Abdominal pain in pregnancy
introduction
Abdominal pain during pregnancy is a common symptom that is often of great concern. However, in most cases this is unfounded, as mild abdominal pain in the lower abdomen is not uncommon. The causes of the pain are very different and, despite everything, require clarification by a doctor.
Other symptoms such as bleeding, painful urination, fever, and chills should also be examined by a doctor.
Further information on this topic can be found at: Fever during pregnancy
Causes of abdominal pain in pregnancy
Changes in the body can cause pain, especially at the beginning of a pregnancy. These are caused by stretching the various ligaments and muscles of the uterus (uterus), which adapts to the new situation. In addition, as the uterus grows, it increasingly takes up space in the abdomen, which can cause discomfort and cramps in the abdomen. Furthermore, the pregnancy hormones (ß- HCG) not yet sufficiently available and the uterus tends to contract, which can cause pain in the abdomen.
Read more on the subject at: Pregnancy hormones, physiotherapy for abdominal pain during pregnancy
In later stages of pregnancy, kicks or an awkward position for the child can also cause pain. But labor pains are also normal in the last trimester and only serve the uterus to prepare for birth. However, these labor pains have no effect on the cervix and are not used to induce labor. For this reason, these must be differentiated from birth-related contractions, which initiate the birth and can cause premature birth.
In addition to the harmless causes due to the adaptation processes in the body, the cause can also have other origins. Especially at the beginning of a pregnancy that has not yet been confirmed, it can be an ectopic pregnancy (ectopic pregnancy). First, the symptoms of normal pregnancy appear:
- Menstruation stops
- morning sickness and
- Chest tension
A pregnancy test will also be positive in this case. However, due to the location of the fertilized egg outside the uterus, inflammation occurs and the egg can burst as it grows. In this case, the abdominal pain is acute and very severe. This is followed by a short symptom-free interval with increasingly dull pain throughout the abdomen. Since the entire abdominal cavity can become inflamed in this case, it is important to rule out such an ectopic pregnancy with the help of an ultrasound device at the beginning of a pregnancy.
If the pain occurs with bleeding at the beginning of the pregnancy, a doctor should also be consulted as in some cases the symptoms are associated with an abortion.
Another possible cause of abdominal pain is adnexitis (inflammation of the fallopian tubes). It is an inflammation, mostly caused by chlamydia, which can rise up into the fallopian tubes and become symptomatic there. Patients complain of pulling in the abdomen and pressing pain in the abdomen. Furthermore, accompanying symptoms such as fever etc. can also occur.
An ovarian cyst can also be responsible for the pain. An ovarian cyst can go unnoticed and symptom-free for a long time before symptoms occur. In this case it can also lead to back pain in the stomach.
Flatulence during pregnancy is also a possible cause: the bigger the child becomes, the more space in the abdominal area is filled. This also leads to different pressures that are exerted on both the gastrointestinal tract and the blood vessels.
While the so-called vena cava compression syndrome can be triggered in a pregnant woman lying on her back (reduced blood flow back to the mother), the child's increasing pressure on the mother's abdominal organs can also lead to imbalances in the mother's digestion.
This can lead to abdominal discomfort, which is not initially interpreted as flatulence, but whose medical significance is harmless.
Read about this too Flatulence in pregnancy
Furthermore, pain can also occur regardless of pregnancy. Appendicitis, severe cystitis or a gastrointestinal upset can also lead to abdominal pain. In this case, attention should always be paid to the accompanying symptoms.
More on this: Appendicitis in pregnancy
Internal causes
Abdominal pain that is on internal clinical pictures are varied and often not clearly distinguishable. The most common diseases are inflammation of unnoticed intestinal sacs (Diverticulitis), Inflammation of the pancreas (Pancreatitis), Biliary colic, renal colic, Appendicitis (appendicitis), Intestinal obstruction (Ileus), Stomach or duodenal ulcer (Gastric ulcer, Duodenal ulcer), Infarct those supplying the intestines Blood vessels (Mesenteric infarction) such as Bulging of the main artery (Aortic aneurysm).
Depending on which internal internal illnesses lead to the abdominal pain, that too Diagnosis and therapy differ. In general, it can be said that the symptoms affect the abdominal area. Of the The character of pain is different and ranges from acute tearing to dull pain to wavy, colicky pain.
