Tummy twinges can be worrying when you’re pregnant, but they’re often harmless. Here’s what might be going on…
Abdominal pain during pregnancy can naturally cause anxiety, but try to relax: if you’re not experiencing any other symptoms, pain of this sort is usually nothing to worry about.
Lesley Gilchrist, registered midwife and co-founder of My Expert Midwife, explains what the most common causes of abdominal pain and discharge during pregnancy are, and when it might be a good idea to seek professional support.
Is abdominal pain in pregnancy normal?
Abdominal pain can be common in pregnancy and, more often than not, is nothing to be concerned about.
Most commonly, abdominal pains in pregnancy are caused by one of three things:
- Trapped wind
- Ligament pain around your bump (also known as ‘growing pains’)
These could be experienced as sharp pains or dull aches, but should ease with a change of position, after a bowel movement or passing gas, for example.
Some other common causes of abdominal pain in pregnancy that require simple medical treatment (such as antibiotics) include:
- Urinary tract infections (UTIs)
- Pelvic inflammatory disease (PID), usually caused by a sexually transmitted infection (STI)
If, however, you experience any of the following, it’s important to contact your maternity unit, midwife or GP for assessment:
- Severe pain
- Cramping that is regular
- Any bleeding or abnormal vaginal discharge
- Burning when (or immediately after) passing urine
- Any any other symptoms that you find concerning
In early pregnancy, more severe abdominal pains, with or without bleeding, could indicate a threatened or early miscarriage, or something more serious, such as an ectopic pregnancy. In the later stages of pregnancy, these symptoms could signify premature labour, although this is rare. Therefore, it’s important to seek professional advice if you have any concerns.
Easing abdominal pain during pregnancy
There are various ways you can ease abdominal pain during pregnancy. If constipation or trapped wind are the causes, you can try:
- Abdominal massage
- Light exercise
- Drinking digestive teas, such as peppermint
These solutions can offer relatively quick relief of milder symptoms. However, prevention and longer-term management options include:
- Eating a diet rich in fibre
- Eating slowly
- Avoiding foods that make you ‘gassy’
- Drinking plenty of water
- Doing regular, gentle exercise
If you’re experiencing ligament pain, it can be eased with regular stretching (pregnancy yoga is great for this), changes of position and/or warmth (for example, in a bath or by applying a heat pack). And while rest can help to ease the pain, regular light exercise can also be a good pain relief tool.
TIP: Emptying your bladder regularly and fully can also help to ease discomfort and, potentially, help to avoid UTIs.
When to see advice for abdominal pain in pregnancy
While abdominal pain in pregnancy is usually nothing to be concerned about, if you’re experiencing additional symptoms or the pain is severe, it’s time to contact your health professional. Here’s what to look out for and what it could be a sign of…
In the first trimester
Mild, period-type cramps tend to be common in early pregnancy. However, if these are not relieved by rest, warmth and/or simple analgesia, or if they are severe, they could be a sign of miscarriage or ectopic pregnancy. While it’s estimated that one in five pregnancies end up in an early miscarriage, only one in 90 are ectopic.
Signs and symptoms to look out for include:
- Bleedingor ‘spotting’
- Abnormal vaginal discharge
- Dizziness and/or fainting
- Feeling and/or looking unwell without a known reason
- Pain in shoulders
- Sudden acute pain or prolonged dull aching in the lower abdomen/pelvic area
In the second trimester
During mid-pregnancy, most abdominal pain is usually related to the ligaments that attach to the womb, which stretch as the latter grows and accommodates.
Late miscarriages are pregnancy losses that occur between the 12th and 24th week of pregnancy. They are rare and only occur in one to two per cent of pregnancies.
Again, any pain (new or worsening) that is not relieved with simple ‘at-home’ measures, or that is accompanied by vaginal bleeding, abnormal discharge and/or other symptoms should be assessed by a midwife or a doctor.
Late miscarriages do sometimes present with similar pain to UTIs, but without other urinary signs or symptoms. The pain may also start in or spread to the lower back.
In the third trimester
More often than not, pain in the third trimester is musculoskeletal (relating to muscles, bones and joints). As the baby grows, pain under the ribs (from the baby pushing against them), around the pelvis and hips (from your joints softening) and to the lower back (from the pull of your growing ‘bump’) are commonplace.
