One may imagine pregnancy as a time of wonderful expectation, mixed with a bit of fatigue and perhaps nausea. The reality of all the incredible changes that occur in the short span of 9 months is that there are a lot of aches and pains that go along with the stretching of the belly. Below is a guide to help you understand those ‘normal’ aches and pains. Of course, you should always check with your doctor or midwife if you have any pain that concerns you. Call your provider right away if you have fever, bleeding, or severe vomiting and diarrhea, or if you think your pain is due to contractions or preterm labor (click for more info). Rarely, pain and bleeding can be associated with a serious condition known as placental abruption. (Click for more information on signs and symptoms of abruption)
Lower right or left side pain:
- Ovarian cysts: If you are in the first trimester, right or left lower quadrant pain is often caused by a corpus luteal cyst which is normal in pregnancy. Click for more information on ovarian cysts in pregnancy. Sometimes these normal functional cysts can bleed into themselves (called hemorrhagic cysts) or rupture, which can cause anything from a dull ache to severe pain that subsides over time. Fortunately, the body is very adept at healing these cysts and they rarely require any kind of intervention, nor should it affect the pregnancy in any way or increase your risk of miscarriage. Corpus luteal cysts usually go away on their own by 12 to 14 weeks, and any discomfort associated with them should go away by then as well. If you are having pain, ultrasound can help diagnose the presence of a hemorrhagic cyst or suspected ruptured cyst.
- Constipation: Another common cause for lower abdominal pain in pregnancy is constipation. Constipation is a normal side effect of some of the pregnancy hormones and iron/vitamin supplements that you might be taking. Normal or not, it can be very unpleasant and painful. Increasing the fiber in your diet with cereals, fruits and vegetables may help. Your doctor or midwife can suggest fiber supplements or natural laxatives for you to take if needed.
- Ligament pain: Starting around 12 weeks and throughout the rest of the pregnancy, many women find that they experience surprisingly sharp and sometimes sudden pain in their lower right or left side, especially if they sneeze, roll to get out of bed, etc. Very often, this is caused by the supportive ligaments that attach to the uterus on both sides. These ligaments are being stretched in ways they have never been before. They will sometimes cramp and spasm with the new and increasing demands of supporting an enlarging uterus. These ligament pains can sometimes really hurt, but they will not affect the pregnancy or put you into preterm labor.
- Urinary tract infections (UTI): A dull generalized ache or more severe discomfort in the lower pelvis can be associated with a urinary tract infection. Often, the pain is more central but it can radiate to one side or the other. Other symptoms that are common with urinary tract infections are frequent urination, burning upon urination, and feeling like you ‘have to go’, even if you just went. Call your provider if you suspect a UTI, especially if you have a fever, since treatment with antibiotics is required.
Pain around the belly button:
In the second trimester, it is not uncommon for you to have pain in the center of your growing belly and for your belly button to burn, ache or even really hurt. This is due to the fact that the rapidly growing uterus puts pressure on the abdominal muscles, which eventually will rip apart in the midline, beginning at the belly button sometime around 16 to 20 weeks. ‘Ripping’ muscles sounds harsh, but this is not an exaggeration. Picture (if you will) the rippled and toned ‘6-pack’ abdomen of any buff swimsuit model or body builder. The abdominal muscles are rectangles of individual muscles, held together by thick fibrous fascia or connective tissue. The uterus lies behind these muscles and as it expands, the muscles and connective tissues are stretched at an uncomfortable rate and, for many women, they put up a protest in the form of discomfort and pain. Gaining this type of ‘weight’ actually hurts, unlike gaining fat which is a much stealthier, painless process of watching the scale move up.
As the uterus grows, it literally unzips the midline connective tissues between the abdominal muscles, usually starting at the belly button and extending downwards, and eventually upwards, creating a partial or sometimes complete separation between the muscles on the left and right sides. This is completely normal and almost every pregnant woman has had their midline muscles ‘unzip’. In most cases, after you have the baby, you will not notice the separation unless you do an abdominal crunch and feel for the hollow in the middle, especially below the belly button. While the separation between the two sides is permanent, it does appear less noticeable over time, and the muscles usually will migrate towards the center again. Exercise can help tighten and contract the muscles so that they can return to their original position.
Pain in the back, pelvis and pubic bone:
As the uterus grows and the baby gets bigger, a lot of pressure is placed on the lower back and pelvic girdle (pelvic bones). Not only does your pelvis, back, muscles, and ligaments have to work much harder to support this new mass that is growing in your abdomen and your new shape, the pregnancy hormones act as a muscle relaxant. These hormones act upon your ligaments and supportive tissues to make them more pliable and lax, in order to allow your pelvis to literally soften and spread so that the baby can pass through at birth. As a result, it is no wonder that your back and body will hurt under the increased demands. The looser ligaments will also affect the way you move and walk, which further exacerbates the stresses placed on your lower back and pelvis. Some women will experience sciatica which is pain, numbness, and/or tingling emanating from pressure on the spinal cord and nerves, which can radiate down one leg or the other. Talk to your doctor or midwife if you are struggling with the pain. They may be able to recommend specific exercises, a trusted prenatal chiropractor or massage therapist, or even medications or referral to specialists if the pain is debilitating.
Some women may experience a dull pain (or worse) in the center of their pubic bone, especially towards the last trimester. This is because there is a disc or band of cartilage (known as the symphisis pubis) that connects the front of the pelvic girdle in the middle (see image). For some, the stress on this area is especially intense and painful. In some cases, it can even separate or crack before delivery or during birth. Fortunately, while it is possible for the cartilage to shear off or fracture at the mid-line, that is uncommon.
For back, pelvis, and pubic symphisis pain, you may find it helpful to try a pregnancy support band. There are many different types on the market, available on the internet or in maternity stores, but they all do the same basic thing which is to help support the growing uterus and take some of the pressure off of your own musculature. 
You will want to avoid standing for long periods of time or doing anything that increases the strain on your back or pelvis. You can also use a heating pad placed on your lower back or on your pubic bone (depending on where the pain is). It is perfectly safe to use a heating pad, rice sock, or warming patch as long as it’s moderate heat, 20-30 minutes at a time during pregnancy.
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