Cramps After Abortion With Lower Back Pain: 5 Reasons To Worry

Question: What causes lower back pain and abdominal cramps after abortion? How long does pain last after an abortion?

All over the world, there are many reasons a woman will be determined to end her pregnancy. Sometimes, it could be due to an unwanted pregnancy after having an unprotected sexual intercourse with a partner. Other times, it could be at the request of your doctor after counseling because of the risk the pregnancy poses to her health.

(Abortion laws are different in each country. Always follow the law where you live and, as much as possible, see a trained doctor or clinic for safe care.)

Either way, whether it’s your decision or not, there are many risks involved when you are trying to terminate a pregnancy and it’s important you inform your doctor first, and then, ask necessary questions about technique and complications.

During the first three months of pregnancy (that is the first trimester) it is usually safer and simpler to have an abortion when it is done by a trained provider. In fact, an abortion done before 7 weeks of pregnancy (or 49 days) is less commonly associated with short or long-term complications, especially when the correct method is used and you are closely followed up.

Nevertheless, an abortion can take place anytime within the legal limit in your country, and if you informed your doctor late in the second trimester, you should be aware that you are at a higher risk of complications from the procedure.

One common side effect of an abortion is lower abdominal cramps and back pain.

The truth is mild to moderate cramping pain on the right side, left side or lower abdomen is not abnormal right after an abortion. This occurs because of uterine contractions and it’s a natural protective way your body prevents excessive blood loss and also expel fetal tissue completely.

Cramping and bleeding after abortion is not unusual and could happen after a medical or surgical termination of pregnancy.

Having said that, cramps after abortion may sometimes indicate something more serious. If you are also experiencing fever, foul-smelling discharge, lower back pain, body weakness, fatigue, dizziness, or very heavy bleeding, then something is wrong and you should see a doctor quickly.

Pelvic inflammatory disease, endometritis, salpingitis, cervical trauma, and problems like incomplete abortion may cause you to have belly cramp weeks after an abortion.

This article explains possible causes of cramps and lower back pain after abortion, when it’s normal, and when cramps may mean something more serious.

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Are cramps after abortion normal?

Immediately after an abortion, you will begin to understand some changes to your body.

First of all, the feeling of guilt sets in and you feel you’ve acted in a wrong way. Sometimes, a lot of women will end their pregnancy because of pressure from family members, husbands, boyfriends or even peer groups.

After the successful removal of your baby, that feeling of guilt could be around for one or two weeks. It’s important you stay strong or talk to a counseling center close to you. If you feel very low, anxious, or can’t cope, please talk to a mental health professional or your doctor.

Another problem that you will experience is cramps in your abdomen. This pain may be mild, moderate or severe, and while some women will complain of a dull short-lived recurrent pain, others will experience severe cramps that may stop them from routine daily activities, especially in the first 24 hours.

It’s important you see your doctor if you’ve taken abortion pills on your own. Pain relief medications are essential to prevent excruciating pains after an abortion, and they are usually given before or soon after the procedure.

However, it’s still common that you will have cramps while on these pain relief, though they will be mild and less severe as the days go by.

Finally, vaginal bleeding will be a new friend after an abortion. Depending on the type of abortion technique used and the age of pregnancy, you may have a light or heavy vaginal bleeding for about 1–2 weeks, sometimes with spotting on and off.

If you are bleeding after an abortion, it is usually nothing you should worry about yet as long as it is getting lighter, and you are not soaking pads very quickly. However, if bleeding is prolonged and heavy, especially if you are soaking through a pad every hour for several hours, passing very large clots, or feeling dizzy and weak, you must see a doctor or go to the hospital immediately.

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How long does cramping pain after abortion pills (misoprostol) last?

Misoprostol tablets, commonly called Cytotec, are used for the ripening of cervix, and also, for an abortion. These tablets are prostaglandin E1 analogs that, when used with mifepristone or sometimes methotrexate, will effectively terminate a pregnancy.

If you’ve used misoprostol as part of a medical abortion, you can expect pain in your lower abdomen and back that is usually worst in the first few hours after taking the tablets and may continue as cramping for a few days. For many women, the strongest pain settles within 24 hours, but milder cramps can come and go for several days and sometimes up to about a week.

Generally, if you are having ongoing cramps 2 weeks after abortion, especially if the pain or bleeding is not getting better, it may be due to retained products of conception. This causes your uterus to intermittently contract to force out remaining fetal tissue.

