Pelvic Pain During Pregnancy: Causes, Diagnosis, and Treatment

Pelvic pain during pregnancy can be a normal part of adjusting to physical changes in the abdomen and pelvis, or even Braxton Hicks contractions. But since it can also be a sign of an ovarian cyst, infection, or early labor, you should always tell your healthcare provider about it.

About 41% to 78% of pregnant people experience pelvic pain. The suspected causes of pelvic pain during pregnancy can be different depending on how far along you are.

This article discusses the causes of pelvic pain during pregnancy. You'll also learn why it's important to talk to your provider if you have pelvic pain while you're pregnant.

Diastasis Recti

During pregnancy, you might see a bulge in the middle of your abdomen. The two sides of your rectus abdominus—the muscles that run from the top to the bottom of your abdomen—can stretch apart and separate during pregnancy, causing diastasis recti (DR).

The separation of your abdominal muscles can cause weakness. You might have trouble lifting heavy objects. DR is common, beginning in the late second and third trimester, and can continue after pregnancy.

Other Symptoms To Look For

Although diastasis recti isn’t dangerous, it can cause complications.

You may need medical treatment for effects such as:

• Loss of bladder or bowel control
• Weakness or pain that interferes with your daily life

If you experience back pain or extreme weakness, you should speak to your healthcare provider.

Braxton Hicks Contractions

Braxton Hicks contractions are also called false labor pains because they feel like real contractions, but you are not actually in labor.

Braxton Hicks contractions can occur as early as six weeks of pregnancy, but you usually won’t feel them that early. You might begin to feel false labor pains around your second or third trimester—which could be frightening if you are several weeks away from your due date.

Braxton Hicks contractions are common and thought to help your body prepare for real labor. What you are feeling is the muscle fibers of your uterus tightening and relaxing.

Differences between real labor contractions and Braxton Hicks include timing and regularity.

• Braxton Hicks contractions often occur after being very active, having sex, if you are dehydrated, or if your bladder is full.
• Real labor contractions start and continue at regular intervals, getting stronger and more painful as they go on.
• Braxton Hicks come and go at irregular intervals and typically are less painful. 

Real labor contractions will lead to the delivery of the baby, while Braxton Hicks contractions will not.

You should talk to your healthcare provider if you are experiencing contractions and are not sure if they are Braxton Hicks contractions.

Braxton Hicks vs Preterm Labor
	Braxton Hicks	Preterm Labor
Frequency	irregular	regular, closer together over time
Duration	unpredictable (30 seconds to 2 minutes)	30 to 90 seconds, longer over time
Intensity	weak, getting weaker, then disappearing	stronger over time

Other Symptoms To Look For

If your contractions are regular, becoming increasingly painful, or don’t stop, you could be in labor.

Seek medical attention if you experience any of the following along with your contractions:

• Spotting or bleeding
• Leaking fluid
• Discharge that isn’t normal, such as bloody or watery
• Feeling crampy or pressure in your abdomen
• Have a dull backache that won’t go away

These symptoms could mean you are in labor. If you are not yet 37 weeks pregnant, you could be experiencing preterm labor and should see a healthcare provider as soon as possible. Don’t worry if it’s a false alarm; it’s always better to be sure, and practitioners see this all the time.

Vaginal Infection

Vaginal infections can occur during pregnancy because changing hormones—particularly, rising estrogen—disrupt the normal acid balance of your vagina. Two types of vaginal infection common during pregnancy are yeast and bacterial vaginosis.

Vaginal infections can cause itching, a burning sensation, redness, swelling, and pain around the vulva, which is right outside your vagina. Pain may occur during sex or when you urinate. You might see some spotting and changes to your discharge, such as abnormal color, smell, or amount. 

If your discharge is:

• Thin and milky, and you have no other symptoms, it’s likely an increase in discharge common in pregnancy.
• White, has lumps, and is thick, it could be yeast.
• Foul-smelling or greyish discharge might mean you have bacterial vaginosis.

Vaginal infections can happen at any time during pregnancy. Before taking any medications, even over-the-counter treatments, talk to your healthcare provider.

