Pelvic Pain During Early Pregnancy
Early in pregnancy, many women have pelvic pain.
Pelvic pain refers to pain in the lowest part of the torso, in the area below the abdomen and between the hipbones (pelvis). The pain may be sharp or crampy (like menstrual cramps) and may come and go.
It may be sudden and excruciating, dull and constant, or some combination. Usually, temporary pelvic pain is not a cause for concern. It can occur normally as the bones and ligaments shift and stretch to accommodate the fetus.
Pelvic pain differs from abdominal pain, which occurs higher in the torso, in the area of the stomach and intestine. However, sometimes women have trouble discerning whether pain is mainly in the abdomen or pelvis. Causes of abdominal pain during pregnancy are usually not related to the pregnancy.
Causes
During early pregnancy, pelvic pain may result from disorders that are related to
The pregnancy (obstetric disorders)
The female reproductive system (gynecologic disorders) but not the pregnancy
Other organs, particularly the digestive tract and urinary tract
Sometimes no particular disorder is identified.
The most common obstetric causes during early pregnancy are
The normal changes of pregnancy
A miscarriage that has occurred or is occurring (spontaneous abortion)
A miscarriage that may occur (threatened abortion)
In a miscarriage that has occurred, all of the contents of the uterus (fetus and placenta) may be expelled (complete abortion) or not (incomplete abortion).
The most common serious obstetric cause is
Rupture of an abnormally located (ectopic) pregnancy—one that is not in its usual place in the uterus, for example, one that is in a fallopian tube
When an ectopic pregnancy ruptures, blood pressure may drop very low, the heart may race, and blood may not clot normally. Immediate surgery may be required.
Pelvic pain may also occur when an ovary twists around the ligaments and the tissues that support it, cutting off the ovary's blood supply. This disorder, called adnexal torsion, is not related to the pregnancy but is more common during pregnancy. During pregnancy, the ovaries enlarge, making an ovary more likely to twist.
Digestive and urinary tract disorders, which are common causes of pelvic pain in general, are also common causes during pregnancy. These disorders include
Gastroenteritis (infection of the digestive tract) due to a virus
Irritable bowel syndrome
Appendicitis
Inflammatory bowel disease
Urinary tract infections (UTIs)
Kidney stones
Pelvic pain during late pregnancy may result from labor or from a disorder unrelated to the pregnancy.
Risk factors
Various characteristics (risk factors) increase the risk of some obstetric disorders that cause pelvic pain.
For miscarriage, risk factors include
Age over 35
One or more miscarriages in previous pregnancies
Cigarette smoking
Use of drugs such as cocaine, consumption of alcohol, or consumption of a lot of caffeine
Abnormalities in the uterus, such as fibroids or scars, as may be caused by surgery, dilation and curettage (D and C), radiation therapy, or infections
For ectopic pregnancy, risk factors include
A previous ectopic pregnancy (the most important risk factor)
Previous abdominal surgery, especially surgery to sterilize the woman (tubal ligation)
A previous infection with a sexually transmitted disease or pelvic inflammatory disease
Cigarette smoking
Use of an intrauterine device (IUD)
Age over 35
A history of infertility, use of fertility drugs, or use of assisted reproductive techniques
Several sex partners
An abortion in a previous pregnancy
Douching
Evaluation
If a pregnant woman has sudden, very severe pain in the lower abdomen or pelvis, doctors must quickly try to determine whether prompt surgery is required—as is the case when the cause is an ectopic pregnancy or appendicitis.
Warning signs
In pregnant women with pelvic pain, the following symptoms are cause for concern:
Fainting, light-headedness, or a racing heart—symptoms that suggest very low blood pressure
Fever, particularly if accompanied by a vaginal discharge that contains pus
Vaginal bleeding
Pain that is severe and is made worse with movement
When to see a doctor
Women with warning signs should see a doctor immediately. Women without warning signs should try to see a doctor within a day or so if they have pain or burning during urination or pain that interferes with daily activities. Women with only mild discomfort and no other symptoms should call the doctor. The doctor can help them decide whether and how quickly they need to be seen.
What the doctor does
To determine whether emergency surgery is needed, doctors first check blood pressure and temperature and ask about key symptoms, such as vaginal bleeding. Doctors then ask about other symptoms and the medical history. They also do a physical examination. What they find during the history and physical examination often suggests a cause and the tests that may need to be done (see Table).
Doctors ask about the pain:
Whether it begins suddenly or gradually
Whether it occurs in a specific spot or is more widespread
Whether moving or changing positions worsens the pain
Whether it is crampy and whether it is constant or comes and goes
Doctors also ask about other symptoms, such as vaginal bleeding, a vaginal discharge, a need to urinate often or urgently, vomiting, diarrhea, and constipation. They ask particularly about previous pregnancy-related events (obstetric history), including past pregnancies, miscarriages, and intentional terminations of pregnancy (induced abortions) for medical or other reasons, as well as risk factors for miscarriage and ectopic pregnancy.
