Abdominal/uterine cramping

This is a common cause of concern for pregnant women, and it can range from mild to severe.  Cramping can indicate a problem or be just another sign of a normal growing, stretching uterus.  So the questions often arise: What is normal? When should I be concerned?  The following are some of the causes of abdominal cramping during pregnancy:

Early Pregnancy: 

  • Implantation Cramping: This usually occurs 8-10 days after ovulation as a result of the fertilised egg travelling and burrowing into the lining of the uterus.  Some women describe it as if their period is about to start (in fact, sometimes implantation of the egg can cause slight bleeding or “spotting” – of a brownish or pinkish looking discharge).
  • Stretching Uterus:  As a woman’s body prepares for the pregnancy her uterus will stretch and expand along with the supporting ligaments, causing period-type cramping.  Some women also describe a sensation of feeling “full/heavy” in their pelvic area.
  • Constipation:  Pregnancy hormones have a relaxing effect on the gut, which slows down the movement of digested food through the body.  This can cause sluggish bowels and constipation with associated discomfort and cramping.  Increasing fluid intake and roughage in the diet can help alleviate this common problem.
  • Miscarriage:  Abdominal cramping in early pregnancy, particularly associated with pain and bleeding/spotting is a warning sign of a possible miscarriage.  If this is the suspected cause then the woman should contact her midwife, early pregnancy unit (EPU), GP or if the bleeding is particularly heavy (soaking a sanitary towel in less than an hour) she should attend A&E for immediate assessment.
  • Ectopic pregnancy: Ectopic pregnancy is a serious condition which requires immediate medical attention.  The fertilised egg implants in the fallopian tube which causes severe pain (particularly on one side) as the growing embryo stretches the tissue.  Watery blood loss from the vagina can accompany the pain.

Second Trimester Onwards:

  • Round Ligament Pain:  A non-pregnant uterus is normally the size of a pear, suspended in place by thick elastic ligaments.  When the uterus increases in size to accommodate the growing baby these ligaments become long and thin, stressing and tensing like rubber bands.  These ligaments pull and tug on nearby nerve fibres, causing sharp and sudden spasm/pain which can be severe at times.  This can cause worry to many pregnant women although it is normal.  These involuntary cramps are experienced more frequently on the right side, as the pregnant uterus tends to lean to this side. The cramps are usually brought on with sudden movement such as rising from a bed, chair or bath, or stretching suddenly.  Women might wake at night with sudden pain after rolling over in their sleep.
  • Braxton Hicks Contractions: These are irregular intermittent contractions that occur throughout pregnancy, usually from around 20 weeks’ gestation.  Usually painless, they are described as a tightening feeling and hardening of the abdomen. Women pregnant with subsequent babies may experience more frequent and stronger Braxton Hicks contractions. Some women experience Braxton Hicks contractions as mild period-type pains.  Although they are generally more of a nuisance to most women, sometimes they can be quite strong and cause actual pain.  The difference between Braxton Hicks and the onset of true labour contractions is that Braxton Hicks contractions do not cause the cervix to dilate.  Real labour contractions become stronger and more frequent and don’t tend to ease when resting or changing position.
  • Pre-Term Labour: Cramping (both mild and severe), lower backache and diarrhoea can be a sign of pre-term labour.

Other Causes of Cramping/Abdominal Pain in Pregnancy:

  • Urinary Tract Infection (UTI): If left untreated in pregnancy UTI’s can lead to the onset of pre-term labour as the irritable bladder can cause the smooth muscle of the uterus to also become irritable, triggering contractions.  If a pregnant woman suspects a UTI (discomfort passing urine, going to the toilet more frequently than usual, dark, smelly urine, feeling unwell, backache, abdominal pain, fever) she should inform her midwife or GP immediately.  Antibiotics will be prescribed to treat the infection.
  • Appendicitis: An inflammation of the appendix may be the cause of abdominal pain.  The symptoms include poor appetite, nausea, vomiting, fever and worsening pain.  As the pregnancy advances the pain from appendicitis will be felt in the upper abdomen instead of the lower abdomen as the growing uterus displaces abdominal organs.
  • Pain in Ovaries/Ovarian Cyst:  As the uterus grows an ovary may twist or an existing cyst may rupture, causing sudden severe abdominal pain.

If any of the above conditions are suspected or abdominal discomfort is causing concern medical help should be sought immediately!