Baby bump begins to appear early in the second trimester (between 16 to 20 weeks). Around this time, round ligament pain in pregnancy presents as a short, sharp, stabbing, or long-lasting dull ache and stomach cramps in the lower abdomen, around the hips, or in the groin area (1) (2).
Round ligaments are present on both sides of the uterus and may resemble ropes. Each ligament is about 10 to 12 centimeters long, connecting the uterus to the pelvis and holding it in its place. Read this post to learn about the symptoms, treatment, and prevention of round ligament pain in pregnancy.
What Causes Round Ligament Pain During Pregnancy?
Round ligament pain is common and normal in pregnancy and usually begins at the end of the first trimester or early in the second trimester (3). However, it can also appear earlier or later in pregnancy. You may experience round ligament pain due to the following factors (4):
- Expansion and tightening of ligaments to accommodate and support the growing baby in the uterus (5)
- Round ligament spasms caused by normal movement and actions such as coughing, laughing, or sneezing, resulting in pain
- Fetal movement and painful Braxton Hick contractions (3)
- Stretching of the uterus caused by being physically active during pregnancy, such as by running or working in a physically demanding job
Although round ligament pain during pregnancy is mostly a benign condition, you may experience it due to the following underlying conditions (3):
- Ruptured ectopic pregnancy
- Placental abruption
- HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome
- Acute fatty liver of pregnancy
- Uterine rupture
What Are The Symptoms Of Round Ligament Pain During Pregnancy?
The symptoms of round ligament pain during pregnancy include (4)
- Intermittent abdominal pain that feels like a sharp, stabbing pain
- Pain that starts deep within the groin and moves vertically on either side to the top of the hips (5)
- Worsening of pain when sneezing, coughing, laughing, or doing other activities
- Worsening of abdominal or acute groin pain when quickly switching to a standing position (6)
When Should You Seek Medical Help?
- The pain lasts for more than a few seconds
- Persistent pain even after resting
- Stomach cramps or severe pain
- Painful/painless contractions (more than four in an hour)
- Lower back pain, especially if you haven’t had back pain before
- Increased pelvic pressure
- Altered vaginal discharge, bleeding, or spotting
- Fever or chills
- Faintness or nausea and vomiting
- Painful urination or burning while peeing
How Is Round Ligament Pain Diagnosed?
Round ligament pain is usually diagnosed based on your symptoms and a physical examination. Since the symptoms of many serious conditions resemble that of round ligament pain, a diagnosis of exclusion is followed (4).
If you’re experiencing bleeding or other symptoms, your doctor may order an imaging test, such as an ultrasound, to rule out other causes of pain (7). They may also run tests for any symptoms of preterm labor or other pregnancy complications (8).
How Is Round Ligament Pain Treated In Pregnancy?
- The over-the-counter drug Acetaminophen can offer symptomatic relief
- Alter or stop doing activities that cause pain (9). Once you’ve recovered, gradually resume your activities until you reach a comfortable level of exertion (5).
- Stay active and try moderate exercises (7)
- Complementary and alternative medicine (CAM) may help, including (4) (10)
- Prenatal yoga, water exercises (such as swimming), and reflexology
- Acupuncture and craniosacral therapy
- Support garments (elastic belly band) for the uterus
- Osteopathic manipulative treatment
- Prenatal massage therapy with essential oils such as camphor and eucalyptol
However, ask your health care provider before using any medicines or essential oils or doing any therapies. Further, consult professionals who have experience working with pregnant women.
How To Ease Round Ligament Pain During Pregnancy?
During an episode of round ligament pain, try the following methods to help relieve discomfort (5):
- Rest comfortably but avoid lying flat on your back (9)
- Flex your knees toward your abdomen
- Lie down on your side with one pillow under your belly for support and the other between your legs (Sim’s position)
- Take a warm bath
- Apply a heating pad on a low setting
Which Exercises Can Help Alleviate Round Ligament Pain?
Regular exercise during pregnancy has been shown to improve posture and provide relief from joint and spinal pain. However, consult your doctor before starting any exercises because strenuous activities may be harmful if you have any underlying medical conditions. Some exercises that can help reduce pelvic pain are (11) (12)
- Pelvic tilt supine exercise: Lie supine on the ground (with your back and feet flat on the floor and knees bent). Extend your arms alongside your torso, palms facing down. Your neck should be aligned with your spine, and the back of your head should be in contact with the mat. Next, shift the pelvis posteriorly by gently tightening the glutes and belly muscles. Hold this position for six seconds and repeat.
- Pelvic tilt standing exercise: The steps are the same as for the supine pelvic exercise, but it requires tilting your pelvis forward and backward while standing (10).
- Cat-cow pose sequence: Get down on all fours (quadruped position) on the floor and arch and relax the back in a rhythmic pattern. Inhale while arching the pelvis and exhale when releasing it to the mat or floor (10).
How To Prevent Round Ligament Pain During Pregnancy?
- Avoid lifting heavy things
- Avoid standing for a long time
- Change positions slowly, such as when you stand up, turn, or bend
- Lean forward and flex your hips when you sneeze, cough, or laugh
- Do gentle stretches and flex your hips throughout the day.
Frequently Asked Questions
1. How is round ligament pain different from abdominal pain during pregnancy?
Abdominal pain during pregnancy can be caused by various factors, including acid reflux and intra-abdominal conditions. Round ligament pain is a type of abdominal pain in pregnancy. It is an obstetric condition caused by the physiological changes in your body (3).
2. Can round ligament pain have adverse effects on the fetus?
Sudden movements such as coughing can cause short episodes of round ligament pain that last for a few seconds, but they do not harm the baby (2).
3. Is a maternity belt effective for relieving round ligament pain?
During pregnancy, a maternity belt or belly band can help ease back, joint, and ligament pain. It assists in distributing your baby’s weight in your uterus so that your ligaments aren’t directly strained (13).
Round ligament pain in pregnancy is mainly caused by womb expansion and may increase during sudden changes in positions or movements. Pelvic tilt exercises, yoga, acupuncture, warm baths, and heating pads can alleviate the symptoms of round ligament pain. However, consult your doctor if you experience persistent or severe pain.
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- Do I Need a Pregnancy Belly Band?