Do you have stomach pains in the evening?
Symptoms
A simple Pulling in the lower abdomen, similar to during the Menstruation, without bleeding is usually harmless and only a sign of changes in the uterus.
Nevertheless, this too should be confirmed by a doctor to one Abortion to avoid. In particular, too little pregnancy hormones can Contractions of the uterus evoke and possibly to a Miscarriage to lead.
If pain occurs later in pregnancy, it usually has to be between Child movements, labor pains and premature labor can be distinguished.
Kicks the child against the abdominal wall or an unfavorable position of the child can be very painful, especially if the space in the abdomen is significantly reduced. By changing the position of the mother or repositioning the child, however, the pain usually stops.
This type of pain is also different from contractions, as the pain does not occur regularly and lasts much shorter or can be ended by repositioning.
Exercise contractions are especially normal in the third part of pregnancy and are used for Preparation of the uterus on the birth. However, they are not relevant to birth and do not lead to one Opening of the cervix. Just like real labor pains, it is about contractions, which are accompanied by a hardening of the abdomen. They differ from birth-related contractions because they only last a maximum of 45 seconds and do not occur more than 3 times an hour.
A CTG be put on by the gynecologist or in the hospital. This shows both the Labor as well as the child's heart.
Right-sided abdominal pain
Abdominal pain during pregnancy is not uncommon and in most cases completely harmless. Nevertheless, cramps and / or abdominal pain that occur during pregnancy can have serious causes and make a prompt visit to the doctor inevitable.
Typically, most women assume that abdominal pain during pregnancy is directly related to the growing baby. However, abdominal pain can also have completely different causes during pregnancy.
Particular caution is required in the case of pain and / or cramps during pregnancy that occur suddenly and are sharp / stabbing.
Read more on the subject at: Cramps during pregnancy
Pregnancy-associated abdominal pain, i.e. pain that is directly related to pregnancy, is particularly often perceived on the right by most women. The reason for the occurrence of this right abdominal pain is usually an overuse of various structures.
As the child grows in the womb, muscles, ligaments, tendons, blood vessels and organs are affected in a special way. Especially the individual ligaments within the abdomen are stretched a lot during pregnancy.
For this reason, intermittent abdominal and abdominal pain (see: Abdominal pain during pregnancy) can occur during the entire pregnancy.
The fact that these complaints are mainly observed on the right can be explained by the fact that the uterus (womb) shifts slightly to the right during pregnancy. The strain on the ligaments, tendons and muscles is therefore particularly pronounced on the right. To counteract common abdominal pain on the right, women should take care to exercise enough during pregnancy.
Read more on the subject at: Pulling the mother ligaments
In the case of acute abdominal pain on the right, the mother-to-be should sit down if possible and adopt a relaxed posture. In addition, the woman affected by abdominal pain should lie down during the acute pain phase. Many pregnant women find it particularly pleasant to tilt the body towards the unaffected half of the body.
In the case of abdominal pain during pregnancy, which mainly occurs on the right, organic causes should also be clarified. This is especially recommended if there is no improvement despite the rest period or if the symptoms increase in intensity with increasing pregnancy.
Abdominal pain during pregnancy that is felt on the right can be caused, among other things, by diseases of the gallbladder. The severe impairment of the hormonal balance can, for example, lead to the formation of gallstones and the associated obstruction of the bile ducts. In addition, right abdominal pain during pregnancy can be caused by inflammation of the gallbladder. In addition, right-sided abdominal pain during pregnancy, which mainly occurs in the lower abdomen as well as in non-pregnant women, can be a sign of appendicitis.
Read more on the subject at: Abdominal pain right - what do I have?
Left side abdominal pain
Abdominal pain during pregnancy can also be left by one excessive stretching of ligaments, tendons, and muscles be evoked.
Although the uterus usually tilts slightly to the right after the fertilized egg cell has implanted, some women show a shift to the left.
Straight to Onset of pregnancy Many of the expectant mothers observe stomach pains that occur left. In most cases, this pain is a completely harmless symptom that does not require any medical intervention.
Colloquially, in connection with abdominal pain that is perceived on the left (or right) in early pregnancy, one speaks of an indication of the stretching of the "Mother bands". Ultimately, this means nothing other than that the position of the uterus changes and space is created for the child to grow up.
