Abdominal pain during pregnancy

Is it normal to have some abdominal pain during pregnancy?

Occasional abdominal discomfort is a common pregnancy complaint, and while it may be harmless, it can also be a sign of a serious problem. (Severe or persistent abdominal painshould never be ignored.)

Below we'll describe the most common causes of abdominal pain and discomfort during pregnancy, but don't try to diagnose yourself. If you experience abdominal pain or cramping along with spotting, bleeding, fever, chills, vaginal discharge, faintness, discomfort while urinating, or nausea and vomiting, or if the pain doesn't subside after several minutes of rest, call your practitioner.

What serious problems can cause abdominal pain during pregnancy?

• Ectopic pregnancy
  An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, typically in one of the fallopian tubes. It may cause some cramping and other symptoms in early pregnancy.
  If left untreated, an ectopic pregnancy can be life-threatening. Call your practitioner immediately if you have any of the following symptoms: abdominal or pelvic pain or tenderness, vaginal spotting or bleeding (can be red or brown, copious or scant, continuous or intermittent), pain that gets worse during physical activity or while moving your bowels or coughing, or pain in your shoulder.
  If you're bleeding heavily or having signs of shock (such as a racing pulse, dizziness, fainting, or pale, clammy skin), call 911.
  Miscarriage
  Miscarriage is the loss of a pregnancy in the first 20 weeks. Vaginal spotting or bleeding is generally the first symptom, followed by abdominal pain a few hours to a few days later.
  The bleeding may be light or heavy. The pain may feel crampy or persistent, mild or sharp, and may feel more like low back pain or pelvic pressure.
  Call your practitioner if you have signs of a miscarriage. If you have severe pain or heavy bleeding, you need to be seen immediately.
  Preterm labor
  You're in preterm labor (also known as premature labor) if you start to have contractions that efface or dilate your cervix before 37 weeks of pregnancy.
  Call your doctor or midwife right away if you're having any of the following symptoms in your second or third trimester (before 37 weeks):
  • An increase in vaginal discharge or a change in the type of discharge (if it becomes watery, mucus-like, or bloody – even if it's just pink or tinged with blood)
  • Vaginal spotting or bleeding
  • Abdominal pain, menstrual-like cramping, or more than four contractions in one hour(even if they don't hurt)
  • An increase in pressure in the pelvic area
  • Low back pain, especially if you didn't previously have back pain

Placental abruption
Placental abruption is a life-threatening condition in which your placenta separates from your uterus, partially or completely, before your baby's born.

There's wide variation in symptoms. A placental abruption can sometimes cause sudden and obvious bleeding, but in other cases there may not be any noticeable bleeding at first, or you might have only light bleeding or spotting. Or you might see bloody fluid if your water breaks.

You might have uterine tenderness, back pain, or frequent contractions, or the uterus might contract and stay hard – like a cramp or contraction that doesn't go away. You might also notice a decrease in your baby's activity. Immediate medical attention is a must.

Preeclampsia
Preeclampsia is a complex disorder of pregnancy that causes changes in your blood vessels and can affect a number of organs, including your liver, kidneys, brain, and the placenta. You're diagnosed with preeclampsia if you have high blood pressure and protein in your urine after 20 weeks of pregnancy.

Symptoms may include swelling in your face or puffiness around your eyes, more than slight swelling in your hands, and excessive or sudden swelling of your feet or ankles. (This water retention can lead to a rapid weight gain.)

With severe preeclampsia, you may have intense pain or tenderness in the upper abdomen, asevere headache, visual disturbances (such as blurred vision or seeing spots), or nausea and vomiting. If you have symptoms of preeclampsia, call your doctor or midwife immediately.

Urinary tract infections
Being pregnant makes you more susceptible to urinary tract infections of all kinds, includingkidney infections.

Symptoms of a bladder infection may include pain, discomfort, or burning when urinating; pelvic discomfort or lower abdominal pain (often just above the pubic bone); a frequent or uncontrollable urge to pee, even when there's very little urine in the bladder; and cloudy, foul-smelling, or bloody urine. Call your caregiver if you have any of these symptoms because an untreated bladder infection can lead to a kidney infection and premature labor.

