Lower left side abdominal pain 36 weeks pregnant

In this article

• Is it normal to feel abdominal pain in pregnancy?
• How can I ease pregnancy abdominal pain?
• What causes abdominal pain in pregnancy?
• When is abdominal pain a worry in the first trimester?
• When is abdominal pain a worry in the second trimester?
• When is abdominal pain a worry in the third trimester?

Is it normal to feel abdominal pain in pregnancy?

Pains, aches and cramps in your belly are common (BMJ 2018, Kilpatrick 2020). Most mums-to-be have them at some point in their pregnancy. They’re usually nothing to worry about, if all is otherwise well.

Carrying a baby puts a lot of pressure on your muscles, joints and veins. This can make your belly feel uncomfortable at times.

Throughout your pregnancy, the tough tissues (ligaments) that connect your womb (uterus) to your pelvis stretch and lengthen (Aguilera nd, Chaudhry and Chaudhry 2020). Pressure on the nerves around your ligaments and womb can cause you to feel pain or discomfort (Aguilera nd, Chaudhry and Chaudhry 2020).

As your baby grows, your womb tends to tilt to the right. The ligament that supports that side of your womb may spasm or contract. So you may feel a cramping pain more often on your right side (Aguilera nd, Kilpatrick 2020).

How can I ease pregnancy abdominal pain?

Resting usually eases cramping or ligament pain, so if you can, sit down and relax for a while.

These tips may also help to prevent, or ease, ligament pain:

• Lie down on the side opposite to the pain (Aguilera nd).
• Have a warm bath (Aguilera nd).
• Use a hot water bottle or wheat bag on the painful areas (Aguilera nd, Chaudhry and Chaudhry 2020).
• Get in the habit of standing up and sitting down more gradually, avoiding sudden movements (Aguilera nd, Chaudhry and Chaudhry 2020). This may help to decrease the spasms.
• Avoid activities that you notice trigger ligament pain (Chaudhry and Chaudhry 2020).
• Standing for too long or lifting heavy objects can make the pain worse, so avoid these if you can (Chaudhry and Chaudhry 2020).

Doing gentle stretching exercises, such as yoga, may help (Chaudhry and Chaudhry 2020). Yoga is suitable once you're through the first trimester (BWY 2016, Cameron and Millar 2014 ). Ask your midwife about antenatal exercise classes in your area.

Sometimes, having sex and reaching orgasm can give you cramps and a slight backache. An orgasm sends pulsations rippling through your vagina and womb, which can feel more like cramping when you’re pregnant (NHS 2018a).

In the third trimester, an orgasm or sex can also set off practice contractions, known as Braxton Hicks contractions (NHS 2018a). But don’t worry, having an orgasm won't trigger labour (NHS 2018a), even if you’re full-term (Carbone et al 2019).

Braxton Hicks make the muscles of your womb go hard as they contract. If it feels uncomfortable, lie still until the contractions pass or try relaxation techniques. A gentle back massage after sex may help (Raines and Cooper 2020).

Braxton Hicks contractions

It may be difficult to distinguish between Braxton Hicks and the real deal, so watch our video to learn the major differences between the two.More pregnancy videos

What causes abdominal pain in pregnancy?

There are many possible causes of abdominal pain. Sometimes, it can be hard for your midwife or doctor to work out if your pain is serious or normal.

Your doctor will want to know exactly how the pain feels, so keep a note of what time of day and what you were doing when it started, how long it lasted and how intense it was (Taylor 2020). Was it a sharp and stabbing pain or more of a dull ache? Did it come and go when you moved, or was it a constant pain?

Note down what you’re feeling so you can give your midwife or doctor a full run-down.

Don’t wait to get help if the pain doesn’t go away after several minutes of rest, or if you feel cramping along with:

• blood in your wee, or pain or burning when you wee
• unusual vaginal discharge
• spotting or bleeding
• tenderness and pain
• vomiting
• fever
• chills
  (Kilpatrick 2020)

Sometimes, your abdominal pain could be a sign of something that’s not related to pregnancy. Appendicitis, an ovarian cyst, kidney problems, a urinary tract infection (UTI), or gall bladder problem can all cause abdominal pain (Kilpatrick 2020).