In addition, abdominal pain can be left through in the first few weeks of pregnancy Adjustment of the hormonal balance to be triggered.
If the symptoms occur more frequently or if they are steadily increasing in intensity, they should be promptly a specialist visited and the reason for the complaint clarified.
In some cases the cause of the left (or right) abdominal pain is something called a Ectopic pregnancy. In this clinical picture, after fertilization of the egg, there is a faulty implantation within the Fallopian tube. An ectopic pregnancy is a potentially life-threatening situation because the affected fallopian tube tears too heavy bleeding leads. Such abdominal pain can also occur on the left during pregnancy, which basically has nothing to do with the growing up of the child.
This is another reason why recurring left stomach pain should urgently be clarified medically.
Left abdominal pain can for example be caused by diseases of the left kidney caused. An impairment of the right kidney would lead to abdominal pain on the right in the pregnant woman. In this regard, the expectant mother should pay attention to additional symptoms. Inflammation of the kidneys and / or the urinary tract is usually severe Discomfort when urinating noticeable. A urine test can indicate the presence of a bacterial infection within minutes. In addition, left abdominal pain can be an expression of inflammatory processes in the colon or an infection of the gastrointestinal tract, even during pregnancy.
Other reasons for the development of abdominal pain during pregnancy that occur to the left or right of the navel are:
- Fallopian tube inflammation
- Diverticulitis
- Ureteral stones
- Inflammation of the pancreas (pancreatitis)
- Diseases of the spleen
- Ovarian cysts in pregnancy
Abdominal pain in the upper abdomen
Upper abdominal pain during pregnancy are nothing unusual. If the pain persists over a longer period of time, it should a doctor for clarification for safety to be visited.
Is the persistent pain a pain in the right upper abdomen, the attending physician will clarify whether a so-called HELLP syndrome present. With HELLP syndrome, there is one increased blood clotting, and an increased breakdown of red blood cells. As a result, blood clots form, mainly in the liver cause damage so that the liver values increase.
Since the liver is located in the right upper abdomen, abdominal pain in the right upper abdomen can be a symptom of a Liver capsule tension be.
HELLP syndrome typically occurs as a pregnancy complication third trimester of pregnancy on.
Upper abdominal pain on the left side can for example for a Inflammation of the kidneys speak. However, the reason is often quite harmless and the upper abdominal pain is a sign of a pregnancy that is often associated with it constipation. But a strong kick by the child in the direction of the pregnant woman's stomach can also be the cause.
Abdominal pain in early pregnancy
Abdominal pain in the early stages of pregnancy, i.e. in the first weeks and months, are nothing unusual.
They are a sign that the body is preparing to host a growing child for nine months.
In the initial phase, it can occur during the implantation of the fertilized egg in the lining of the uterus weak drawing in the abdomen come.
Furthermore, at the beginning of the placenta (placenta) and it comes to New formation of blood vessels.
Some pregnant women also feel this as light pain.
Increasingly, muscles and ligaments also stretch and the uterus grows. Those affected can perceive all of this as pulling pain. Especially the so-called Mother bands stretch in the early stages of pregnancy. The Mother bands attach the uterus to the pelvic bone.
The pain is often described as having sore muscles and is mostly projected onto the Groin.
The application of warmth, rest and relaxation helps against this type of pain.
Read more on the subject at: Pain in early pregnancy
In some cases, pregnant women only go to the doctor because of the pain and are informed in this context that these are the "consequences" of pregnancy.
Abdominal pain in the third trimester
The bigger the child gets, the more the stomach pain can increase. At the end of pregnancy organs such as the intestines in the abdominal cavity are pushed to one side or together.
The pain can therefore become more severe after eating.
The child is also growing more activeso that the child's kicks can also trigger abdominal pain.
In the last trimester of pregnancy there can also be more frequent occurrences of so-called Exercise contractions come. These start around from the 20th week of pregnancy. They are designed to prepare the body for birth. The exercise contractions occur in the form of abdominal cramps lasting about 45 seconds and that a maximum of three times an hour.
However, it doesn't always have to be practice contractions, it could be premature labor as part of a possible Premature birth act.
Very rarely can severe abdominal pain towards the end of pregnancy for one Ruptured uterus speak. Those affected feel a very strong pain. A rupture of the uterus usually occurs during childbirth, but in rare cases it can also occur towards the end of pregnancy.
