Pelvic Pain During Pregnancy
Pregnancy-related pelvic discomfort is quite common. After all, in order to accommodate your expanding uterus, your ligaments are extending, your hormone levels are fluctuating, and your organs are moving.
However, pelvic pain can occasionally be a sign of a more serious condition, such as appendicitis or preterm labor. So how can you distinguish symptoms that are "normal" from those that are "red flag"?
Here, we asked the professionals to list the top 20 reasons why pregnant women have pelvic pain. We also go through when to see a doctor and how to handle pelvic pain.
What Does Pelvic Pain Feel Like?
First of all, you may be questioning if pelvic pain—also known as pelvic girdle pain—that you're really feeling during your pregnancy. It feels like pain in the region surrounding your pelvic joints, namely the groin, hips, thighs, lower back, and perineum (the region between your vagina and anus). There may also be a grinding or clicking sound.
Pelvic pain might worsen with the following movements:
- Walking
- Ascending and descending stairs
- Turning over in bed
- Getting in and out of your car
- Lifting
- Bending
- Pelvic pain ranges from mild to severe. It can affect your everyday tasks and quality of life.
Causes of Pelvic Pain During Pregnancy
There are many reasons why people experience pelvic pain during pregnancy. Here are the most common causes, ranging from benign to serious.
Symphysis pubis dysfunction (SPD)
During pregnancy, a joint in front of your pelvis known as the symphysis pubis can become unstable, causing pelvic bone pain. It may start happening soon after conception, and it usually gets worse toward the end of pregnancy.
Symphysis pubis dysfunction (SPD) occurs when certain hormones, such as relaxin, rise during pregnancy. An increase in these hormones causes the pelvic ligaments to become more relaxed and soft, and the joints start to become more mobile.
Accommodation pain
This cramp-like pelvic pain tends to occur 8 to 12 weeks into pregnancy and can feel like you're getting your period. As long as there's no bleeding, it's probably just your uterus expanding to accommodate your growing baby. You're less likely to feel this in your first pregnancy than in subsequent pregnancies, experts say.
Round ligament pain
In your second trimester, you may feel a sharp, stabbing, or aching pain in your side near your pelvis. This pain can happen when your baby's growth stretches a ligament that goes from your uterus to your groin.1
You may notice this round ligament pain more with movement. When you walk or get up from a chair, for example, "the uterus tilts and pulls on the ligament," says Suzanne Merrill-Nach, MD, an OB-GYN in San Diego. Lying down on the side that's bothering you can make the pain disappear (alternate sides if both hurt). Most round ligament pain resolves by 24 weeks.
Diastasis recti
Diastasis recti is extremely common during and after pregnancy, and it can sometimes feel like pelvic pain caused by SPD. The condition occurs when your rectus abdominis muscles (those responsible for six-pack abs) separate. It may create a bulge in the stomach (though this bulge is most noticeable postpartum).2
"The muscles of your abdomen attach from your breast bone down to your pubic bone, and pubic muscles are being stretched by hormone changes," explains Shaheed. If you develop diastasis recti and it doesn't resolve on its own after your baby is born, your health care provider can suggest an exercise plan; more severe cases may warrant surgery.
Pressure from your baby's weight
In the third trimester, you may experience pressure in your pelvic region as your baby presses down on nerves that run from your vagina into your legs. This pain typically occurs with movement, such as when you walk or ride in a car, because the baby bounces. To help relieve the pressure, lie down on one side and rest.
Ovarian cysts
Ovarian cysts can form and grow larger during pregnancy,3 which might result in pelvic pain—partly because your growing uterus puts pressure on your ovaries. Cysts develop when there are changes in the way your ovaries make or release eggs. They are common, noncancerous, and generally harmless. Let your OB-GYN know if you've had cysts before or think you do now. They can use an ultrasound to look for them.
If a cyst ruptures, that pain gets worse. In rare cases, a cyst can grow larger and cause an ovary to twist in on itself (a condition known as ovarian torsion), which produces sharp, severe, abdominal pain with possible nausea and vomiting.4 If you have these symptoms, call your health care provider.
Braxton hicks contractions
These "practice contractions" are usually not painful; they tend to feel like pressure or tightening in the pelvis, and they come and go more sporadically than labor contractions. Braxton Hicks first occur in the second or third trimester and can be triggered by dehydration, so drink plenty of water. They should disappear on their own, but if you have more than four contractions an hour for two hours, call your health care provider—you could actually be in labor.
Urinary tract infection (UTI)
As in your pre-pregnancy life, getting a UTI during pregnancy can give you a sudden urge to urinate, and you may experience a burning sensation with urination and blood in your urine. Some people also have abdominal pain. The difference is that with pregnancy, untreated infections can create serious complications for you and your baby.