Your pregnancy may even have triggered a problem. Fibroids in your womb that didn’t bother you before you conceived may feel uncomfortable, or even painful, now that you’re pregnant (Kilpatrick 2020).

When is abdominal pain a worry in the first trimester?

Abdominal pain is usually nothing to worry about in early pregnancy. But if you’re having other symptoms, you need to seek help (Kilpatrick 2020, RCOG 2016a).

Early miscarriage

Miscarriages in early pregnancy are much more common than most people realise. Sadly, up to one in five pregnancies ends in early pregnancy, usually because the baby isn’t developing properly (RCOG 2016a).

Light bleeding is common, and often harmless, in early pregnancy but if it continues or gets heavier it’s more likely to be a miscarriage (NHS 2018b). You’ll probably also have stomach cramps, and discharge of fluid and tissue from your vagina (NHS 2018b). Call your doctor, midwife or hospital, and then lie down or sit with your feet up.

If you have bleeding and/or pain that you feel you cannot cope with, you can get medical help and advice from the accident and emergency department (A&E) of your nearest hospital (RCOG 2016a).

You may be able to go straight to an early pregnancy assessment unit (EPAU), or your midwife may refer you to one. Find out if there’s an EPAU in your area.

Ectopic pregnancy

An ectopic pregnancy develops outside the womb. Unfortunately, the pregnancy can’t be saved. It’s a serious condition, so you’ll need swift treatment.

Just over one per cent of pregnancies in the UK are ectopic (NHS 2018c, RCOG 2016b). Symptoms of an ectopic pregnancy are most likely to be experienced at around six weeks of pregnancy, but they can happen at any time in the first trimester (NHS 2018c).

An ectopic pregnancy can be very serious, so call your GP or call NHS 111 if you have these symptoms:

• pain in your lower abdomen, which may come on gradually or suddenly and be just on one side.
• vaginal bleeding or spotting that’s different to your normal period. It may be lighter, and brighter, or darker red than usual, or watery.
• an upset tummy, such as diarrhoea or pain when you poo.
  (RCOG 2016b)

Go to A&E immediately if you’re experiencing any of the following symptoms:

• A sharp, sudden intense pain in your tummy (NHS 2018c, RCOG 2016b).
• Feeling like you’re going to collapse (RCOG 2016b). You may feel sick, dizzy or faint and look pale (NHS 2018c).
• Shoulder-tip pain (where your shoulder ends and your arm begins) that is constant even when you move around and may be worse when you lie down (RCOG 2016b). This can be a sign of internal bleeding.

Ovarian hyperstimulation syndrome (OHSS)

If you had fertility treatment to get pregnant, especially IVF, there’s a chance your abdominal pain is caused by the fertility drugs over-stimulating your ovaries.

A third of women who’ve had IVF suffer mild discomfort from OHSS in the days after their egg collection (RCOG 2016c ). The discomfort can last a few weeks into the pregnancy (RCOG 2016c ). Call your fertility clinic if your pain isn’t getting better. Get urgent help if you start to vomit or have urinary problems or chest pain (RCOG 2016c).

When is abdominal pain a worry in the second trimester?

Abdominal pain on its own in the second trimester is probably nothing to worry about (Kilpatrick 2020).

There’s a very slight chance of it signalling a late miscarriage, but only if you have bleeding as well (Kilpatrick 2020). Late miscarriages are far less common than early miscarriages and happen between 12 weeks and 24 weeks of pregnancy (NHS 2018b, RCOG 2012).

The most common signs of late miscarriage are cramps and heavy bleeding (NHS 2018b). If you have these symptoms, go straight to your nearest A&E or maternity department.

If you have vaginal bleeding or unusual discharge during pregnancy, call your doctor or midwife for advice (NHS 2018b).

When is abdominal pain a worry in the third trimester?

Pain and discomfort may be caused by your baby changing position, your womb getting bigger as your baby grows, or Braxton Hicks starting (Kilpatrick 2020).