It is a rare but dangerous complication.
Labor pains
Abdominal pain that occurs during pregnancy is, in many cases, about early onset labor.
In medical terminology, one speaks of so-called in this context "Practice contractions".
Labor that shows up as a slight pulling or moderate abdominal pain can occur as early as the 30th week of pregnancy. Usually these labor pains are completely harmless and not cause for alarm.
The mother-to-be's body consciously triggers these contractions during pregnancy to help her Prepare uterus for childbirth. Many women already notice a noticeable hardening of the abdominal wall during this slight contraction, but this disappears again after the abdominal pain subsides.
From the 35th week onwards, abdominal pain during pregnancy can be so-called "Senkwehen" act. This type of labor ensures that the child is pushed deeper into the pelvis.
Labor pains usually occur at completely irregular intervals and are pronounced in many women Back pain accompanied (read also the article Abdominal pain and back pain).
Especially young women who are in their first pregnancy can experience the abdominal pains of the contractions very violently. As the internal organs (especially the lungs and stomach) move back down during this type of labor, most women experience an overall improvement in their wellbeing. Sink labor is also considered completely harmless and harmless. If the abdominal pain / cramps during pregnancy occur shortly before the calculated due date, it may be „real labor“ act.
In order to differentiate between sub-contractions and true contractions, some characteristics should be known.
Real labor redeem with the expectant mother severe drawing in the entire abdomen out. So usually not just one side of the abdomen is affected. Many women report that the contractions radiate down to their back and thighs.
Further evidence that abdominal pain during pregnancy is labor can be found in the intervals between cramps.
In real contractions, the intervals are getting shorter. In addition, contractions are characterized by their occurrence in regular intervals out. The duration of real contractions is between approximately 30 and 60 seconds. Many women also report that the pain gets worse over time.
In addition, attention should be paid to more details in the event of abdominal pain at the end of pregnancy. If the abdominal pain is actually real labor, in most cases it will take place quite quickly Rupture of the bladder instead of. In addition, an increasing expansion of the cervix can be observed. As a rule, this becomes gradually thinner and softer and takes on an opening width of about 10 centimeters.
Abdominal pain after eating in pregnancy
Abdominal pain during pregnancy that is immediate after eating occur are not uncommon. Almost every woman suffers from this problem at least once during pregnancy.
Affected women should keep in mind that pregnancy and the growing up of the child are a burden on the organism. As the child grows in size in the womb and the uterus expands for this reason, there is less space for the rest of the abdominal organs.
The stomach in particular is subjected to enormous pressure as the child grows up. The larger the unborn child becomes during pregnancy, the wider it becomes Stomach towards the chest relocated.
If abdominal pain occurs after eating during pregnancy, this phenomenon is in most cases due to excessive filling of the Stomach traced back. Since the stomach cannot expand properly during advanced pregnancy, overeating can lead to post-meal abdominal pain.
In addition, it can be hormone-related in the course of pregnancy Increase in acid secretion come inside the stomach. For this reason too, abdominal pain can occur after eating.
Nocturnal abdominal pain during pregnancy
In the Early pregnancy the body changes. It comes to Stretching muscles and ligaments and forming new blood vessels. Since the body is at rest at night and other functions of the body tend to be subdued, the body often has more time at night to devote itself to these remodeling processes.As a result, some pregnant women are more often plagued by pulling pains at night.
With increasing pregnancy, i.e. in the course of the third trimester of pregnancy, it can become a Vena cava syndrome come.
The Vena cava directs the human blood from the body back to the heart. At the end of pregnancy, the uterus is large enough to compress the vein. This can manifest itself in a hardened and slightly sore stomach during the night. In addition, the pregnant women often feel a slight dizziness, one nausea as well as a increased heart rate.
Why does vena cava syndrome typically occur at night? Vena cava syndrome occurs when pregnant women lie on their back for a long period of time.
Therefore, a sleeping position on the side is recommended. By changing the lying position from the supine position to the side position, the symptoms usually subside.
Diagnostics for abdominal pain during pregnancy
Especially when a pregnancy is suspected due to the first signs of the absence of the Menstrual period, morning sickness or general malaise should a gynecologist for Diagnostic assurance and confirmation of a correct position of the embryo to be visited. Here is a pregnancy test, such as. Clearblue®, by determining the pregnancy hormone ß-HCG and a Ultrasound examination of the abdomen.
