Human Suspension System
An average uterus is about the size and shape of a toddler's fist and is located between the hip bones. Rather than resting atop your bladder (a situation that could become uncomfortable with an 8-pound baby inside of it), the uterus is suspended within your abdominal cavity by elastic fibers called round ligaments. Like the wires that keep a tightrope walker from falling, these ligaments keep the uterus and your fetus stabilized inside your body so they don't go crashing into your other organs every time you happen to change direction.
Ouch! What Was That?
Most women experience round ligament discomfort, a dull ache or sharp pain on one side of their lower abdomen, during their second trimester. That's when the weight of the baby is significant enough to start pulling on the round ligaments, stretching them too quickly, and tugging at the sensitive nerves in your groin where they attach. Obstetrician Dr. John Wilters, an OB-GYN and Chief of Staff at Centennial Medical Center in Nashville, Tennessee, says most women don't notice round ligament pain until at least 8 weeks gestation. "The uterus is still its normal size before that point," he says. By the third trimester, the thick bands of fiber have been stretched and thinned, so they have a bit more "give" and aren't as tender as they were a few weeks before.
Round ligament pain is usually felt to the right or left side of the uterus and occurs frequently when moms-to-be make sudden movements like standing up, laughing, coughing, turning quickly, or rolling over. "If someone comes in at 18 weeks with discomfort in the right lower quadrant of their abdomen, you suspect round ligament pain," says Dr. Wilters.
Could This Be Serious?
If the ache in your belly doesn't ease with rest or if it's bad enough to bring tears to your eyes, it may be something more serious like an ovarian cyst, urinary tract infection, or appendicitis, which also presents itself with a pain on the right side of the abdomen.
"Round ligament strain should not double you over in pain, shouldn't cause a fever, or make you nauseous," says Dr. Wilters. It shouldn't cause painful urination or a vaginal discharge either. If you have any of these symptoms, call your OB-GYN for advice or go to the emergency room.
Labor or Ligaments?
Round ligament pain tends to show up in the second trimester, while labor pains almost always show up in the third. But early labor is still a possibility, so how can you tell the difference? Labor pains are usually centrally located and will come and go like a belt tightening around your midsection. Round ligament pain tends to occur on one side, and it will catch you suddenly when you move. Or it feels like a constant dull ache.
Prevention and Relief
While there are no exercises and no medication to prevent round ligament discomfort, some women find they can avoid a sharp pain by moving slowly when they sit, stand, or roll over. Dr. Wilters recommends wearing a maternity belt or girdle for support. "I've been a firm believer in them for years," he says. "Maternity belts support the uterus and keep the abdominal muscles taut."
You may find relief by slipping into a warm bath or simply shifting positions. For instance, if you feel pain on one side, try gently rolling over to the other. Ibuprofen isn't recommended for pregnant women, but check with your doctor to see if acetaminophen is allowed. Luckily, the round ligament pain usually eases by the third trimester, and most women only experience it with their first or second pregnancies. And some moms never feel it at all!