Other Symptoms to Look For

You should see your healthcare provider if you experience any of the following:

• Fever (temperature reaching 100.4 degrees Fahrenheit)
• Chills
• Pain in your pelvis

Ovarian Cysts

Ovarian cysts are small sacs filled with fluid that can grow on or inside your ovaries. Normally, two small oval-shaped ovaries are located in the lower abdomen. Each month, one of them will release an egg. The ovaries produce the hormones estrogen and progesterone, which are involved in pregnancy.

Ovarian cysts can occur at any time and often go unnoticed. During pregnancy, a cyst during the first trimester usually won't cause any symptoms. They usually go away after a while, on their own.

If a cyst ruptures or twists, it can cause pain, bloating, or swelling one side of your abdomen. The pain may come and go, feel dull, or can be sharp and stabbing.

If you feel any symptoms of a possible ovarian cyst during pregnancy you should see your healthcare provider. The symptoms could be a sign of a more dangerous situation, such as ectopic pregnancy, if it is in your first trimester.

Other Symptoms to Look For

Seek emergency care if you feel any symptoms of an ovarian cyst, especially:

• Sudden, intense pain
• Nausea or vomiting
• Vaginal bleeding
• Dull backache 
• Trouble fully emptying your bladder or bowels
• Feeling the need to pee more often
• Feeling faint or dizzy
• Fever (temperature reaching 100.4 degrees Fahrenheit)

Round Ligament Pain

Round ligament pain is common during pregnancy. The round ligaments look like ropes or cords that attach your uterus to your groin. These ligaments provide support to your uterus, and they might become painful during the second trimester when they soften and stretch as your belly grows.

If you are experiencing round ligament pain:

• It might feel like something is pulling inside of you
• It could be sharp and sudden
• Pain is felt on the right side of your abdomen, although it can happen on the left side or both sides
• Sudden movements, like rolling in bed, can trigger the pain

Often the pain will go away if you sit or lay down and rest. Try to avoid sudden movements if they precipitate your pain. Applying a warm compress may also help.

Other Symptoms to Look For

While round ligament pain is not dangerous, you should tell your healthcare provider about it.

See your healthcare provider if you experience any of the following:

• Pain when you pee
• Bleeding
• Nausea, bloating, or vomiting
• Fever (100.4 degrees F) or chills, which could mean you have an infection
• Intense pain
• Pain that spreads to your back
• Trouble walking

Sacroiliac Joint (SIJ) Pain

Sacroiliac joint (SIJ) pain is low back pain that sometimes radiates down your legs. Around your pelvis, at the base of your spine, the bones form your pelvic girdle. The two sacroiliac joints, located at the back of your body, help support the pelvic girdle. 

Pregnancy weight gain can add stress to your pelvic girdle bones and joints. Your joints may begin to bear the load unevenly, causing greater stress and friction on your SIJ. This type of SIJ pain typically starts in the late second or third trimester.

Another factor is hormone changes during pregnancy. The same hormone—relaxin—that helps your muscles relax and prepare for birth can weaken the ligaments needed for support, contributing to pain.

You may feel pain when climbing stairs, walking, rolling over in bed, balancing, or getting out of the bathtub. SIJ pain can be felt in your lower back, down your legs, or in your hips, and groin. This pain can feel sharp or dull and numbing, causing you to feel like your leg might buckle.

Other Symptoms to Look For

If your back pain is severe or won’t go away no matter what position you are in, you should talk to your healthcare provider.

Signs that need medical attention include:

• Vaginal bleeding
• Fever (temperature reaching 100.4 degrees Fahrenheit) 
• Burning pain when you pee

Symphysis Pubis Dysfunction (SPD)

Symphysis pubis dysfunction (SPD) is also called pelvic girdle pain because, like SIJ pain, SPD affects the pelvis—in this case, at the front. 

SPD causes are the same as with SIJ—namely relaxin and weight gain causing uneven pressure and friction on the pelvic girdle's bones and joints.

SPD pain feels like shooting pain in the front of your pelvis that may spread over your lower abdomen, back, groin, perineum, and thighs. You might hear or feel clicking, grinding, and snapping sensations. It might get worse when you are climbing stairs, getting in and out of bed or the bathtub, or bending over.

Other Symptoms to Look For

You should tell your healthcare provider about pelvic girdle pain, especially if you have trouble moving around or if going up and downstairs is painful. If you have any other symptoms, that could mean something more serious is going on.