Testing
Doctors use a handheld Doppler ultrasound device, placed on the woman's abdomen, to check for a heartbeat in the fetus.
A pregnancy test using a urine sample is almost always done. If the pregnancy test is positive, ultrasonography of the pelvis is done to confirm that the pregnancy is normally located―in the uterus―rather than somewhere else (an ectopic pregnancy). For this test, a handheld ultrasound device is placed on the abdomen, inside the vagina, or both.
Blood tests are usually done.
If a woman has vaginal bleeding, testing usually includes a complete blood cell count and blood type plus Rh status (positive or negative—see Rh Incompatibility), in case the woman needs a transfusion. Knowing Rh status also helps doctors prevent problems in subsequent pregnancies. If doctors suspect an ectopic pregnancy, testing also includes a blood test to measure a hormone produced by the placenta early during pregnancy (human chorionic gonadotropin, or hCG). If symptoms (such as very low blood pressure or a racing heart) suggest that an ectopic pregnancy may have ruptured, blood tests are done to determine whether the woman's blood can clot normally.
Other tests are done depending on which disorders are suspected. Doppler ultrasonography, which shows the direction and speed of blood flow, helps doctors identify a twisted ovary, which can cut off the ovary’s blood supply. Other tests can include cultures of blood, urine, or a discharge from the vagina and urine tests (urinalysis) to check for infections.
If pain is persistently troublesome and the cause remains unknown, doctors make a small incision just below the navel and insert a viewing tube (laparoscope) to directly view the uterus and thus identify the cause of the pain. Rarely, a larger incision (a procedure called laparotomy) is required.
Treatment
Specific disorders are treated. If pain relievers are needed, acetaminophen is the safest one for pregnant women, but if it is ineffective, an opioid may be necessary.
Pain due to normal changes during pregnancy
Women may be advised to
Limit how much they move, but move often.
Avoid heavy lifting or pushing.
Maintain good posture.
Sleep with a pillow between their knees.
Rest as much as possible with their back well-supported.
Apply heat to painful areas.
Do Kegel exercises (squeezing and releasing the muscles around the vagina, urethra, and rectum).
Use a maternity support belt.
Possibly try acupuncture.
Early in pregnancy, many women have pelvic pain.
Pelvic pain refers to pain in the lowest part of the torso, in the area below the abdomen and between the hipbones (pelvis). The pain may be sharp or crampy (like menstrual cramps) and may come and go.
It may be sudden and excruciating, dull and constant, or some combination. Usually, temporary pelvic pain is not a cause for concern. It can occur normally as the bones and ligaments shift and stretch to accommodate the fetus.
Pelvic pain differs from abdominal pain, which occurs higher in the torso, in the area of the stomach and intestine. However, sometimes women have trouble discerning whether pain is mainly in the abdomen or pelvis. Causes of abdominal pain during pregnancy are usually not related to the pregnancy.
Causes
During early pregnancy, pelvic pain may result from disorders that are related to
The pregnancy (obstetric disorders)
The female reproductive system (gynecologic disorders) but not the pregnancy
Other organs, particularly the digestive tract and urinary tract
Sometimes no particular disorder is identified.
The most common obstetric causes during early pregnancy are
The normal changes of pregnancy
A miscarriage that has occurred or is occurring (spontaneous abortion)
A miscarriage that may occur (threatened abortion)
In a miscarriage that has occurred, all of the contents of the uterus (fetus and placenta) may be expelled (complete abortion) or not (incomplete abortion).
The most common serious obstetric cause is
Rupture of an abnormally located (ectopic) pregnancy—one that is not in its usual place in the uterus, for example, one that is in a fallopian tube
When an ectopic pregnancy ruptures, blood pressure may drop very low, the heart may race, and blood may not clot normally. Immediate surgery may be required.
Pelvic pain may also occur when an ovary twists around the ligaments and the tissues that support it, cutting off the ovary's blood supply. This disorder, called adnexal torsion, is not related to the pregnancy but is more common during pregnancy. During pregnancy, the ovaries enlarge, making an ovary more likely to twist.
Digestive and urinary tract disorders, which are common causes of pelvic pain in general, are also common causes during pregnancy. These disorders include
Gastroenteritis (infection of the digestive tract) due to a virus
Irritable bowel syndrome
Appendicitis
Inflammatory bowel disease
Urinary tract infections (UTIs)
Kidney stones
Pelvic pain during late pregnancy may result from labor or from a disorder unrelated to the pregnancy.
Risk factors
Various characteristics (risk factors) increase the risk of some obstetric disorders that cause pelvic pain.
