament pain, the doctor usually recommends taking proper rest. Relief can be obtained with the help of:
    • Stretching exercises.
    • Yoga poses that are recommended in pregnancy.
    • Heating pads or taking a warm bath.
    • Changing body position slowly and gradually.
    • Bending, and flexing the hips before sneezing or coughing.
  • Management of abdominal pain due to constipation
    This can be addressed with the following measures:
    • Consuming a fibre rich diet
      The fibre in the food must be from healthy sources like fruits and vegetables. Other good sources of fibre include bran, oats, whole grain bread and nuts.
    • Drinking plenty of fluids
      Fluids include juices and water. One must consume at least 10-12 cups of liquids every day to not only stay hydrated but to ensure proper bowel movements and prevent constipation.
    • Exercising daily
      Exercising such as walking, swimming or yoga can be very helpful in preventing constipation and stimulating the bowels. However, it is important to know how much exercise can be excessive. Do not strain yourself while doing physical activity and restrict the exercising duration to 20 minutes. 
    • Reducing iron supplements
      If you experience constipation after taking iron supplements, your doctor may ask you to meet the iron needs of the body through a healthy and balanced diet. Please consult your doctor before stopping or reducing your iron supplement intake, especially during pregnancy.
  • Management of Braxton Hicks Contractions
    It can be managed through a few self-care measures:
    • Change the body position. If you are standing when you begin to feel the pain, sit down and relax. If it is a true labour contraction, the pain may not subside. However, a Braxton Hick contraction will subside slowly.
    • Taking a warm bath or using a heating pad can also reduce the pain.
    • Keep sipping on water or coconut water to keep yourself hydrated.

Prognosis

Abdominal pain during pregnancy is a common occurrence. Outcomes are generally excellent as most episodes of pain are mild and subside spontaneously. In case of severe pain, timely diagnosis and intervention can help.

Complications

Complications of untreated abdominal pain during pregnancy include:

  • Miscarriage.
  • Premature delivery.
  • Sepsis, a condition where there is a spread of infection to the bloodstream.
  • Eclampsia, a condition which occurs during pregnancy when pre-eclampsia is not controlled. It is characterized by high blood pressure, swelling in the feet and presence of protein in the urine.
  • Ruptured appendix.
  • Kidney infections.
  • Strangulated hernia, a complication of an untreated hernia, where the blood supply to the herniated tissues is cut off, leading to severe pain and is a medical emergency. 
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References

  1. American Pregnancy Association. [Internet]; Abdominal Pain During Pregnancy.
  2. National Health Service [Internet]. UK; Miscarriage.
  3. National Health Service [Internet]. UK; Stomach pain in pregnancy.
  4. American Pregnancy Association. [Internet]; Pregnancy And Constipation.
  5. American Pregnancy Association. [Internet]; Braxton Hicks Contractions.
  6. Charlie C. Kilpatrick. Abdominal Pain in Early Pregnancy. U.S. Department of Health & Human Services
  7. National Health Service [Internet]. UK; Miscarriage.