‘Physiological’ pain in pregnancy
Are all types of abdominal pain in pregnancy something to worry about?
Not really. A majority of cases of mild and moderate abdominal pain in pregnancy are described as "physiological". This means that they are a result of the changes brought about by the growing pregnancy. The expectant mother needs to give her doctor a good and precise history and description of the pain. The doctor will then distinguish between physiological pain and pain resulting from an underlying disease requiring specific action.
What are the common causes of the so-called physiological pain?
This diagnosis should be made by exclusion.
It is important that conditions such as urinary tract infection, kidney stone, appendicitis or pregnancy complications (such as placental abruption) are excluded. Once this is established, then the pain may be caused by:
Stretching of ligaments
Braxton Hicks contractions
Mild torsion of the uterus.
We shall expand on these below.
How will the expectant mother know whether the pain is only physiological, or whether there is an underlying condition?
A mother should never try to make a diagnosis herself. If she has any pain, it is imperative that she consults her doctor to verify the symptoms. It could be dangerous to ignore any symptoms, however mild they may seem to her.
What is this ‘ligament stretching’ business?
On the front of the womb there are two ligaments, one on either side. These are called ‘round ligaments’ and they run from near the fundus of the womb to the pelvic wall. As the womb grows, the ligaments inevitably stretch. In some people, this stretching is believed to cause considerable pain, although there is no cast-iron evidence of this being a cause of pain.
Strong subjective evidence exists to show that up to a third of all pregnancies may be affected by ligament stretching to varying degrees. For most, it appears to be only a mild discomfort over the lower abdomen, usually midway through the pregnancy.
Are Braxton-Hicks contractions supposed to be painful?
In most cases they are not, but there is a substantial proportion of women who find them uncomfortable, even painful. They are very rarely perceptible before 28 weeks of gestation. Any painful contractions, however remote from term, should be taken seriously, as these might be a sign of preterm labour. A vaginal examination is frequently required to rule out labour.
What about heartburn and constipation?
Both heartburn and constipation are common in pregnancy. Most people will have no trouble in recognizing heartburn, by virtue of its symptoms and location (in the upper part of the abdomen). In very late pregnancy, near term, this may not be straightforward and, if in doubt, an examination will distinguish uterine fundal pain from heartburn.
Pain resulting from constipation is usually colicky and confined to the left side on the lower part of the abdomen. Again, it may be wise to have an examination to establish or confirm whether the pain is indeed of bowel origin and due to constipation. Constipation is easily relieved but is notorious for recurring again and again in pregnancy.