Constipation
Researchers estimate that nearly 40% of people experience constipation when they're expecting. Common culprits include an increase in pregnancy-related hormones or taking iron supplements that slow down your digestive tract, leading to pelvic discomfort.
Stay hydrated and eat fiber-rich foods such as raw fruits and vegetables. Exercising more or changing your prenatal vitamin (if it contains iron) may also lessen symptoms. If that doesn't help, ask your prenatal health care provider about over-the-counter treatments such as fiber supplements, stool softeners, non-stimulant laxatives, or glycerin suppositories.
Vulvodynia
A disorder known as vulvodynia causes persistent pain in the pelvic area, especially in the vulvar and vaginal regions, but its etiology is unknown. Even though there is no visible damage, infection, or injury to cause it, the pain can nevertheless be rather intense. It's challenging to diagnose, and even if a medical professional makes the correct diagnosis, receiving the necessary therapy may be challenging. An epidural, if available, can lessen labor and delivery pain.
Tip
Sometimes pelvic pain during pregnancy can be serious. If your pain is coupled with worrisome symptoms, such as fever and vaginal bleeding, call your health care provider right away.
Miscarriage
When a woman feels discomfort in her abdomen or pelvis during the first trimester of pregnancy, miscarriage is always a possibility. Up to 26% of all pregnancies and 10% of known pregnancies are thought to result in miscarriage. Miscarriage symptoms include cramping and bleeding, which may be periodic or similar to monthly pains.
Preterm labor
If you're experiencing a persistent backache and pelvic pressure that comes and goes in waves, you may be in labor. When you have these symptoms before the 37th week of pregnancy, it's considered a possible sign of preterm labor.
Ectopic pregnancy
When a fertilized egg implants anywhere other than the uterus—typically in the fallopian tube—it results in ectopic or "tubal" pregnancies. In 1% to 2% of pregnancies, this can occur. In the uncommon case that your pregnancy is ectopic, you can have severe pelvic discomfort and heavy bleeding between weeks six and ten as the dilation of the tube occurs.
People who have had one ectopic pregnancy are more likely to have another. The risk is further increased for those who've had endometriosis, tubal ligations, pelvic infections, and prior pelvic, abdominal, or fallopian tube surgeries, as well as those who had an intrauterine device (IUD) in place at the time of conception. Anyone with an abnormally shaped uterus also has a higher chance of an ectopic pregnancy, as do people who used artificial reproductive techniques to become pregnant.
Placental abruption
Less than 1% of pregnant people experience placental abruption,10 typically in the third trimester. This too-early separation of the placenta from the uterine wall can generate "severe, constant, progressively worsening lower abdomen pain," says Dr. Duff. Your uterus may become rock hard (if you press on your abdomen, it won't indent), and you may bleed dark, red blood with no clots.
In milder cases, a health care provider may choose to simply monitor your pregnancy, though they could decide to induce labor and deliver the baby vaginally. If the condition itself triggers labor, an emergency C-section section may be necessary. People who've had a previous placental abruption, abdominal trauma, preeclampsia, or high blood pressure are most at risk.
Uterine fibroids
Uterine fibroids are common during the childbearing years, but pregnancy further stimulates these noncancerous growths. If they grow too fast, they can outpace their own blood supply and start to degenerate, which causes pelvic pain. Sometimes they must be surgically excised for the pregnancy to continue.
Uterine rupture
Although incredibly rare, the uterus may rupture during pregnancy, particularly if you have scars from previous abdominal surgeries or C-sections. Around the trauma site, you'll experience an abrupt, excruciating, tearing agony in your abdomen or pelvis.
Even though it can't be avoided, let your doctor know if you've ever had injuries there and ask them to keep an eye on your situation. If pain starts later in pregnancy and grows worse, give them a call right once.
Preeclampsia
Preeclampsia affects 5% to 8% of pregnant people11 and can begin anytime after the 20th week of pregnancy. It involves constriction of blood vessels around the uterus (which can seriously diminish the supply of oxygen and nutrients to your baby), the sudden onset of high blood pressure, and potential kidney or liver damage. Preeclampsia also increases the risk of placental abruption.
When the condition is severe, it can be accompanied by pain in the upper right portion of your abdomen and trigger nausea, headaches, and visual disturbances (such as flashing lights). For many people, high blood pressure and abnormal swelling in the face, hands, and feet are the first indications that something is wrong. If you suspect you have preeclampsia, call a health care provider immediately.
