Pelvic Pain During Pregnancy: Causes, Diagnosis, and Treatment

Any pain during pregnancy can be frightening, especially in the pelvis. Pelvic pain during pregnancy is pretty common, with estimates ranging from 41 to 78%. It can be due to multiple factors, most of which are normal and harmless.

pregnant woman in pain with eyes closed

damircudic/Getty Images

Diastasis Recti

When your rectus abdominus—the muscles of your abdomen—separate due to your growing uterus, it is called diastasis recti (DR). These abdominal muscles run from the top to the bottom of your abdomen and help to move your body forward or sideways. During pregnancy, you might see a bulge in the middle of your abdomen. When this happens, it’s because the two sides of your rectus abdominus have stretched apart and separated.

The separation of your abdominal muscles can cause weakness and back pain. 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

If you experience back pain or extreme weakness, you should speak to your doctor. Although diastasis recti isn’t dangerous, other symptoms of this condition that you should seek care for include:

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

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 won’t feel them. 

You might begin to feel false labor pains around the 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.

The difference between real labor contractions and Braxton Hicks is timing and how regular they are. 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 end with birth, while Braxton Hicks do not.

While the science is out on the exact causes of Braxton Hicks contractions, they most often occur after being very active, having sex, if you are dehydrated, or if your bladder is full. It may be the body's way of getting more blood flow to the placenta.

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. Other warning signs that you should seek medical attention include:

  • 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 doctor as soon as possible. Don’t worry if it’s a false alarm; it’s always better to be sure, and doctors see this all the time.

Vaginal Infection

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

Bacterial infections can cause you to feel itchy, burning sensation, redness, swelling, and pain around the outside of your vagina (vulva). 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. If it is 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 over the counter medications, talk to your doctor, especially in the first trimester.

Other Symptoms to Look For

If you have never had a vaginal infection before and are unsure of the signs, see your doctor. You should also tell your doctor if you experience any of the following:

  • Fever (temperature reaching 101 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. Typically, you have two small oval-shaped ovaries in your lower abdomen. Each month, one of them will release an egg. These organs produce the hormones estrogen and progesterone, which are involved in pregnancy.

Ovarian cysts can occur at any time and often go unnoticed. During pregnancy, you might have a cyst during the first trimester without any symptoms. They usually go away after a while, on their own. However, if a cyst ruptures or twists, it can be painful. Symptoms can feel like bloating and swelling or pain on one side of your abdomen. The pain may come and go, feel dull, or may be sharp and stabbing. If you feel any symptoms you suspect could be an ovarian cyst, you should see your doctor.

ovarian cysts possible symptoms

Illustration by Emily Roberts, Verywell

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 101 degrees Fahrenheit)

Round Ligament Pain

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

If you are experiencing round ligament pain, it might feel like something is pulling inside of you, and it could be sharp and sudden. Typically, round ligament pain is felt on the right side of your abdomen, although it can happen on the right side or both sides. Sudden movements can cause round ligament pain, even rolling over in bed.

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

Other Symptoms to Look For

While round ligament pain is not dangerous, you should see your doctor and rule out any other causes if it doesn't go away. To rule out more serious causes, see your doctor if you experience any of the following:

  • Pain when you pee
  • Bleeding
  • Nausea, bloating, or vomiting
  • Fever (101 degrees F) or chills, which could mean you have an infection
  • Pain that feels too intense
  • 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 body, at the base of your spine, are bones that form what’s called your pelvic girdle. The sacroiliac joints—there are two of them—are located at the back of your body. 

What causes sacroiliac joint pain.

Jo Zixuan Zhou / Verywell

Pregnancy causes inevitable weight gain, and this extra load 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. 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, causing pain.

What is Relaxin?

Relaxin is a hormone that helps prepare your body for childbirth by relaxing the ligaments, muscles, and joints, and softening your cervix. It is produced in your ovaries and placenta.

You may feel pain when climbing stairs, walking, rolling over in bed, or balancing on one leg, like when 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 doctor. Other symptoms that could be a sign of something that needs more attention include:

  • Vaginal bleeding
  • Fever (temperature reaching 101 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. Just as with SIJ pain, it might get worse when you are climbing stairs, balancing on one foot, such as getting in and out of bed or the bathtub, or bending over.

Other Symptoms to Look For

You should tell your doctor about pelvic girdle pain, especially if you have trouble moving around and 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 101 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. Just as with SIJ and SPD pain, you might feel a clicking, grinding, or snapping sensation.