If cramping and bleeding continue beyond 2 weeks, or get worse instead of better, you should see a doctor for examination. Most times, your doctor will examine you, do an ultrasound scan, and if necessary evacuate your womb through a suction tube or a gentle D & C to remove any tissue left behind.

If you don’t see a doctor, you may continue to bleed for a long time, and the truth is, it’s risky if you lose too much blood. Signs of excessive blood loss are body weakness, lightheadedness, low blood pressure, fast heart rate and dizziness. These are emergency signs and you should go to a hospital immediately.

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Cramps and lower back pain after abortion: When to worry?

Remember that after an abortion, it’s okay if you experience abdominal cramps for a few days. Mild cramps may continue for up to one or two weeks as your uterus goes back to its normal size. Pain will be very severe if you’ve failed to use pain relief medications.

However, in some women, severe or worsening pain may be an early sign of possible complications. It’s important you are observant of any changes and quickly inform your doctor. Here are some signs that indicate something’s wrong:

1. Bleeding and cramping more than 2 weeks after abortion

If you are cramping one week after abortion, it’s not abnormal that you will feel this way. In few days time, you should notice bleeding gets lighter and eventually stops.

After a medical abortion, that is after the use of misoprostol tablets, your body may fail to remove fetal tissue completely. If this happens, it’s likely you will continue bleeding for 3 or 4 weeks after the procedure, often with clots and cramping that do not improve.

It’s important you inform your doctor. You may need an ultrasound scan, blood tests and sometimes another treatment to complete the abortion safely.

2. Fever

High body temperature after an abortion is one quick way to tell if you have an infection or not. Other ways are a smelly discharge that is yellow-green, persistent abdominal and back pain, vomiting, nausea, dizziness, painful urination and fast heart rate.

Having said that, a low-grade fever or chills can be common right after a medical abortion with Cytotec, and in few hours or within a day, you will feel okay. If your temperature is 38°C or higher, or fever lasts more than 24 hours, you should see a doctor.

3. Endometritis

This is the inflammation of the lining that coats the inside of the uterus (endometrium). It can occur after an abortion and cause you to have a fever, lower abdominal tenderness, irregular vaginal spotting and reddish brown discharge.

Talk to your doctor if you experience these symptom weeks after an abortion. Broad-spectrum antibiotics prescribed by your doctor are needed to fight infections and prevent sepsis.

4. Pelvic inflammatory disease (PID)

After an abortion, infections can spread to different parts of your reproductive tract resulting in lower back pain and belly cramps.

If infections spread up and affect your fallopian tube, uterus, inner pelvis and ovaries, you will experience cramps for weeks or months.

Right-sided pain after abortion can occur from inflammation of the right ovaries and fallopian tube. Likewise, a left-sided pain after abortion can occur after inflammation of the left ovaries and fallopian tubes.

Other symptoms you will experience during a pelvic infection are:

• Smelling vaginal discharge

• Fever (temperature more than 38ºC)

• PAin during intercourse

• Pain while urinating

• Back pain

5. Trauma to uterus and cervix

If you had a surgical abortion through a D & C or other instruments, a sharp instrument might cause injury to the walls of the uterus and cervix resulting in bleeding and cramps. This usually presents as sudden severe pain soon after the procedure, not weeks later.

If you develop very sharp pain, cannot stand upright, feel faint, or your stomach becomes very hard and tender, you should seek emergency care immediately.

 

Further reading:

1. ACOG – Induced Abortion: What You Need to Know
   https://www.acog.org/womens-health/faqs/induced-abortion ACOG

2. MedlinePlus – Abortion: Aftercare and Recovery
   https://medlineplus.gov/ency/patientinstructions/000658.htm MedlinePlus

3. NHS – Recovery after an abortion
   https://www.nhs.uk/tests-and-treatments/abortion/recovery/ nhs.uk

4. WHO – Clinical practice handbook for quality abortion care (patient-friendly summary parts)
   https://cdn.who.int/media/docs/default-source/reproductive-health/clinical-practice-handbook-for-quality-abortion-care.pdf WHO

5. Cleveland Clinic – Medical Abortion: What It Is, Pain, Risks & Recovery
   https://my.clevelandclinic.org/health/treatments/21899-medical-abortion Cleveland Clinic

6. RCOG – Best Practice in Post-Abortion Care (good for clinicians, you can summarise for lay readers)
   https://www.rcog.org.uk/media/k4df0zqp/post-abortion-care-best-practice-paper-april-2022.pdf RCOG