Ovarian torsion
Rarely, ovarian torsion—which occurs when an ovary twists around its connected ligaments and shuts off its own blood supply—causes fever, nausea, and abdominal or pelvic pain. Although it can occur at any point during pregnancy, the early stages are the most common. If you have ovarian cysts or have had ovulation induction, which can result in larger ovaries, you may be more vulnerable.
Appendicitis
Yes, this inflammation of the appendix happens to pregnant people, too. You'll generally feel it in the lower right part of your abdomen, though it may move: Appendicitis can be sneaky during pregnancy because as you get further along, the appendix might be pushed up higher in the abdomen. In the case of appendicitis, emergency surgery is often needed to remove the appendix before it ruptures.
Gas
Your digestive tract muscles relax during pregnancy, which slows down everything. This may cause pelvic gas pain that feels different from what it did before you became pregnant, in addition to the weight of your developing baby and hormones that affect digestion.
How to Relieve Pelvic Pain During Pregnancy
Your health care provider will help you determine the best treatment for pelvic pain during pregnancy. They might refer you to a physical therapist specializing in the pelvic floor, who will likely try manual therapy and exercises for pain relief.
For run-of-the-mill pelvic discomfort during pregnancy, try these tips:
- Take a warm—not hot—bath or stand in the shower and let the water hit your back.
- Get a prenatal massage from a certified massage therapist.
- Try a pelvic support garment, which can keep your uterus from pushing down on your pelvis.
- Wear low-heeled shoes with good arch support.
- Avoid quick movements and sharp turns at the waist.
- Exercise regularly.
- Avoid long periods of sitting or standing.
- Stay seated while changing clothes.
- Put a pillow between your legs in bed.
- Balance weight between both legs when standing.
When to Call the Doctor
Never hesitate to contact your health care provider if you experience pelvic pain that gives you a gut feeling that something's not quite right. Your doctor or midwife would much rather have you call and determine that there's nothing wrong than not call and risk a serious issue.
If you have any of the following symptoms, call your doctor or midwife immediately:
- Pelvic pain that you can't walk or talk through
- Fever and/or chills
- Vaginal bleeding
- Severe headache
- Dizziness
- Sudden swelling of the face, hands, and/or feet
- Persistent nausea and/or vomiting
- Fewer than 10 fetal kicks in one hour (any time between 28 weeks and delivery)
- More than four contractions an hour for two hours
- Watery, greenish, or bloody discharge
Pregnancy-related pelvic discomfort is quite common. After all, in order to accommodate your expanding uterus, your ligaments are extending, your hormone levels are fluctuating, and your organs are moving.
However, pelvic pain can occasionally be a sign of a more serious condition, such as appendicitis or preterm labor. So how can you distinguish symptoms that are "normal" from those that are "red flag"?
Here, we asked the professionals to list the top 20 reasons why pregnant women have pelvic pain. We also go through when to see a doctor and how to handle pelvic pain.
What Does Pelvic Pain Feel Like?
First of all, you may be questioning if pelvic pain—also known as pelvic girdle pain—that you're really feeling during your pregnancy. It feels like pain in the region surrounding your pelvic joints, namely the groin, hips, thighs, lower back, and perineum (the region between your vagina and anus). There may also be a grinding or clicking sound.
Pelvic pain might worsen with the following movements:
- Walking
- Ascending and descending stairs
- Turning over in bed
- Getting in and out of your car
- Lifting
- Bending
- Pelvic pain ranges from mild to severe. It can affect your everyday tasks and quality of life.
Causes of Pelvic Pain During Pregnancy
There are many reasons why people experience pelvic pain during pregnancy. Here are the most common causes, ranging from benign to serious.
Symphysis pubis dysfunction (SPD)
During pregnancy, a joint in front of your pelvis known as the symphysis pubis can become unstable, causing pelvic bone pain. It may start happening soon after conception, and it usually gets worse toward the end of pregnancy.
Symphysis pubis dysfunction (SPD) occurs when certain hormones, such as relaxin, rise during pregnancy. An increase in these hormones causes the pelvic ligaments to become more relaxed and soft, and the joints start to become more mobile.
Accommodation pain
This cramp-like pelvic pain tends to occur 8 to 12 weeks into pregnancy and can feel like you're getting your period. As long as there's no bleeding, it's probably just your uterus expanding to accommodate your growing baby. You're less likely to feel this in your first pregnancy than in subsequent pregnancies, experts say.
Round ligament pain
In your second trimester, you may feel a sharp, stabbing, or aching pain in your side near your pelvis. This pain can happen when your baby's growth stretches a ligament that goes from your uterus to your groin.1
You may notice this round ligament pain more with movement. When you walk or get up from a chair, for example, "the uterus tilts and pulls on the ligament," says Suzanne Merrill-Nach, MD, an OB-GYN in San Diego. Lying down on the side that's bothering you can make the pain disappear (alternate sides if both hurt). Most round ligament pain resolves by 24 weeks.