Seek medical care right away if you experience:

• Vaginal bleeding
• Fever (temperature reaching 100.4 degrees Fahrenheit) 
• Burning pain when you pee

Pubic Symphysis Separation

The pubic symphysis is a joint that joins the bones in the front of your pelvis. During pregnancy, this joint needs to widen to make room for delivery. Sometimes, this widening can cause pain as the pelvis becomes unstable and less supportive. 

Pubic symphysis separation—also known as diastasis symphysis pubis (DSP)—can feel like shooting, sharp pain at the front of your pelvis. The pain can spread over your lower back, hips, thighs, lower abdomen, and back of your legs. You might feel a clicking, grinding, or snapping sensation.

The pain might get worse when turning over in bed or when you carry your child on one hip. If you waddle when you walk, it could be related to pubic symphysis separation.

Other Symptoms to Look For

In some cases, this condition can prevent you from fully emptying your bladder, which can lead to urinary tract infections.

Signs that something else is going on that requires emergency attention include:

• Vaginal bleeding
• Fever (temperature reaching 100.4 degrees Fahrenheit) 
• Burning pain when you pee
• Weakness or pain in your legs
• Headache 
• Loss of bladder or bowel control

Sciatica

Your sciatic nerve is the largest nerve in your body. It begins in your lower back and branches over your buttocks, hips, and down the back of your legs. When the nerve gets pinched, it can cause sciatica.

Sciatica symptoms can begin as you start to get heavier, in the later second and third trimesters. Pressure on the nerve from weight gain, fluid retention, and your growing uterus can pinch the sciatic nerve along its path. Sometimes your baby’s head can press against the nerve. Posture changes as you grow heavier in the front can also contribute to sciatica.

Relaxin also comes into play with sciatica as the ligaments loosen their support, shifting your joints and bones. These changes can contribute to a pinched sciatic nerve.

Sciatica feels like tingling, numbness, or can be sharp and shooting pain. Typically, you will feel it starting from your lower back or buttocks and running down one leg. Sometimes you might feel it in both legs or down to your feet.

Other Symptoms to Look For

Sometimes sciatica can be a sign of a herniated disc. You should tell your healthcare provider about any symptoms of pain or numbness.

Warning signs of nerve impairment include:

• Pain that is sudden and intense in your low back or leg
• Muscle weakness that interferes with your daily activities
• Loss of bladder or bowel control

Obstetric Emergencies

Obstetric emergencies are less common causes of pelvic pain during pregnancy. These emergencies are life-threatening for the mother, baby, or both. Medical or surgical intervention is needed for any obstetric emergency.

Miscarriage

Miscarriages are pregnancies that end in loss before the 20th week of pregnancy. Most happen early, sometimes before a mother is aware of the pregnancy, and often go unnoticed. Around 10 to 20% of known pregnancies end in miscarriage. Pregnancy loss, although common, can be emotionally challenging.

Once in progress, miscarriage cannot be stopped. Miscarriage can occur if the embryo or fetus is not developing normally.

Although miscarriage can’t be stopped, it is important that you contact your healthcare provider or healthcare provider. Miscarriage can cause heavy bleeding or infections. Also, getting help in dealing with the emotional side of pregnancy loss is helpful for many people who experience this.

Signs include:

• Bleeding or spotting from your vagina
• Cramping or pain in your lower abdomen, shoulder, or low back
• Blood clots, fluid, or tissue passing from your vagina
• Pain when using the bathroom
• Feeling dizzy or faint
• Fever (temperature reaching 100.4 degrees Fahrenheit) or chills

Not all bleeding in early pregnancy is a miscarriage. Mild spotting during early pregnancy is usually harmless. However, you should tell your healthcare provider about it.

Preterm Labor

Preterm labor is when contractions and cervical opening for birth happen too early. Preterm labor can happen between the 20th and 37th week of pregnancy and occurs in about 12% of pregnancies.

At or after 37 weeks, you are considered full-term. The sooner preterm labor occurs in the 20 to 37-week window, the more dangerous it is.

Seek emergency medical attention if you believe you are in labor before 37 weeks of pregnancy.

