When Should I Be Concerned About Pelvic Pain During Pregnancy?

You should be concerned about pelvic pain during pregnancy if you also experience fever or chills, vaginal bleeding, fainting or lightheadedness, severe pain, trouble moving around, fluid leaking from the vagina, the baby moving less, blood in bowel movements, nausea or vomiting, or repeated diarrhea.

Pelvic pain in pregnancy is a common issue for many women. As many as 80% of women report pelvic pain at some point during their pregnancy. Early in your pregnancy, it can be a sign that your body is stretching to make room for your baby. Later in your pregnancy, it can be caused by the ligaments in your abdomen stretching.

It can also be a sign of symphysis pubis dysfunction (SPD) or pelvic girdle pain (PGP), a condition that occurs when the ligaments supporting the pelvic bones relax due to a pregnancy hormone called relaxin.

For most women this pain is mild, but for some it can be severe and even disabling. Talk to your doctor about your symptoms to determine their cause and the best course of treatment.

Some different types of pelvic pain that can be present in pregnancy include:

• Cramping pain similar to menstrual cramps
• Pressure in your pelvic area
• Pain in your pubic area
• Pain in your lower back
• Pain that goes down your thighs
• Clicking sensation in your pelvis

Sometimes the cause of your pelvic pain during pregnancy can be minor. It could be due to cramping, gas and bloating, or constipation. Persistent and serious causes of pelvic pain can vary as your pregnancy progresses:

First trimester

Pelvic pain in the first trimester is normally caused by your body adjusting to and making room for the baby. It may also be related to digestive issues that tend to be worse during pregnancy, such as gastroesophageal reflux disease (GERD).

Pelvic pain in early pregnancy may also be caused by miscarriage. The most serious cause of pelvic pain in early pregnancy is an ectopic pregnancy, which is pregnancy that occurs outside the uterus. Ectopic pregnancies require immediate medical attention.

Second trimester

Round ligament pain is the most common cause of pelvic pain in pregnancy during the second trimester. The round ligaments support the uterus. They stretch during pregnancy to accommodate your growing baby. Round ligament pain is a sharp pain that's felt in the abdomen or in the hip area, on either side. Any sudden movement that makes these ligaments retract quickly can cause this pain. It only lasts for a few seconds and generally gets better in the third trimester.

Third trimester

Pelvic girdle pain (PGP), sometimes called symphysis pubis dysfunction (SPD) can occur at any stage in pregnancy but is more common late in pregnancy. The pain may occur in your pubic bone, at approximately the level of your hips, in either side of your lower back, or in the perineum, which is the area between your vagina and anus. It may spread to your thighs as well. You may also have a grinding or clicking feeling in your pubic area. PGP is not harmful to your baby, but it can be very uncomfortable for you.

If you have any of the following symptoms accompanying your pelvic pain, you should call you doctor right away:

• Fever or chills
• Vaginal bleeding
• Fainting or lightheadedness
• Severe pain
• Trouble moving around
• Fluid leaking from the vagina
• The baby moving less
• Blood in bowel movements
• Nausea or vomiting
• Repeated diarrhea

Your doctor will take a medical history, ask about your symptoms, and do a physical exam. If necessary, your doctor may order an ultrasound or magnetic resonance imaging (MRI) scan to determine the exact cause of your pelvic pain. They may also order some blood or urine tests to check for other issues.

The treatment for your pelvic pain will depend on what is causing it. It may include a combination of home treatments, medication, or therapy.

Normal changes of pregnancy

For pelvic pain that is related to normal pregnancy changes, some helpful options include:

• Don't do any heavy lifting.
• Try sleeping with a pillow between your knees.
• Move more slowly but more often.
• Use a heating pad, but never for more than 10 minutes at a time.
• Rest more often.
• Do Kegel exercises.
• Use a maternity belt for extra support.

Round ligament pain

If your pelvic pain is caused by round ligament pain, try to:

• Get extra rest.
• Move and change positions slowly.
• If you know you need to cough or sneeze, bend and flex your hips.
• Ask your doctor about stretching exercises for persistent pain.