Even with other symptoms, such as Abdominal pain and nausea, Bleeding, The ultrasound scan will increase pain and vomiting used. In this way, an intact pregnancy can be confirmed and other causes such as appendicitis can be excluded. With the help of the determination of Inflammatory parameters in the blood can a inflammatory cause for the pain to be noted.
In addition, a Blood test performed in the Signs of inflammation detected and it will be seen whether that Pregnancy hormone still sufficient is formed. A severe decrease in the pregnancy hormone indicates one unconscious termination of pregnancy that has taken place down (abortion).
In addition to the ultrasound and blood tests usually an extensive pelvic exam carried out in which the Cervix inspected and depicted and corresponding abnormalities can be seen.
If all the gynecological causes for the abdominal discomfort have been ruled out, it must be considered whether the cause is not in an internal illness lies. However, there are some investigation options due to the teratogenic diagnostics path.
So it must be very carefully weighed whether an ileus is suspected X-ray examination of the abdomen should be carried out. The Radiation could harm the fetus.
With many other internal diseases, such as pancreatitis, means Blood count and ultrasound can already be seen whether it is pancreatitis. Ultrasound can also provide important information in the case of biliary or renal colic.
Last can MRI during pregnancy give a lot of helpful information. With an MRI, there is no radiation exposure to the fetus. Nevertheless, the indication for an MRI during pregnancy must be clearly considered.
Therapy / what helps?
Most causes of abdominal pain do not require any form of therapy.
In particular, contractions at the beginning of a pregnancy cannot be treated well, as this is an adaptation of the body to the new circumstances. Early labor, on the other hand, must be taken very seriously and, under certain circumstances, treated as an inpatient. Most of the time, the affected mothers have to keep a strict bed rest for the rest of the pregnancy and are treated with medication to prevent labor. If the cervix has opened too early, it can be closed again on a trial basis using a so-called cerclage in order to avoid an ascending infection of the child and a premature birth.
Relaxation measures such as a warm bath or a hot water bottle often help with harmless abdominal pain as part of the adjustment processes in the body. A rest period usually helps to relax the stressed muscles and ligaments.
The pre-contractions can also be relieved through relaxation measures and calm, deep breaths. However, if it is just the pre-birth practice contractions, they should stop on their own not too long.
In the case of an ectopic pregnancy that causes severe discomfort, the egg cell must be surgically removed from the fallopian tube. This is mostly done using minimally invasive laparoscopy. If the patient's symptoms improve increasingly, an attempt can first be made to wait for the further course. In general, however, this is also followed by an operative fallopian tube removal. Alternatively, medication can be used to try to get the body to reject the fetus so that surgical evacuation is no longer necessary. In the case of fallopian tube inflammation, anti-inflammatory drugs and pain relievers are usually used to reduce the symptoms. Furthermore, bed rest should be observed by the patient.
The treatment of an ovarian cyst can either be carried out in a wait-and-see manner using ultrasound or surgical removal (depending on the size). However, if the cyst is already causing symptoms, an early surgical removal should be considered.
If the pain is the cause of an abortion, in many cases the uterus must be cleared to avoid complications for another pregnancy.
If there is a bladder infection, this can often be treated with plenty of fluids at the beginning. If the inflammation is advanced, an antibiotic may need to be used to treat the inflammation. For this, macrolides, cephalosporins or penicillins are used. These have no influence on the unborn child and therefore do not represent any danger or risk.
If appendicitis is the cause of the pain, it must always be operated on as soon as possible to avoid a rupture of the appendix. The operation does not pose a risk to pregnancy in experienced hands. An ectopic pregnancy must also be treated surgically as quickly as possible in order to avoid life-threatening complications.
You may also be interested in the following article: Physiotherapy for abdominal pain during pregnancy
Summary
Abdominal pain during pregnancy is a common and often harmless symptom as a sign of the body's adjustment to the new situation.
Depending on the week of pregnancy, the causes of abdominal pain can be numerous and some are completely harmless.
However, so that there is no serious danger to mother or child, there is one Medical consultation usually makes sense. By simple methods using Ultrasonic, CTG and laboratory the doctor can easily determine whether the pain is in need of therapy or not.