Diastasis recti
Diastasis recti is extremely common during and after pregnancy, and it can sometimes feel like pelvic pain caused by SPD. The condition occurs when your rectus abdominis muscles (those responsible for six-pack abs) separate. It may create a bulge in the stomach (though this bulge is most noticeable postpartum).2
"The muscles of your abdomen attach from your breast bone down to your pubic bone, and pubic muscles are being stretched by hormone changes," explains Shaheed. If you develop diastasis recti and it doesn't resolve on its own after your baby is born, your health care provider can suggest an exercise plan; more severe cases may warrant surgery.
Pressure from your baby's weight
In the third trimester, you may experience pressure in your pelvic region as your baby presses down on nerves that run from your vagina into your legs. This pain typically occurs with movement, such as when you walk or ride in a car, because the baby bounces. To help relieve the pressure, lie down on one side and rest.
Ovarian cysts
Ovarian cysts can form and grow larger during pregnancy,3 which might result in pelvic pain—partly because your growing uterus puts pressure on your ovaries. Cysts develop when there are changes in the way your ovaries make or release eggs. They are common, noncancerous, and generally harmless. Let your OB-GYN know if you've had cysts before or think you do now. They can use an ultrasound to look for them.
If a cyst ruptures, that pain gets worse. In rare cases, a cyst can grow larger and cause an ovary to twist in on itself (a condition known as ovarian torsion), which produces sharp, severe, abdominal pain with possible nausea and vomiting.4 If you have these symptoms, call your health care provider.
Braxton hicks contractions
These "practice contractions" are usually not painful; they tend to feel like pressure or tightening in the pelvis, and they come and go more sporadically than labor contractions. Braxton Hicks first occur in the second or third trimester and can be triggered by dehydration, so drink plenty of water. They should disappear on their own, but if you have more than four contractions an hour for two hours, call your health care provider—you could actually be in labor.
Urinary tract infection (UTI)
As in your pre-pregnancy life, getting a UTI during pregnancy can give you a sudden urge to urinate, and you may experience a burning sensation with urination and blood in your urine. Some people also have abdominal pain. The difference is that with pregnancy, untreated infections can create serious complications for you and your baby.
Constipation
Researchers estimate that nearly 40% of people experience constipation when they're expecting. Common culprits include an increase in pregnancy-related hormones or taking iron supplements that slow down your digestive tract, leading to pelvic discomfort.
Stay hydrated and eat fiber-rich foods such as raw fruits and vegetables. Exercising more or changing your prenatal vitamin (if it contains iron) may also lessen symptoms. If that doesn't help, ask your prenatal health care provider about over-the-counter treatments such as fiber supplements, stool softeners, non-stimulant laxatives, or glycerin suppositories.
Vulvodynia
A disorder known as vulvodynia causes persistent pain in the pelvic area, especially in the vulvar and vaginal regions, but its etiology is unknown. Even though there is no visible damage, infection, or injury to cause it, the pain can nevertheless be rather intense. It's challenging to diagnose, and even if a medical professional makes the correct diagnosis, receiving the necessary therapy may be challenging. An epidural, if available, can lessen labor and delivery pain.
Tip
Sometimes pelvic pain during pregnancy can be serious. If your pain is coupled with worrisome symptoms, such as fever and vaginal bleeding, call your health care provider right away.
Miscarriage
When a woman feels discomfort in her abdomen or pelvis during the first trimester of pregnancy, miscarriage is always a possibility. Up to 26% of all pregnancies and 10% of known pregnancies are thought to result in miscarriage. Miscarriage symptoms include cramping and bleeding, which may be periodic or similar to monthly pains.
Preterm labor
If you're experiencing a persistent backache and pelvic pressure that comes and goes in waves, you may be in labor. When you have these symptoms before the 37th week of pregnancy, it's considered a possible sign of preterm labor.
Ectopic pregnancy
When a fertilized egg implants anywhere other than the uterus—typically in the fallopian tube—it results in ectopic or "tubal" pregnancies. In 1% to 2% of pregnancies, this can occur. In the uncommon case that your pregnancy is ectopic, you can have severe pelvic discomfort and heavy bleeding between weeks six and ten as the dilation of the tube occurs.