The pain might get worse when balancing on one leg, turning over in bed, or when you carry your child on one hip. If you find yourself waddling when you walk, it could also mean you have pubic symphysis separation.

Other Symptoms to Look For

Tell your doctor about any pain you feel during pregnancy. In some cases, this condition can prevent you from fully emptying your bladder, which can lead to urinary tract infections. Other symptoms that could mean something else is going on that requires emergency attention include:

  • Vaginal bleeding
  • Fever (temperature reaching 101 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 in your body. It begins in your lower back and branches over your bum, hips, and down the back of your legs. When this nerve gets pinched, it can lead to sciatica.

Sciatica can begin as you start to get heavier, in the later second and third trimesters. Relaxin also comes into play with sciatica. This hormone causes ligaments to loosen their support, shifting your joints and bones. This change can lead to a pinched sciatic nerve.

Pressure on the nerve from weight gain, fluid retention, and your growing uterus can pinch the sciatic nerve. Poor posture from your center of gravity changing as you grow heavier in the front can also cause sciatica. Sometimes your baby’s head can press against the nerve and cause it to become pinched.

Sciatica feels like tingling, numbness, or can be sharp and shooting pain. Typically, you will feel it starting from your lower back or bum 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 happens when you have a slipped or herniated disc. You should tell your doctor about any symptoms of pain or numbness. Other symptoms to notify your doctor about 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 are emergencies that are life-threatening for the mother, baby, or both. In-hospital treatment is needed for any obstetric emergency.

Miscarriage

Miscarriages are pregnancies that end in loss before the 20th week of pregnancy. Most happen early 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 can not be stopped. The cause of miscarriage is most often because the embryo or fetus is not developing normally. Not all bleeding in early pregnancy is a miscarriage. Bleeding in early pregnancy is common and usually harmless. However, you should still tell your doctor, just in case.

Although miscarriage can’t be stopped, it is still vital that you get medical care. Heavy bleeding and infections are risks with miscarriage. Also, getting help in dealing with the emotional side of pregnancy loss is essential for many.

Make sure you seek medical attention right away if you think you’re having a miscarriage. 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 101 degrees Fahrenheit) or chills

Preterm Labor

When contractions that lead to your cervix opening for birth happen too early, this is preterm labor. Preterm labor can happen between the 20th and 37th week of pregnancy and occurs in about 12% of pregnancies.

After 37 weeks, you are considered full-term. The earlier in that window preterm labor occurs, 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:

  • Tightening of your abdomen, like contractions
  • 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 are rare, happening 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.

Symptoms include:

  • 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 outside of the uterus, it is called an ectopic pregnancy. Most often, an 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 fetus and, if left untreated, can be life-threatening. Around 15 percent of ectopic pregnancies can cause a rupture in the fallopian tube, which is painful and causes bleeding that can be dangerous. It is vital to get medical attention if you experience an ectopic pregnancy.

You may have a positive pregnancy test with ectopic pregnancies, miss your period, and have other pregnancy symptoms such as nausea and feeling tired. Warning signs to seek emergency care for include:

  • Spotting or light vaginal bleeding
  • Pain in your lower abdomen or cramping on one side
  • Shoulder pain
  • Feeling the need to empty your bowels
  • Feeling lightheaded or dizzy
  • Intense abdominal pain and bleeding

Uterine Rupture

Uterine ruptures are rare. They are very dangerous and need emergency attention. For women who have had a prior c-section, about 1 in 67 to 500 have a uterine rupture.

A uterine rupture happens when the uterine wall tears. This tear can happen during pregnancy or during childbirth. If you’ve already had a cesarean section, you are at a higher risk of uterine rupture if you have a vaginal birth. Other causes of uterine rupture are if you’ve been in a car accident or had a bad fall. See your doctor straight away if you’ve been in an accident.

Uterine ruptures are dangerous and need emergency medical attention. 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

The reasons for pelvic pain during pregnancy are broad, so your doctor will need to examine you carefully to determine what is causing it. A pelvic exam to check for anything abnormal is likely. Your doctor may examine the outside and inside, including your vagina and cervix. You may have blood tests and an ultrasound. 

Your doctor may ask you questions about your activities and habits, including whether or not you’ve taken drugs or been in an accident. Tell your doctor 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.

