Nausea, night sweats, trouble sleeping — pregnancy can cause a lot of changes in your body, and pelvic pain during pregnancy is just another of those early parenthood discomforts you may experience. Pelvic pain can start in your first trimester, or it may not begin you’re close to your due date. The good news is that nearly all pelvic pain is easily treatable and totally normal. Any causes that are more serious are usually something your doctor will pick up on early in your pregnancy.
Reasons for pelvic pain during pregnancy
So, on top of everything else, why do you feel like your lower abdomen is cramping, tugging, or throbbing when you move? There are many factors that conspire to cause pelvic pain during pregnancy, and many of them are related to normal (even beneficial) things your body is doing to prepare itself for birth.
Tonick explained that the body releases more of the hormones progesterone and relaxin during pregnancy to help the joints loosen, so the pelvis can expand for birth. So, while the hormone help in that way, they hurt in others.
“Hormone changes can lead to joint laxity, which can strain muscles. Widening of the pubic symphysis joint leads to pain as well. In the third trimester is when patients might start to have issues with pubic symphysis pain,” says Shawna Tonick, an OB-GYN and assistant professor at UCHealth.
Round ligament pain
The round ligament attaches your uterus to your groin, Tonick said, and it stretches out as your uterus grows to accommodate your baby.
“The uterus tends to grow and people start showing pregnancy around that 20-week mark, and the pregnancy reaches the belly button. You tend to have more round ligament pain as the uterus expands and grows,” says Dr. Victor Feldbaum, an OB-GYN at Bayfront Health St. Petersburg. “The second trimester in the later portion you might even get into practice contractions and what we call Braxton Hicks.”
Natural weight gain
You may notice weight gain during pregnancy, as your baby grows and your body does its thing to keep you both healthy. This can put some extra strain on muscles and ligaments in your pelvis.
“Of course, patients tend to gain weight during pregnancy — on average 25 to 35 pounds,” says Tonick. “The added weight can cause pain, and their growing abdomen shifting their distribution of weight can cause pain as well.”
A urinary tract infection (UTI)
Pregnant people are at a higher than usual risk for UTIs between weeks six through 24 of due to changes in the urinary tract, according to the American Pregnancy Association. If you’ve ever had a UTI, you know they can cause all sorts of discomfort.
“In the first trimester, it’s usually a UTI, some kind of infection, or an STD,” says Feldbaum.
Ah yes, Braxton Hicks, also known as practice contractions. If you’ve already been experiencing pelvic pain during pregnancy, you might think your body gearing up for labor is the same thing, just more intense. It’s best to let your doctor know what’s going on, just in case.
“It’s important to make sure you’re not going into preterm labor,” said Feldbaum. “The uterus is a huge muscular organ that tends to fire up in different parts of the muscle. The way to know you’re having contractions is when those muscles fire together, coming and going at regular intervals. You will start having some pain come and go at night and during long walks, and that’s more along the lines of Braxton Hicks.”
Feldbaum said that patients with health conditions like IBS, uterine fibroids, or ovarian cysts may be more likely to experience pelvic pain in pregnancy.
“Anything and everything you might have had a problem with before pregnancy can be exacerbated. With IBS, you can have pain coming from the GI tract that’s hard to manage and know if it’s coming from the pregnancy or something they had before. Consult your doctor if you know you have fibroids; cysts or fibroids that maybe are already there can cause pain when pregnancy gets added to the equation.”
While rare — Planned Parenthood says they only occur in about two of every 100 pregnancies — an ectopic pregnancy can cause severe pain in the lower abdomen. Feldbaum encourages anyone who may be pregnant or who is planning to get pregnant to get established with a doctor as soon as possible, so ectopic pregnancy can be detected early.
How to relieve pelvic pain during pregnancy
Most pelvic pain is caused by the natural growing and expanding happening all over your body during pregnancy. So, getting relief is all about comfort measures rather than treating some specific cause.
“A lot of our interventions are nonmedical,” said Tonick. “Physical therapy can be a huge help to patients. There are different support belts, girdles, and abdominal belts to help with the weight of the pregnancy and providing support. A lot of them are not super costly and can be purchased on Amazon. Heating pads can help with lower back pain, and pregnancy support pillows can help if you’re having trouble sleeping because of the pain. Taking Tylenol during pregnancy is safe if you’d like to take something for the pain.”
Both experts agree you should always let your prenatal care provider know if you’re experiencing pelvic pain at any point in pregnancy. They can help you rule out any major concerns and help you get relief.
“It’s always worth bringing up if you’re concerned or want recommendations for how to deal with it,” said Tonick. “Definitely call if you’re having severe pain that makes you unable to walk or go about your daily activities, if you’re having difficulty with urination, you’re concerned the pain is contractions, or anything happens that could indicate a problem with the pregnancy itself.”
To make the most of that convo with your doc, tune into when your pain occurs and anything else new your body is doing.
“Always think about what’s associated with the pain,” said Feldbaum. “Did you notice it when you stand up, sit down, move sideways, stand on one leg? The more information about when that pain started the better, and any associated symptoms like diarrhea, nausea, bleeding, or discharge. Anytime pain is persistent or questionable it’s always best to give your doctor a call, especially if you have fever, chills, discharge, or anything in addition to pain, or if Tylenol doesn’t help.”
Shawna Tonick, M.D., an OB-GYN and assistant professor at UCHealth
Victor Feldbaum, M.D., an OB-GYN at Bayfront Health St. Petersburg