People who have had one ectopic pregnancy are more likely to have another. The risk is further increased for those who've had endometriosis, tubal ligations, pelvic infections, and prior pelvic, abdominal, or fallopian tube surgeries, as well as those who had an intrauterine device (IUD) in place at the time of conception. Anyone with an abnormally shaped uterus also has a higher chance of an ectopic pregnancy, as do people who used artificial reproductive techniques to become pregnant.
Placental abruption
Less than 1% of pregnant people experience placental abruption,10 typically in the third trimester. This too-early separation of the placenta from the uterine wall can generate "severe, constant, progressively worsening lower abdomen pain," says Dr. Duff. Your uterus may become rock hard (if you press on your abdomen, it won't indent), and you may bleed dark, red blood with no clots.
In milder cases, a health care provider may choose to simply monitor your pregnancy, though they could decide to induce labor and deliver the baby vaginally. If the condition itself triggers labor, an emergency C-section section may be necessary. People who've had a previous placental abruption, abdominal trauma, preeclampsia, or high blood pressure are most at risk.
Uterine fibroids
Uterine fibroids are common during the childbearing years, but pregnancy further stimulates these noncancerous growths. If they grow too fast, they can outpace their own blood supply and start to degenerate, which causes pelvic pain. Sometimes they must be surgically excised for the pregnancy to continue.
Uterine rupture
Although incredibly rare, the uterus may rupture during pregnancy, particularly if you have scars from previous abdominal surgeries or C-sections. Around the trauma site, you'll experience an abrupt, excruciating, tearing agony in your abdomen or pelvis.
Even though it can't be avoided, let your doctor know if you've ever had injuries there and ask them to keep an eye on your situation. If pain starts later in pregnancy and grows worse, give them a call right once.
Preeclampsia
Preeclampsia affects 5% to 8% of pregnant people11 and can begin anytime after the 20th week of pregnancy. It involves constriction of blood vessels around the uterus (which can seriously diminish the supply of oxygen and nutrients to your baby), the sudden onset of high blood pressure, and potential kidney or liver damage. Preeclampsia also increases the risk of placental abruption.
When the condition is severe, it can be accompanied by pain in the upper right portion of your abdomen and trigger nausea, headaches, and visual disturbances (such as flashing lights). For many people, high blood pressure and abnormal swelling in the face, hands, and feet are the first indications that something is wrong. If you suspect you have preeclampsia, call a health care provider immediately.
Ovarian torsion
Rarely, ovarian torsion—which occurs when an ovary twists around its connected ligaments and shuts off its own blood supply—causes fever, nausea, and abdominal or pelvic pain. Although it can occur at any point during pregnancy, the early stages are the most common. If you have ovarian cysts or have had ovulation induction, which can result in larger ovaries, you may be more vulnerable.
Appendicitis
Yes, this inflammation of the appendix happens to pregnant people, too. You'll generally feel it in the lower right part of your abdomen, though it may move: Appendicitis can be sneaky during pregnancy because as you get further along, the appendix might be pushed up higher in the abdomen. In the case of appendicitis, emergency surgery is often needed to remove the appendix before it ruptures.
Gas
Your digestive tract muscles relax during pregnancy, which slows down everything. This may cause pelvic gas pain that feels different from what it did before you became pregnant, in addition to the weight of your developing baby and hormones that affect digestion.
How to Relieve Pelvic Pain During Pregnancy
Your health care provider will help you determine the best treatment for pelvic pain during pregnancy. They might refer you to a physical therapist specializing in the pelvic floor, who will likely try manual therapy and exercises for pain relief.
For run-of-the-mill pelvic discomfort during pregnancy, try these tips:
- Take a warm—not hot—bath or stand in the shower and let the water hit your back.
- Get a prenatal massage from a certified massage therapist.
- Try a pelvic support garment, which can keep your uterus from pushing down on your pelvis.
- Wear low-heeled shoes with good arch support.
- Avoid quick movements and sharp turns at the waist.
- Exercise regularly.
- Avoid long periods of sitting or standing.
- Stay seated while changing clothes.
- Put a pillow between your legs in bed.
- Balance weight between both legs when standing.
When to Call the Doctor
Never hesitate to contact your health care provider if you experience pelvic pain that gives you a gut feeling that something's not quite right. Your doctor or midwife would much rather have you call and determine that there's nothing wrong than not call and risk a serious issue.
If you have any of the following symptoms, call your doctor or midwife immediately:
- Pelvic pain that you can't walk or talk through
- Fever and/or chills
- Vaginal bleeding
- Severe headache
- Dizziness
- Sudden swelling of the face, hands, and/or feet
- Persistent nausea and/or vomiting
- Fewer than 10 fetal kicks in one hour (any time between 28 weeks and delivery)
- More than four contractions an hour for two hours
- Watery, greenish, or bloody discharge