If you get a severe pain just below your ribs, call your midwife or GP straight away (Kilpatrick 2020, NHS 2018d). This could be a symptom of pre-eclampsia. If you have pre-eclampsia, you'll have other symptoms, including a severe headache, vision problems and sudden swelling of your hands, feet or face (NHS 2018d).

Abdominal pain in the third trimester may mean your body is getting ready for birth too soon. But going into premature labour doesn’t always mean that your baby is going to be born there and then. Sometimes, as long as your waters haven’t broken and you haven’t got any bleeding, it’s just a false alarm (Kilpatrick 2020).

Premature labour can happen any time between 24 weeks and 37 weeks of pregnancy. You’ll feel pain in your pelvic or lower tummy area from the contractions (NHS 2019). You may have a show, when the mucus plug that has sealed the entrance to your womb comes away (NHS 2019). You may also find that your waters break (NHS 2019).

Call your midwife or the maternity unit of your nearest hospital immediately if you think you’re in premature labour or your waters have broken early (NHS 2019, RCOG 2019).

Having cramps once you’re past 37 weeks may mean you’re in the early stages of labour (Kilpatrick 2020). At this stage your pregnancy has reached term, so the cramps are a normal part of your body gearing up to give birth.

Find out more about common pregnancy side effects:

• Morning sickness
• Constipation
• Tiredness

References

Aguilera PA. nd. Pregnancy, round ligament pain. emedicinehealth. www.emedicinehealth.com [Accessed July 2020]

BMJ. 2018. Assessment of abdominal pain in pregnancy. BMJ Best Practice. bestpractice.bmj.com [Accessed July 2020]

BWY. 2016. BWY guidelines for teaching yoga in pregnancy. British Wheel of Yoga. www.bwy.org.uk [Accessed July 2020]

Cameron J, Millar K. 2014. Guidelines for teaching yoga to pregnant women. Yoga Scotland. www.yogascotland.org.uk [Accessed July 2020]

Carbone L, De Vivo V, Saccone G, et al. 2019. Sexual Intercourse for Induction of Spontaneous Onset of Labor: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Sex Med 16:1787-95. www.iris.unina.it [Accessed July 2020]

Chaudhry SR, Chaudhry K. 2020. Anatomy, abdomen and pelvis, uterus round ligament. StatsPearls. www.ncbi.nlm.nih.gov [Accessed July 2020]

Kilpatrick CC. 2020. Approach to acute abdominal pain in pregnant and postpartum women. UpToDate www.uptodate.com [Accessed July 2020]

NHS. 2018a. Sex in pregnancy. NHS, Health A-Z, Pregnancy and baby. www.nhs.uk [Accessed July 2020]

NHS. 2018b. Miscarriage. NHS, Health A-Z, Pregnancy and baby. www.nhs.uk [Accessed July 2020]

NHS. 2018c. Ectopic pregnancy. NHS, Health A-Z, Pregnancy and baby. www.nhs.uk [Accessed July 2020]

NHS. 2018d. Pre-eclampsia - symptoms. NHS, Health A-Z, Pregnancy and baby. www.nhs.uk [Accessed July 2020]

NHS. 2019. Premature labour and birth. NHS, Health A-Z, Pregnancy and baby. www.nhs.uk [Accessed July 2020]

Raines A, Cooper DB. 2020. Braxton Hicks contractions. StatPearls. www.ncbi.nlm.nih.gov [Accessed July 2020]

RCOG. 2012.Information for you. Recurrent and late miscarriage:tests and treatment of couples. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk [Accessed July 2020]

RCOG. 2016a. Information for you: early miscarriage. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk [Accessed July 2020]

RCOG. 2016b.Information for you: Ectopic pregnancy. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk [Accessed July 2020]

RCOG. 2016c. Information for you: Ovarian hyperstimulation syndrome. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk [Accessed July 2020]

RCOG. 2019.Information for you: when your waters break early. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk [Accessed July 2020]

Taylor D. 2020. Acute abdomen and pregnancy. MedScape. emedicine.medscape.com [Accessed July 2020]

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