Signs of preterm labor include:

• Contractions, which feel like tightening of your abdomen
• Low backache that is dull and doesn’t go away
• Cramping or pressure in your abdomen 
• Vaginal bleeding or spotting
• A gush of fluid from your vagina
• Discharge that is mucus-like or bloody

Placental Abruption

Placental abruptions occur when your placenta detaches partly or entirely from the wall of your uterus. Since the placenta provides your baby with nutrients and oxygen, this can be an emergency. Placental abruptions typically happen in the third trimester.

Placental abruptions happen in one out of 100 pregnancies. Half of these cases are mild, 25% are moderate, and 25% are life-threatening to mother and baby.

Seek medical care right away if you experience:

• Lower back pain that doesn’t go away
• Pain or tenderness in your abdomen
• Contractions that come without a pause, right after another
• Vaginal bleeding

Ectopic Pregnancy

When a fertilized egg attaches anywhere outside the uterus, it is called an ectopic pregnancy. Most often, ectopic pregnancy happens in the fallopian tubes, which normally act as passageways for eggs to travel from the ovaries to the uterus. Ectopic pregnancies can happen in other parts of the body, like the cervix, ovary, or abdominal cavity. Ectopic pregnancies are rare, occurring in about five out of every 1000 pregnancies.

Ectopic pregnancies cannot grow into a baby and, if left untreated, can be life-threatening to the mother. Around 15% of ectopic pregnancies cause a fallopian tube rupture, which is painful and causes bleeding that can be dangerous.

It is vital to get emergency medical attention if you experience symptoms of an ectopic pregnancy.

Warning signs include:

• Spotting or light vaginal bleeding
• Pain in your lower abdomen
• Cramping on one side of the abdomen
• Shoulder pain
• Feeling the need to empty your bowels
• Feeling lightheaded or dizzy
• Vaginal bleeding

You may have a positive pregnancy test with an ectopic pregnancy, miss your period, and have other pregnancy symptoms such as nausea and feeling tired.

Uterine Rupture

Uterine ruptures are rare, very dangerous, and require emergency attention. For women who have had a prior cesarean (C)-section, about 1 in 67 to 1 in 500 may later experience a uterine rupture.

A uterine rupture happens when the uterine wall tears. This can happen during pregnancy or during childbirth. If you’ve already had a C-section, you are at risk of uterine rupture during a subsequent vaginal birth.

Signs to watch for include:

• Vaginal bleeding
• Sudden tearing or abnormal pain
• The baby seems in distress
• Labor contractions are slowing down or becoming less intense
• Your heart rate is decreasing
• Sudden pain at the location of a cesarean or other abdominal scar

Diagnosis

There is a range of reasons for pelvic pain during pregnancy, so your healthcare provider will need to examine you carefully to determine what is causing it. Your practitioner may ask you questions about your activities and habits, including whether or not you’ve taken drugs or been in an accident.

Tell your healthcare provider about any symptoms you are having, even if they are embarrassing or seem unrelated to the pain. If possible, try to record information about your symptoms, like when they started and for how long you’ve had them.

Your healthcare provider may examine your vagina and cervix. A pelvic exam is likely. You may have blood tests and an ultrasound. 

Treatment

At Home

Although you should always tell your healthcare provider about any pain you are experiencing, there are some at-home treatments for pelvic pain that are not a risk to you or your baby. Depending on the cause of your pain, you can try:

• Acetaminophen, such as Tylenol, is safe during pregnancy. Avoid NSAIDs like ibuprofen or naproxen
• Professional massage
• Warm bath
• A warm compress or ice packs
• A supportive pillow between your knees or under your belly during sleep
• Gentle stretching and strengthening exercises, such as child’s pose and cat-cow
• Pelvic floor exercises, such as Kegels
• Try a belly band or maternity belt
• Exercising in water
• Getting plenty of rest

Medical

Your healthcare provider may provide medical treatment for your pelvic pain. Depending on the cause, medical treatments may include:

• Surgery after birth, in the case of diastasis recti
• Physiotherapy 
• TENS therapy, which uses a device that helps relieve pain through electrical stimulation

A Word From Verywell

Pelvic pain during pregnancy can be very scary. It is normal to be concerned, and talking with your healthcare provider about your pain is a good idea. Most causes of pelvic pain are not dangerous, but in some cases, pain can signal an emergency. Get help right away if you experience any intense or unusual pain, bleeding, fever, chills, or other concerning symptoms.