Is it normal to have abdominal pain or cramps during pregnancy?

Having occasional mild to moderate abdominal pain is normal throughout pregnancy [1]. The pain is often more severe in women carrying twins than in single pregnancies. Severe pain with or without certain other symptoms may indicate a number of serious complications [2].

Are abdominal pain and cramping early signs of pregnancy?

Menstrual-like abdominal cramps that come and go are one of the earliest symptoms of pregnancy [3], often occurring even before you notice the missed period and a home pregnancy test shows positive results. It is generally accompanied by other symptoms like spotting (implantation bleeding) fatigue, breast tenderness, nausea and constipation [4] in the first months.

Why is lower right abdominal pain more common during pregnancy?

With the growth of the embryo, the uterus begins to tilt towards the right, causing the ligaments to stretch or contract. This often leads to lower right abdominal pain and cramping [5].

What causes upper/lower abdominal pain in pregnancy?

Common harmless causes

  • The embryo implanting itself to the uterus wall (constant low period-like pain in the upper abdomen, lasting for about a day) [1]
  • Indigestion, gas, bloating and constipation occurring as a result of the hormonal changes [6]
  • The growing uterus putting excessive pressure on the intestine, bladder, muscles and ligaments (the uterus pulling on the ligaments often cause pain around the bellybutton)
  • Exercising while pregnant, putting additional pressure on the muscles and ligaments [2]
  • The cramping may become more noticeable due to rapid movements such as standing up suddenly, coughing or sneezing
  • Round ligament pain, mainly occurring during the second and third trimester (caused by the extra stress on certain ligaments due to holding the growing uterus in suspension within your abdomen) [6]
  • Having a history of c-section delivery
  • Braxton Hicks contractions or false contractions
  • Pelvic girdle pain
  • Having intercourse

Serious causes

  • Ectopic pregnancy (especially during the first three months), a complication in which the embryo gets implanted outside the uterus
  • Miscarriage
  • Premature labor [7]
  • Placental Abruption
  • Preeclampsia or HELLP syndrome [8]
  • Chorioamnionitis
  • Acute fatty liver of pregnancy (life threatening complication usually occurring later in pregnancy) [9]
  • Acute polyhydramnios
  • Uterine fibroids [23]
  • Yeast infection [25]

Non-pregnancy related causes

  • A viral stomach infection [10], food poisoning or allergies
  • Kidney and urinary tract infections [10]
  • Appendicitis
  • Gallstones [6]
  • Inflammatory bowel syndrome
  • Gastroesophageal reflux disease (GERD) [22]
  • Pelvic inflammatory disease
  • Hernia
  • Lactose intolerance

How to prevent lower abdominal pain while pregnant?

  • Drinking lots of fluid to stay hydrated [11]
  • Getting plenty of rest
  • Doing regular stretching exercise to keep the abdominal muscles strong and toned for avoiding conditions like round ligament pain (avoid exercises that require you to lie on your back for over a few minutes in the first trimester as they may be harm your baby by reducing the blood supply) [12]
  • Practicing relaxation techniques such as deep breathing
  • Avoiding lifting heavy objects or climbing stairs quickly (especially during the second and third trimesters) [13]

How to relieve pregnancy abdominal pain?

  • Taking a warm bath [14]
  • Lying down on the opposite side of the pain
  • Massage therapy by a licensed practitioner
  • If the symptom is resulting from round ligament pain, reducing the amount of daily activities and avoiding the sitting, standing and lying positions that trigger the pain can help manage it [15]
  • For sudden pain, bending forward to the point of pain relief and then relaxing the muscles again (this helps to reduce the tension of the muscles and tissues) [11]
  • Home remedies such as lemon juice and ginger may help with fast pain-relief (make sure to consult your doctor before using these natural remedies)
  • Walking or changing positions (helps to relieve pain caused by gas) [21]

When to call the doctor?

  • Severe pain that wakes you up at night
  • Sharp lower abdominal pain in early pregnancy accompanied by vaginal bleeding or passing blood clots and tissues (might indicate miscarriage or ectopic pregnancy) [16]
  • One sided abdominal pain [24]
  • Constant pain with or without bleeding (especially during the first trimester) [2]
  • Pain accompanied by fever or chills [5]
  • Pain along with the symptoms of faintness or lightheadedness
  • Intense pain in the upper abdominal area along with headache, nausea and vision disturbances, especially during the third trimester (might indicate preeclampsia) [17]
  • Abdominal cramps accompanied by a burning sensation while urinating (might indicate urinary tract infection)
  • Pain accompanied by lower back pain and diarrhea [18]
  • Menstrual-like cramping accompanied by over 5 contractions within an hour before the 37th week of pregnancy (might be a sign of premature labor) [7]

ICD-9 and ICD-10 Codes

The ICD-9 code used for indicating abdominal pain is 789.0 [19] while its ICD-10 code is R10 [20].

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