Treatment

At Home

Although you should always tell your doctor 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
  • Massage or 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

What Are Kegels?

Kegels are exercises for your pelvic floor that help strengthen the muscles supporting your uterus, bladder, rectum, and small intestine. Not all pelvic floor issues are because of weak muscles. Sometimes, these muscles are too rigid and have trouble relaxing. In this case, Kegels can do more harm than good. Discuss with your health care provider whether or not Kegel exercises are right for you.

Medical

Your doctor 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 checking with your doctor for any 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 emergency symptoms. Tell your doctor everything you can so they can help you as much as possible.

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Article Sources
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  1. Kanakaris NK, Roberts CS, Giannoudis PV. Pregnancy-related pelvic girdle pain: an update. BMC Medicine. 2011;9(1). doi:10.1186/1741-7015-9-15

  2. Sperstad JB, Tennfjord MK, Hilde G, et al. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. British Journal of Sports Medicine 2016;50:1092-1096. DOI:10.1136/bjsports-2016-096065

  3. Raines DA, Cooper DB. Braxton hicks contractions. In: StatPearls [Internet]. Updated November 18, 2020.

  4. March of Dimes. Signs and symptoms of preterm labor. Updated August 2017.

  5. Hay P. Bacterial vaginosisF1000Res. 2017;6:1761. doi:10.12688/f1000research.11417.1

  6. U.S. Department of Health and Human Services. Office on Women’s Health. Ovarian cysts. Updated April 1, 2019.

  7. Office on Women’s Health. Ovarian cysts. Updated April 1, 2019.

  8. Chaudhry SR, Chaudhry K. Anatomy, abdomen and pelvis, uterus round ligament. In: StatPearls [Internet]. Updated August 23, 2020.

  9. Zachariah SK, Fenn M, Jacob K, Arthungal SA, Zachariah SA. Management of acute abdomen in pregnancy: current perspectives. International Journal of Womens Health. 2019;Volume 11:119-134. doi:10.2147/ijwh.s151501

  10. Jeanne Bertuit, Clara Leyh & Véronique Feipel (2018) Pelvic belts and pregnancy-related pelvic girdle pain: influence on temporal and spatial gait parameters, International Biomechanics, 5:1, 104-112. doi:10.1080/23335432.2018.1544853

  11. Morino S, Ishihara M, Umezaki F, Hatanaka H, Yamashita M, Aoyama T (2019) Pelvic alignment changes during the perinatal period. PLoS ONE 14(10): e0223776. DOI: 10.1371/journal.pone.0223776

  12. Dehghan F, Haerian BS, Muniandy S, Yusof A, Dragoo JL, Salleh N. The effect of relaxin on the musculoskeletal systemScand J Med Sci Sports. 2014;24(4):e220-e229. doi:10.1111/sms.12149

  13. Cedars Sinai. Sacroiliac joint dysfunction.

  14. American College of Obstetricians and Gynecologists. Back pain during pregnancy. Updated May 2020.

  15. Howell ER. Pregnancy-related symphysis pubis dysfunction management and postpartum rehabilitation: two case reports. J Can Chiropr Assoc. 2012;56(2):102-111.

  16. Owens , Kelly  & Pearson , Anne . (2002). Pubic symphysis separation. Fetal and Maternal Medicine Review. 13. 141 - 155. doi:10.1017/S0965539502000244.

  17. American Academy of Orthopaedic Surgeons. Sciatica. Updated December 2013.

  18. Cleveland Clinic. How to handle sciatica during your pregnancy. Updated December 17, 2014.

  19. Cedars Sinai. Miscarriage.

  20. American Pregnancy Association. Premature labor. Updated April 26, 2017.

  21. Preterm Labor. Mayo Clinic. June 9, 2019

  22. Ghaheh HS, Feizi A, Mousavi M, Sohrabi D, Mesghari L, Hosseini Z. Risk factors of placental abruptionJ Res Med Sci. 2013;18(5):422-426.

  23. Victoria State Government: Better Health. Placental abruptions. Updated August 2014.

  24. Victoria State Government: Better Health. Ectopic Pregnancy. Updated April 2014.

  25. Bates CK, Carroll N, Potter J. The challenging pelvic examination. J Gen Intern Med. 2011;26(6):651-7. doi:10.1007/s11606-010-1610-8

  26. Centers for Disease Control and Prevention. Use of pain medication during early pregnancy may be related to birth defects. Updated July 16 2020.