Upper Abdominal Pain During Pregnancy: Causes, Treatment

Question: What causes upper abdominal pain during pregnancy?

Whether you are in your first, second or third trimester of pregnancy, having to deal with any form of abdominal pain will get you concerned about the well being of your baby.

The truth is, most women who get pregnant will experience some form of pain/cramps in their abdomen that may also radiate to other parts of the body.

In the first trimester, abdominal cramps could be a sign of pregnancy. In the second and third trimester of pregnancy, it is not abnormal for women to experience irregular, unpredictable contractions (Braxton hicks contractions) or abdominal pain attributed to gas formation, constipation and stretching of the supportive uterine ligaments.MyHealth Alberta+1

Having said that, upper abdominal pain during pregnancy may be due to serious health issues. In the first trimester, abdominal pain can be the first sign of a miscarriage. Also, ectopic pregnancy, which affects about 1–2 out of every 100 pregnancies (around 1 in 50), may also cause abdominal pain and can be life-threatening if not treated quickly. Cleveland Clinic+1

In the second trimester, strong uterine contractions and dilated cervix precede preterm deliveries. Other serious causes of abdominal pain during pregnancy are Preeclampsia (raised blood pressure while pregnant), urinary tract infections, gallbladder infections, and gastroesophageal reflux disease (GERD).MedlinePlus+1

This article explains causes of upper abdominal pain during pregnancy and simple lifestyle changes that can make your pain go away when the cause is minor. However, any new, severe, or persistent upper abdominal pain in pregnancy should be checked by your doctor or midwife as soon as possible.

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What causes upper abdominal pain during pregnancy

Like already mentioned, pain in the abdominal is not unusual during pregnancy. In fact, most experienced mothers ignore mild abdominal pain and only inform their doctor or midwife if the pain gets too severe, or if they experience vaginal bleeding, body weakness, fever or vomiting.

Here are causes of upper abdominal cramps while pregnant.

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1. Pressure effect of growing uterus

One common reason women have abdominal discomfort, especially in the second and third trimester of pregnancy, is increasing the size of the uterus. As your baby grows, the womb expands and occupies much more intra-abdominal space.

As a result, you could feel abdominal discomfort or a feeling of fullness under your ribs. You should inform your doctor if pains get worse.

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2. Progesterone effect

During pregnancy, your hormones spike up and could interfere with normal intestinal movement.

Estrogen and progesterone are elevated once you get pregnant and can slow down the movement of food within your intestines. Because of this, its take quite a long time for intra-abdominal content to be expelled through your anus. This, and the compressive effect of your growing uterus, will allow constipation to set in.MedlinePlus

Constipation and gas can easily make you feel uncomfortable with pain in your abdomen. If symptoms get worse, I recommend you see your doctor for help.

Usually, taking fiber diets, vegetables, drinking lots of water, and asking your doctor to review your iron supplements if they are making constipation worse may ease your pain.

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3. Round ligament stretching

Another reason you will feel a sharp pain in your abdomen is stretching of the round ligament that supports the uterus.

The round ligament supports the uterus and originates from the upper part of the womb (where your fallopian tube fuses with the body of the uterus) and attaches at the mons pubis.

During pregnancy, this ligament is stretched as your baby increased in size. Because of this, its common for women in the second and third trimester to experience abdominal pain, back pain, and buttocks pain.MyHealth Alberta+1

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4. Ectopic pregnancy

Ectopic pregnancy is a common cause of abdominal pain during pregnancy and occurs when your pregnancy grows outside the uterus. Abdominal cramps due to ectopic pregnancy happen in the first trimester, usually before the 11th week of pregnancy.Mayo Clinic+1

In ectopic pregnancies, the pregnancy is often situated in the fallopian tube and may cause one-sided lower abdominal pain even before the tube bursts. If the fallopian tube ruptures and bleeds into the abdomen, the pain becomes sudden, severe, and is a medical emergency.Mayo Clinic+1

Risk factor for developing an ectopic are previous untreated pelvic infections that affected your fallopian tubes, chlamydia and gonorrhea infections, women with prior history of fallopian tube surgery, and previous ectopic pregnancy.NCBI

Symptoms include abdominal cramps with or without vaginal bleeding, though you may also feel fatigue, dizziness, fast heart/pulse rate depending on the severity of bleeding. Sudden severe pain with shoulder-tip pain or fainting needs urgent hospital care.

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5. Miscarriage

If you are in the first trimester and have mild to severe abdominal cramps, it could be an early warning sign of a miscarriage.