‘Growing pains’, from the stretching of the ligaments that hold your womb, and digestive discomforts, such as constipation, trapped wind and ‘heartburn’, are also familiar causes of abdominal pain in the third trimester. Braxton-Hicks contractions are very common in the third trimester and can cause discomfort for some women.
As with pain earlier in pregnancy, any severe and/or sudden pain that is accompanied by bleeding or other symptoms should always be checked by a professional.
Vaginal discharge during pregnancy
Vaginal discharge in pregnancy is known as leukorrhea and it is not only a little different to non-pregnancy discharge, but it also increases as the pregnancy reaches term. This tends to look clear or ‘milky’ and can be thin or creamy in consistency. It may have a distinct smell, but should not be offensive.
Its purposes include:
- Maintaining a balanced pH
- Protecting the unborn baby from infection by washing away unwanted pathogens
- Acting as a lubricant in labour
Assessment by a midwife or doctor becomes necessary when the vaginal discharge changes in colour, is green or yellow, looks and/or smells odd, or is accompanied by pain, itching or burning.
During the last couple of weeks of pregnancy, vaginal discharge may contain pink or brown-ish mucous. This is called a ‘show’ and can indicate that labour is close.
Bleeding during pregnancy
Light bleeding, or ‘spotting’, in early pregnancy can be common. This is usually harmless and is caused by the embryo embedding into the inner wall of the womb, or by changes that occur to the cervix (neck of the womb) during pregnancy, which make it more prone to bleeding.
In pregnancies where the placenta is low or covering the exit to the cervix (placenta praevia), bleeding can be common and should be monitored by the maternity team.
Some vaginal infections could cause some bleeding, which may be seen as a ‘pink’ loss as it mixes with vaginal fluids. Occasionally, UTIs may cause bleeding. This blood would come from the urethra (the orifice from which urine comes out) rather than the vagina, but you may not realise this, as blood is seen on underwear or in the toilet.
In the early stages of labour, a blood-stained ‘show’ – which may be a pinkish or blood-streaked mucous-y loss – is normal. However, a loss of fresh red blood, particularly if heavy, needs to be reviewed by a professional.
Bleeding in pregnancy, particularly when accompanied by pain and/or other symptoms, should be assessed by a midwife or doctor.
Braxton Hicks contractions
Braxton Hicks contractions, or ‘tightenings’, occur when the womb contracts and relaxes, in preparation for labour. Although some refer to them as ‘false labour pains’, they can start weeks or even months before labour actually starts.
Braxton Hicks contractions will usually occur during the second or third trimester of pregnancy and, for most women, are unnoticeable. Yet, whereas some women may feel a gentle tightening of their ‘bump’ without any pain or discomfort, others may experience them as similar to menstrual cramps.
They differ from labour contractions in that they are often too short-lasting, irregular and mild to be considered labour contractions, with women describing them as more uncomfortable than painful. However, some Braxton Hicks can vary in duration and strength.
Although the exact cause of Braxton Hicks contractions is unknown, we do know some of the triggers. These can include:
To ease any discomfort from Braxton Hicks contractions, try:
- Changing position
- Having a warm bath
If these do not help, or you are concerned about them, do contact your maternity unit.
What does early labour feel like?
Early labour, or the latent phase of labour, is the first stage of labour, when the body is doing a lot of work to get contractions into a regular pattern and the cervix thinned, soft and in a more central position.
As every woman is unique, the experience of early labour will be individual. Still, most commonly, women experience:
- At the very start, period-type pains
- Irregular contractions that may stop and start
- Backache that may come in waves or be persistent
- The mucus ‘show’ may appear for the first time or become more copious and the waters around the baby may break
If you experience any of these symptoms at less than 37 weeks pregnant, it is important to call your midwife or hospital immediately.
When to contact your midwife
Even if you do not have any of the accompanying symptoms as outlined above, it’s always best to consult your midwife if you ever feel concerned about any aspect of your pregnancy – even if it seems silly.
Maternity assessment centres are open 24 hours a day and staffed with experienced midwives, who will help put your mind at ease or invite you in for assessment, if needed. They are there to help and ensure you have the smoothest pregnancy possible.