Ligament stretch pain in pregnancy

On the front of the womb there are two ligaments, one on either side. These are called ‘round ligaments’ and they run from near the fundus of the womb to the pelvic wall. As the womb grows, the ligaments inevitably stretch.

For some people, this stretching is believed to cause considerable pain, although there is no cast-iron evidence of this being a cause of pain. Strong subjective evidence exists to show that up to a third of all pregnancies may be affected by ligament stretching to varying degrees. For most, it appears to be only a mild discomfort over the lower abdomen, usually midway through the pregnancy.

Braxton-Hicks contractions as a source of pain

In most cases Braxton-Hicks contractions are not painful. However, there is a substantial proportion of women who find them uncomfortable, even painful. They are very rarely perceptible before 28 weeks of gestation.

Any painful contractions, however remote from term, should be taken seriously, as these might be a sign of preterm labour. A vaginal examination is frequently required to rule out labour.

Heartburn and constipation in pregnancy

Both heartburn and constipation are common in pregnancy. Most people will have no trouble in recognizing heartburn, by virtue of its symptoms and location (in the upper part of the abdomen). In very late pregnancy, near Term, this may not be straight-forward and, if in doubt; an examination will distinguish uterine fundal pain from heartburn.

Pain resulting from constipation is usually colicky and confined to the left side on the lower part of the abdomen. Again, it may be wise to have an examination to establish or confirm whether the pain is indeed of bowel origin and due to constipation. Constipation is easily relieved but is notorious for recurring again and again in pregnancy.

Torsion of the uterus and its causes

For torsion to be regarded as physiological, it has to be mild. When it is severe (which is rare), it becomes pathological. Pathological torsion is a serious condition which may require an emergency operation.

Mild rotation of the uterus is in fact quite common, probably occurring in the majority of pregnancies. Because a pregnant uterus is much bigger on the fundal part, it is not unusual for it to rotate on its axis, usually towards the right.

When this rotation (or torsion) goes beyond a certain degree, which happens from time to time, it may be perceived as discomfort or pain. This usually occurs late in the pregnancy, normally well beyond 20 weeks. It could possibly occur earlier, in the presence of predisposing factors such as large fibroids or uterine abnormalities.

Mild torsion does not require any specific action.

Severe torsion of the uterus in pregnancy

Severe torsion of the uterus is extremely rare. The causes are not always immediately apparent but the presence of benign tumours, such as fibroids or large ovarian cysts, are predisposing factors.

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