For many women, the physiological changes that occur during pregnancy can be accompanied by physical discomfort and even intense pain. Sometimes we have a good explanation for the symptoms and sometimes we don’t. Here’s a guide to the most common aches and pains, and when you should call your doctor.
First-Trimester Cramping
During the first few weeks of pregnancy, many women experience diffuse cramping that feels like the beginning of a menstrual period. There is no need to be concerned about this discomfort or to call your doctor unless there is bleeding associated with it or unless the pain is sharp and persistent on one side or the other. This normal cramping is likely a result of early growth of the uterus. Even spotting and one-sided pain can result from normal physiological changes, but could also be signs of an ectopic or tubal pregnancy. If you have a positive pregnancy test and are having pain on one side or the other, especially accompanied by any bleeding, you should call your doctor.
Second-Trimester Ligament Pain
During the second trimester, pain on one or both sides of the lower abdomen that radiates to the groin likely results from the stretching of ligaments that support the uterus in the pelvis. Stretching of these round ligaments, especially when caused by such sudden movements as a cough or a sneeze, can be quite intense. Getting up quickly or turning over in bed can also stretch these ligaments and cause pain. Keeping your core abdominal muscles strong and avoiding sudden movements will help minimize discomfort from round ligament pain. Pain on the right side associated with such symptoms as nausea, vomiting or fever could be appendicitis and should be reported to your doctor.
Third-Trimester Nerve Pain
The compression of nerves can cause several types of pain during pregnancy.
Carpal tunnel syndrome, the result of the swelling of tissues around the nerves that enter the hand, can cause numbness and tingling in one or both hands, especially in the morning. This symptom usually persists throughout pregnancy, and it takes some time for the symptoms to resolve after delivery. It may help to wear a wrist brace to keep the wrist in a neutral postion and minimize pressure on the nerves.
Sciatica, pain that radiates from the buttocks down the back of the leg, is another common pain caused by nerve compression during pregnancy. It is most common toward the end of pregnancy and can be intermittent. It is thought to be caused by the baby’s head pressing on nerves in this area. This pain can be debilitating and, in severe cases, can cause a loss of mobility. There are a number of stretches that can be helpful and, for many women, physical therapy is very useful.
Another common third-trimester nerve pain occurs on the abdominal wall, usually in the right or left upper parts of the abdomen just below the ribs, and feels like burning or pin pricks. This pain usually results from the growing uterus compressing the nerves to the skin. Some positions make it better and some make it worse, but, unfortunately, nothing can be done about it. Pain occurring in the upper abdomen, either in the middle or on the right, that feels deeper and more severe could indicate a problem with your liver or gallbladder and should be reported to your doctor.
Some women also experience the same tingling or burning pain in a small patch of skin on the front or inner upper thigh. This occurs from compression of a cutaneous nerve, and it usually only happens on one side. While it’s not dangerous, it can be very bothersome. Although there’s no way to fix it, you can find positions that ease the discomfort.
Heartburn
Most everyone knows that heartburn has nothing to do with your heart. Many men and non-pregnant women suffer from heartburn, which is really stomach acid coming up into the lower esophagus, or reflux.
The hormones of pregnancy make the muscle or sphincter between the stomach and the esophagus loose, allowing acid to reflux into the lower esophagus more easily. As pregnancy progresses, pressure from the uterus on the stomach exacerbates this problem. In addition to pain, some women have vomiting associated with reflux that can be confused with a return of morning sickness.
It may help to not lie completely flat at night and to prop up the head of the bed. Using an antacid like Tums may be all you need to combat heartburn, and Tums provides calcium, which is important in pregnancy. Sometimes, an antacid like liquid Gaviscon works better because it floats on top of stomach contents to bathe the lower esophagus. When these measures don’t work, using something like Pepcid or Zantac can be helpful because they decrease acid production in the stomach. Constant pain in the upper abdomen below the sternum or on the right side that does not improve with antacids can be a sign of serious liver problems in the third trimester and you should be seen by your doctor.
