What is Round Ligament Pain?
Ligaments supporting the uterus and connecting it to the groin region are collectively known as the round ligaments. Women often experience a sharp pain (round ligament pain) in this region during pregnancy due to the normal changes the body goes through during this time . It does not harm the baby, but may lead to serious pain and discomfort for the mother. Round ligament pain (RLP) is most common during the second trimester , but can occur earlier in cases of twin pregnancies.
What Causes Round Ligament Pain in Pregnancy?
During pregnancy, the uterus grows considerably in size with certain ligaments holding it in suspension within the abdomen. The growing size and weight of the uterus puts extra stress on the ligaments, which gradually become very thin and long .
As mentioned above, the round ligament is one of the principal ligaments holding the uterus in place, connecting it to the groin area (the region where the legs attach to the pelvis). The significant pressure put on this ligament by the growing uterus makes it stretch too much during pregnancy . Then the ligament starts pulling and tugging on the nerve fibers and other sensitive structures located nearby, leading to moderate to severe pain . An involuntary contraction of the round ligament is the most common cause of the pain.
Round Ligament Pain Triggering Factors
The pain may be triggered by exercises like running and jogging as well as sudden movements like:
- Coughing 
- Rolling over in bed
- Laughing 
- Standing up quickly
The pain may be triggered by baby movements (e.g. kicking) as it flexes the uterus, putting pressure on the ligament.
Signs and Symptoms of Round Ligament Pain during Pregnancy
- Sharp pain in the groin or lower belly area (near the belly button), lasting for a few minutes or a constant mild ache
- The pain often starts in the groin region, extending upward to the abdomen and hip 
- Ligament spasms or cramping that are more common on one’s right side (as the uterus tends to turn right while growing), but can also be felt on both sides 
- Sharp pain in the middle of night, triggered by simple movements such as turning over in the bed
- Pain that tends to get worse with movement and exercise
- Pain that gets worse with a full bladder
It may be confused with labor pain , but the latter does not generally occur until later in the third trimester. In case of pre-term labor, the nature, location and severity of the pain can help to distinguish it from RLP. Some women may also confuse it with Braxton Hicks contractions – another common pregnancy symptom occurring during the second and third trimesters. But unlike RLP, Braxton Hicks contractions do not usually cause any pain, which helps to differentiate between the two.
Round Ligament Pain Prevention
- Making sure to avoid sudden movements, especially when changing position (lying to sitting or sitting to standing) 
- Supporting the belly with pillows and cushions while lying on one side
- Drinking lots of fluids to stay properly hydrated 
- Flexing the hip muscles before simple activities like sneezing and coughing
- Avoiding remaining in the same position for an extended time
Round Ligament Pain Tests and Examinations
RLP does not require any diagnostic tests and exams as it is a common and harmless type of abdominal pain associated with pregnancy. However, doctors may perform a physical examination, blood tests, ultrasonography and urine tests to rule out more serious condition that may lead to similar symptoms .
Round Ligament Pain Differential Diagnosis
- Appendicitis 
- Ectopic pregnancy
- Uterine contractions
- Symphysis Pubis Dysfunction (If the pain is felt around the pubic bone
- Bladder or kidney stones
- Urinary tract infection
- Kidney infection
- Fibroids 
- Ovarian cysts
- Inguinal hernia 
- Polyhydramnios 
When to Call the Doctor?
It is advisable to contact one’s health care provider in case of the following symptoms as they may indicate a more serious condition:
- Severe persistent pain 
- Fever 
- Vomiting 
- Pain when urinating
- Pain and discomfort when walking
- Changed or increased vaginal discharge 
- Vaginal bleeding or spotting
- Lower back pain 
- Increased pressure in one’s pelvic region
Round Ligament Pain Treatment and Management
Tips for Pain Relief
- Taking lots of rest
- Lying down on the opposite side  (usually the left side as the pain commonly occurs on the right side)
- Applying heating pads 
- Taking a hot bath
- Applying a warm soak on the area
- Wearing maternity belts or pelvic support belts
The pain often goes away automatically as the pregnancy progresses .
Exercise and Physical Therapy
- Prenatal massage  by a licensed practitioner
- Chiropractic therapy
- Practicing certain prenatal yoga moves such as savasana (side lying) and the cat cow pose 
- Doing regular exercises for strengthening the stomach muscles (stretches, pelvic tilt,  hip hiker and kneeling exercise). A commonly used exercise technique involves placing one’s knees and hands on the floor, then lowering the head as much as possible to the floor while keeping the hip in the air .
The doctor may prescribe an over-the-counter medication, such as acetaminophen (Tylenol) , for relieving severe RLP.
Round Ligament Pain Outcome
The duration of RLP may vary from one woman to another. It usually goes away completely once the baby is born  as it allows the ligament to go back to its normal size and shape.
Round Ligament Pain ICD-9 and ICD-10 Codes
Its ICD-9 code is 625.9  while the ICD-10 code is R10.2 .[ref]
- http://www.icd10data.com/ICD10CM/Codes/R00-R99/R10-R19/R10-/R10.2 [/ref]