Abdominal Pain During Pregnancy


Many women who become pregnant are young and healthy. Thanks to advances in medical treatment, however, more older women are becoming pregnant. As we age, we are more likely to develop a variety of diseases. About 40% of women who become pregnant have some form of chronic disease, including gastrointestinal disease, which can lead to abdominal pain.

Severe Abdominal Pain During Pregnancy

If you are having severe abdominal pain during pregnancy, contact a physician immediately. Sometimes the source of severe cramps will be something perfectly normal, like round ligament pain, but other times there may be a condition requiring treatment or even a medical emergency, such as ruptured ectopic pregnancy or appendicitis.

In any case of severe abdominal pain, you should see a physician right away to find out the source. If the pain is so bad that you're not able to conduct your daily routines, and cramps aren't going away with rest, go to the emergency room.

Some amount of abdominal pain is normal during pregnancy. As your uterus grows and stretches, you may feel various types of abdominal cramps ranging from sharp twinges to dull aches that resemble menstrual cramps. The difference between an urgent medical problem and normal pregnancy cramps is that normal pregnancy cramps usually won't involve extreme pain, and they will usually subside after a few minutes, especially with rest. With any pain that you would label severe, err on the side of caution and see a physician immediately.

What Causes Abdominal Pain During Pregnancy?

Many women who experience abdominal pain during pregnancy automatically think that abdominal pain is indicative of miscarriage or some other serious problem. Rest assured that although it's always best to remain vigilant and contact your physician with any concern, there are many other less serious causes of abdominal pain that commonly affect women who are pregnant.

Less Serious Causes

Although these causes are usually not a reason to worry, always check with your doctor if pain or other symptoms are severe or increasing, or anytime you have a question or concern.

  • Gastroesophageal reflux disease or GERD. GERD commonly presents as heartburn. Progesterone produced during pregnancy messes the tone of the sphincter separating the esophagus (food tube) and stomach thus causing acidic stomach contents to flow back into the esophagus. These stomach contents result in abdominal pain.
  • Constipation. We all know what it's like to be constipated. Constipation during pregnancy can present as abdominal pain. Much like GERD, constipation occurs because progesterone relaxes the smooth muscle of the bowels.
  • Urinary retention. If your bladder is full but you are unable to urinate, this will cause pain. Talk to your doctor if you are having difficulty urinating.
  • Ovarian cyst (corpus luteum cyst). These cysts are usually mild and resolve on their own, but sometimes they are painful and require treatment.
  • Pelvic joint disease (arthropathy). Progesterone can cause pain in the hip joint, which you may experience as pain in the lower abdomen or pubic area.

More Serious Causes

In these cases, abdominal pain can be a sign of an urgent medical problem. Always call your healthcare provider if your pain is severe, lasts more than a few hours, or is accompanied by fever, lightheadedness, or vaginal bleeding or discharge.

  • Cholelithiasis (gallstones). Increased estrogen levels during pregnancy can contribute to the formation of gallstones stones in pregnant women.
  • Cholecystitis. If gallstones are not treated, the gallbladder can become inflamed and painful.
  • Fibroids. These benign tumors grow on the walls or lining of the uterus. They usually do not cause pain, but sometimes fibroids can be painful and cause pregnancy complications.
  • Pyelonephritis. The relaxing effects of progesterone can enable an infection to ascend the urinary tract and take hold of the kidneys. Pain in the abdomen is a symptom of kidney infection, as is painful or burning urination.
  • Ovarian torsion. This occurs when the ovary twists around the ligaments that hold it in place. It can happen during pregnancy and cause pain, nausea and vomiting, and fever.
  • Appendicitis. Infection of the appendix is characterized by severe abdominal pain and is a medical emergency.
  • Placental abruptionVery rarely, the placenta detaches itself from the uterus. The placenta is the baby's lifeline, and if placental blood flow is disrupted, both the baby and mother are in serious danger.
  • Contractions. Contractions can feel like cramping and pain that does not go away with rest.
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  • March of Dimes. Abdominal pain or cramping. Updated December 2013.

  • Mehta ND, Chen KK, Monzon C, Rosene-Montella K. Chapter 223. Common Medical Problems in Pregnancy. In: McKean SC, Ross JJ, Dressler DD, Brotman DJ, Ginsberg JS. eds. Principles and Practice of Hospital Medicine. McGraw-Hill, 2012. 

By Krissi Danielsson
Krissi Danielsson, MD is a doctor of family medicine and an advocate for those who have experienced miscarriage.