A miscarriage means your pregnancy stops developing and the baby (embryo or fetus) dies with severe intermittent contraction-like belly cramps. Other symptoms of a miscarriage are disappearing pregnancy symptoms, vaginal bleeding (usually in clots), body weakness, back pain, and abdominal cramps.Mayo Clinic+1

About 10 to 20 percent of known pregnancies will end in a miscarriage; So, inform your doctor, especially if you’ve had a miscarriage in previous pregnancy. Mayo Clinic+1

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6. GERD (Gastroesophageal reflux disease)

One common cause of burning upper abdominal pain during pregnancy is gastroesophageal reflux disease.

Within your thoracic cavity (oh, I mean your chest wall) is a vertical tubing that carries food from your mouth to your stomach. This is called the esophagus, and within its lower end is a sphincter that involuntarily controls the movement of food.

After the passage of food into your stomach, the esophageal sphincter closes up, prevent backward movement of food into your esophagus.

If this sphincter goes defective, it could cause movement of acidic stomach content into the esophagus resulting in inflammation and lower chest/ upper abdominal pain.

Other factors that could affect the lower esophageal sphincter are pregnancy hormones and increased pressure inside the abdomen due to the growing uterus.nhs.uk+1

Other symptoms of GERD are cough, lack of appetite, difficulty swallowing, and poor night sleep.Mayo Clinic+1

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7. Gallbladder infection

Gallbladder stone and inflammation could be the reason you have upper abdominal pain, especially on the right side. Under your liver is a pear-shaped structure called the gallbladder which is involved in the storage of bile needed for the breakdown of fats in your meals.

After ingestion of fatty meals, your body releases an enzyme that triggers the release of bile into the intestine for breakdown fo fat.

If there is blockage of bile flow or the gallbladder does not empty properly, it could cause the formation of gallstones and sometimes inflammation or infection of the gallbladder.

During pregnancy, the rate of emptying of the gallbladder slows down allowing stones to form. This, with the increased secretion of cholesterol in pregnancy, will result in gallstones.Cambridge University Hospitals+1

As a rule, it’s best to see your doctor. Pain from gallstones or gallbladder infection often needs hospital assessment; some people are treated with antibiotics and pain relief, while others will need surgery to remove the gallbladder at the safest time in or after pregnancy.WebMD+1

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8. Preeclampsia

Preeclampsia is a common cause of epigastric pain in the upper abdomen. In simple terms, preeclampsia means elevated blood pressure levels and occurs in the later stages of pregnancy after the 20th week. Usually, in mild cases, most pregnant women are asymptomatic.CDC+1

However, in severe cases, patients will experience pain in the upper abdomen, headache, dizziness, blurred vision, right upper abdominal pain, vomiting, and sometimes, convulsion.UpToDate+1

Presence of convulsion in pregnant women with elevated blood pressure is called eclampsia, and it is a life-threatening condition. Preeclampsia and eclampsia can be associated with HELLP syndrome (a serious liver and blood clotting problem) and can ultimately lead to death if quick intervention is not administered.ScienceDirect+1

If you’ve been diagnosed with high blood pressure during your pregnancy, quickly see your doctor or go to the hospital if you experience burning, sharp or stabbing upper abdominal pain, especially with headache, visual problems, or swelling of your face and hands.ACOG+1

Your doctor will usually monitor your blood pressure and urine closely, give safe anti-hypertensive medications when needed, and decide the best time and place for delivery. In severe cases, you may need admission, magnesium sulfate to prevent fits, and early delivery of the baby.Preeclampsia Foundation+1

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How to ease upper abdominal tenderness while pregnant

If you experience abdominal pain while pregnant, you need to see your doctor to be sure it is not something serious. Here are some tips that will help alleviate your pain while preparing to see your doctor, especially when the cause is minor like gas, constipation, or heartburn:

Instead of taking all meal at a go, it is best you take small meals at intervals. This will help prevent regurgitation or indigestion.nhs.uk

Stay away from fatty diet because they can trigger gallbladder pain and cause relaxation of the lower esophageal splinters.

Don’t lie down immediately after taking your meals. It is best to wait for a while for your food to digest before sleeping.

Don’t eat late in the night because it could force regurgitation.

Avoid food that worsens constipation during pregnancy – Caffeine, bananas, red meat, iron supplements, fast junk foods, chocolates, and alcohol (alcohol should be avoided completely in pregnancy for many other reasons too).MedlinePlus+1

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When to see a doctor?

If you have abdominal cramps in the 1st, 2nd, or 3rd trimester, see your doctor immediately if you develop any of these symptoms

• Excruciating pain in your abdomen that stops you daily activities

• Pain that is mainly in the upper right abdomen or under your ribs

• Fast heart rate

• Dizziness and fainting attacks

• Vomiting

• Passage of blood in stool

• Vaginal bleeding with or without clots

• Severe back pain

• A long-lasting contraction in your abdomen especially when close to delivery

• Severe leg, face, hand swelling

• New or severe headache with blurred vision

• Fever (high body temperature)MedlinePlus+1