For miscarriage, risk factors include
Age over 35
One or more miscarriages in previous pregnancies
Cigarette smoking
Use of drugs such as cocaine, consumption of alcohol, or consumption of a lot of caffeine
Abnormalities in the uterus, such as fibroids or scars, as may be caused by surgery, dilation and curettage (D and C), radiation therapy, or infections
For ectopic pregnancy, risk factors include
A previous ectopic pregnancy (the most important risk factor)
Previous abdominal surgery, especially surgery to sterilize the woman (tubal ligation)
A previous infection with a sexually transmitted disease or pelvic inflammatory disease
Cigarette smoking
Use of an intrauterine device (IUD)
Age over 35
A history of infertility, use of fertility drugs, or use of assisted reproductive techniques
Several sex partners
An abortion in a previous pregnancy
Douching
Evaluation
If a pregnant woman has sudden, very severe pain in the lower abdomen or pelvis, doctors must quickly try to determine whether prompt surgery is required—as is the case when the cause is an ectopic pregnancy or appendicitis.
Warning signs
In pregnant women with pelvic pain, the following symptoms are cause for concern:
Fainting, light-headedness, or a racing heart—symptoms that suggest very low blood pressure
Fever, particularly if accompanied by a vaginal discharge that contains pus
Vaginal bleeding
Pain that is severe and is made worse with movement
When to see a doctor
Women with warning signs should see a doctor immediately. Women without warning signs should try to see a doctor within a day or so if they have pain or burning during urination or pain that interferes with daily activities. Women with only mild discomfort and no other symptoms should call the doctor. The doctor can help them decide whether and how quickly they need to be seen.
What the doctor does
To determine whether emergency surgery is needed, doctors first check blood pressure and temperature and ask about key symptoms, such as vaginal bleeding. Doctors then ask about other symptoms and the medical history. They also do a physical examination. What they find during the history and physical examination often suggests a cause and the tests that may need to be done (see Table).
Doctors ask about the pain:
Whether it begins suddenly or gradually
Whether it occurs in a specific spot or is more widespread
Whether moving or changing positions worsens the pain
Whether it is crampy and whether it is constant or comes and goes
Doctors also ask about other symptoms, such as vaginal bleeding, a vaginal discharge, a need to urinate often or urgently, vomiting, diarrhea, and constipation. They ask particularly about previous pregnancy-related events (obstetric history), including past pregnancies, miscarriages, and intentional terminations of pregnancy (induced abortions) for medical or other reasons, as well as risk factors for miscarriage and ectopic pregnancy.
Testing
Doctors use a handheld Doppler ultrasound device, placed on the woman's abdomen, to check for a heartbeat in the fetus.
A pregnancy test using a urine sample is almost always done. If the pregnancy test is positive, ultrasonography of the pelvis is done to confirm that the pregnancy is normally located―in the uterus―rather than somewhere else (an ectopic pregnancy). For this test, a handheld ultrasound device is placed on the abdomen, inside the vagina, or both.
Blood tests are usually done.
If a woman has vaginal bleeding, testing usually includes a complete blood cell count and blood type plus Rh status (positive or negative—see Rh Incompatibility), in case the woman needs a transfusion. Knowing Rh status also helps doctors prevent problems in subsequent pregnancies. If doctors suspect an ectopic pregnancy, testing also includes a blood test to measure a hormone produced by the placenta early during pregnancy (human chorionic gonadotropin, or hCG). If symptoms (such as very low blood pressure or a racing heart) suggest that an ectopic pregnancy may have ruptured, blood tests are done to determine whether the woman's blood can clot normally.
Other tests are done depending on which disorders are suspected. Doppler ultrasonography, which shows the direction and speed of blood flow, helps doctors identify a twisted ovary, which can cut off the ovary’s blood supply. Other tests can include cultures of blood, urine, or a discharge from the vagina and urine tests (urinalysis) to check for infections.
If pain is persistently troublesome and the cause remains unknown, doctors make a small incision just below the navel and insert a viewing tube (laparoscope) to directly view the uterus and thus identify the cause of the pain. Rarely, a larger incision (a procedure called laparotomy) is required.
Treatment
Specific disorders are treated. If pain relievers are needed, acetaminophen is the safest one for pregnant women, but if it is ineffective, an opioid may be necessary.
Pain due to normal changes during pregnancy
Women may be advised to
Limit how much they move, but move often.
Avoid heavy lifting or pushing.
Maintain good posture.
Sleep with a pillow between their knees.
Rest as much as possible with their back well-supported.
Apply heat to painful areas.
Do Kegel exercises (squeezing and releasing the muscles around the vagina, urethra, and rectum).
Use a maternity support belt.
Possibly try acupuncture.
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