Lower Abdominal Pain in Pregnancy: What Is Normal and What Is Not

A sharp pull in your side when you stand up too quickly, a cramp that feels like a period, a bump that tightens at the end of the day. Lower abdominal pain in pregnancy is common, and most of it is nothing to worry about: the womb is growing, the ligaments are stretching, digestion is slowing down.

But the belly is also where the complications you must not miss make themselves felt. The idea is not to watch every sensation anxiously, but to know the few signs that should make you pick up the phone. Here are the landmarks, trimester by trimester.

Why does your lower belly hurt when you are pregnant?

Because everything is shifting. The womb takes up more room and presses on the bladder and the bowel. Under the effect of hormones, the ligaments, especially those of the pelvis, gradually loosen. Quebec's INSPQ notes that this loosening can cause pain, during physical activity and even at rest.

The UK's NHS lists among the usually harmless causes:

• ligament pain, often a sharp cramp on one side of the lower belly;
• constipation, very common in pregnancy;
• wind.

Its rule of thumb is simple: mild pain that goes away when you change position, rest, open your bowels or pass wind is probably not a cause for concern.

Common pains, trimester by trimester

Ligament pain

It often comes with a change of position: getting up suddenly, turning over in bed, coughing or sneezing. The pain is sharp, on one side or both, and passes within moments or with rest. To avoid it, get up by rolling onto your side first, move more slowly, and hold a hand under your bump when you cough.

Constipation and wind

Hormones slow the gut down, and iron tablets do not help. Santé publique France advises against taking a laxative without medical advice; our practical tips (fibre, water, walking) are gathered in the article on the minor discomforts of pregnancy.

Braxton Hicks contractions

These are practice contractions: the bump tightens, then relaxes. According to Naître et grandir, they can occur throughout pregnancy but are more frequent in the third trimester. They are uncomfortable rather than painful, and irregular. A full bladder, physical activity, sex or not drinking enough can trigger them. Rest, a big glass of water, a change of position or a warm bath calm them down.

Pubic and pelvic pain

In late pregnancy, pain over the pubic bone that gets worse when walking or turning over in bed suggests pelvic girdle pain. The NHS says it affects up to one pregnant woman in five. A physiotherapist trained in pregnancy care can relieve it: our article on back pain during pregnancy details the useful movements.

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Practice contractions or the real thing?

The difference lies in regularity. Naître et grandir sums it up like this:

• Braxton Hicks contractions stay irregular, do not get stronger or closer together, and ease with rest or a drink;
• real contractions are regular, last at least 30 seconds, become more intense, longer and closer together, and are often felt in the lower belly and lower back.

Before 37 weeks, regular cramps or tightenings of the bump mean you should call the maternity unit immediately, the NHS insists. The INSPQ advises getting checked if contractions are regular or number more than seven a day, especially with heavier discharge. The tests and rest that may be offered are explained in our article on threatened preterm labour.

At term, the NHS advises calling the maternity unit when contractions come every 5 minutes or more often.

Pains that should never wait

Some lower abdominal pains signal a complication. The NHS describes several:

• Ectopic pregnancy, when the embryo implants outside the womb, most often in a fallopian tube. Symptoms usually appear between 4 and 12 weeks: tummy pain, often on one side, bleeding, pain at the tip of the shoulder, discomfort when peeing or opening your bowels. It is an emergency: everything is explained in our article on ectopic pregnancy.
• Miscarriage or threatened miscarriage, with cramps and bleeding before 24 weeks. See our article on bleeding during pregnancy.
• Placental abruption, in the second half of pregnancy: bleeding with pain that is constant, or that comes and goes like a contraction.
• Pre-eclampsia, after 20 weeks: pain higher up, under the ribs on the right, with headaches, vision problems or sudden swelling.
• Urinary tract infection, common in pregnancy: lower abdominal pain, sometimes burning when peeing, cloudy or discoloured urine. It is easy to treat, but should not be left to drag on.

What relieves harmless pain

When the cause has been identified and is not serious, a few simple steps are often enough:

• stop and lie down on your side for a while;
• drink a big glass of water and empty your bladder;
• have a warm bath or shower, not a hot one, which relaxes the belly;
• change position slowly, rolling onto your side;
• tackle constipation day to day.

No painkiller should be taken without advice: the dose is set by the doctor or pharmacist, and a medicine can mask an important sign. And if something feels different from usual, even if you cannot explain it, call: maternity teams would rather check for nothing than see a complication arrive too late.