Pelvic girdle pain

Pelvic girdle pain can range from mild to severe. You can try the following options for relief:

• Avoid strenuous activity or heavy lifting.
• Try a heating pad or ice pack on painful areas, but don't use a heating pad for more than 10 minutes at a time.
• Wear a pelvic support belt.
• Do kegel exercises.
• Sleep with a pillow between your legs.
• Talk to your doctor about pain relievers if the pain is severe.
• Talk to your doctor about physical therapy if home measures aren't helping.

Pelvic pain is common in women and can have a variety of causes. The pain may originate from your genitals or be caused by problems in your surrounding organs. Sometimes pelvic pain can also be related to psychological issues.

The pain can be acute and happen suddenly or it can be chronic and last for months. Sometimes pelvic pain can go away before the specific cause is diagnosed. If you experience severe pain that lasts, you may need to consult your gynecologist. 

Variations in pain level range from sharp to dull aches. It’s also possible that your abdomen is sensitive to the touch. In some cases, pelvic pain in a woman may be accompanied by abnormal vaginal bleeding or vaginal discharge.

You may experience different symptoms of pelvic pain. Your pelvic pain will vary in severity and location. Some symptoms to look for include:  

• Blood in stool
• Chills
• Constipation
• Fever
• Nausea
• Pain during sex
• Vomiting

Pain in your pelvic region can be worsened by activities like using the bathroom or having intercourse. Some women have had pain worsen during menstruation.

Pelvic pain can be experienced in many ways. There are five types of pain that you should be aware of to help your doctor make a proper diagnosis. They include: 

Localized pain

If you have localized pain, it may be caused by inflammation in your organs. 

Cramping pain

This kind of pain can be caused by spasms in your intestine, ureter, or appendix. 

Sudden onset of pain

You may experience sudden pain due to a deficiency of blood supply to your organs. This may be caused by an obstruction in the circulation of your blood and is usually temporary. 

Slow developing pain

This may happen because of inflammation in your appendix. It could also happen because of intestinal obstruction. 

Aggravated pain

You may experience this pain when you move or put pressure on your lower abdomen or groin region. This can be caused by irritation in your abdominal cavity lining. 

Pelvic pain in a woman can have many causes. It may be hard to pinpoint where your pain is coming from on your own. To determine where your pelvic pain could be coming from, you need to know the causes. Here are some possibilities: 

Inflammation

Inflammation is a common issue your body has to fight off. If you have a pelvic inflammatory disease, you may need to go on antibiotics to fight off potential infections. 

Irritable bowel syndrome (IBS)

IBS causes your gastro-intestines to be uneasy which can lead to pelvic pain. This condition can also cause stomach cramps and bloating. 

Endometriosis

This is a painful condition that makes you feel like you are having menstrual cramps, but will persist past your period. Diagnosis of this condition often starts with a physical examination that includes your pelvis.

Severe, sudden pelvic pain should be a cause for concern. See your doctor as it may be a sign of ovarian torsion or appendicitis. If you are pregnant, it could be a sign of an ectopic pregnancy. You will need to seek emergency medical treatment. 

Consider going to a doctor if you experience chronic pelvic pain for six months or more. Whether it’s persistent or it comes and goes, medical treatment may ease the pain once your doctor determines the cause.

Your doctor can diagnose the root cause of your pelvic pain if it becomes overwhelming. 

They will ask about your medical history and perform a physical exam. Your doctor may also order blood work and urine tests. To determine the exact location of your pelvic pain, the doctor may recommend a pelvic ultrasound, laparoscopy, or magnetic resonance imaging (MRI). A cystoscopy might be requested to get footage inside.

Most mild cases of pelvic pain do not require medical attention as they may come and go. You may take medications like pain relievers or muscle relaxants. 

If your pain is caused by issues in your reproductive system like endometriosis or menstruation, your doctor may prescribe hormone treatment. Hormone treatment includes birth control pills, progestin-releasing intrauterine devices, or other methods. 

Chronic pelvic pain that appears to have no root cause may be treated by “talk therapy.” You will be able to discuss the root of your feelings and find where you are holding pain related to mental health issues.