Signs that the infection has spread to your kidneys – and that you need medical attention immediately – include a high fever, often with shaking, chills, or sweats; pain in your lower back or in your side just under your ribs, on one or both sides (and possibly in your abdomen as well); nausea and vomiting; and possibly pus or blood in your urine.

Other causes
Many other conditions can cause abdominal pain, whether you're pregnant or not. Some of the most common causes of abdominal pain that your practitioner will consider are a stomach virus,food poisoning, appendicitis, kidney stones, hepatitis, gallbladder disease, pancreatitis, fibroids, and bowel obstruction.

Both gallbladder disease and pancreatitis are often a result of gallstones, which are more common during pregnancy. Fibroids may grow during pregnancy and cause discomfort. And the pressure of the growing uterus on previously scarred intestinal tissue may cause bowel obstruction, which is most likely to occur in the third trimester.

What serious problems can cause abdominal pain during pregnancy?

• Ectopic pregnancy
  An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, typically in one of the fallopian tubes. It may cause some cramping and other symptoms in early pregnancy.
  If left untreated, an ectopic pregnancy can be life-threatening. Call your practitioner immediately if you have any of the following symptoms: abdominal or pelvic pain or tenderness, vaginal spotting or bleeding (can be red or brown, copious or scant, continuous or intermittent), pain that gets worse during physical activity or while moving your bowels or coughing, or pain in your shoulder.
  If you're bleeding heavily or having signs of shock (such as a racing pulse, dizziness, fainting, or pale, clammy skin), call 911.
  Miscarriage
  Miscarriage is the loss of a pregnancy in the first 20 weeks. Vaginal spotting or bleeding is generally the first symptom, followed by abdominal pain a few hours to a few days later.
  The bleeding may be light or heavy. The pain may feel crampy or persistent, mild or sharp, and may feel more like low back pain or pelvic pressure.
  Call your practitioner if you have signs of a miscarriage. If you have severe pain or heavy bleeding, you need to be seen immediately.
  Preterm labor
  You're in preterm labor (also known as premature labor) if you start to have contractions that efface or dilate your cervix before 37 weeks of pregnancy.
  Call your doctor or midwife right away if you're having any of the following symptoms in your second or third trimester (before 37 weeks):
  • An increase in vaginal discharge or a change in the type of discharge (if it becomes watery, mucus-like, or bloody – even if it's just pink or tinged with blood)
  • Vaginal spotting or bleeding
  • Abdominal pain, menstrual-like cramping, or more than four contractions in one hour(even if they don't hurt)
  • An increase in pressure in the pelvic area
  • Low back pain, especially if you didn't previously have back pain

Placental abruption
Placental abruption is a life-threatening condition in which your placenta separates from your uterus, partially or completely, before your baby's born.

There's wide variation in symptoms. A placental abruption can sometimes cause sudden and obvious bleeding, but in other cases there may not be any noticeable bleeding at first, or you might have only light bleeding or spotting. Or you might see bloody fluid if your water breaks.

You might have uterine tenderness, back pain, or frequent contractions, or the uterus might contract and stay hard – like a cramp or contraction that doesn't go away. You might also notice a decrease in your baby's activity. Immediate medical attention is a must.

Preeclampsia
Preeclampsia is a complex disorder of pregnancy that causes changes in your blood vessels and can affect a number of organs, including your liver, kidneys, brain, and the placenta. You're diagnosed with preeclampsia if you have high blood pressure and protein in your urine after 20 weeks of pregnancy.

Symptoms may include swelling in your face or puffiness around your eyes, more than slight swelling in your hands, and excessive or sudden swelling of your feet or ankles. (This water retention can lead to a rapid weight gain.)

With severe preeclampsia, you may have intense pain or tenderness in the upper abdomen, asevere headache, visual disturbances (such as blurred vision or seeing spots), or nausea and vomiting. If you have symptoms of preeclampsia, call your doctor or midwife immediately.

Urinary tract infections
Being pregnant makes you more susceptible to urinary tract infections of all kinds, includingkidney infections.

Symptoms of a bladder infection may include pain, discomfort, or burning when urinating; pelvic discomfort or lower abdominal pain (often just above the pubic bone); a frequent or uncontrollable urge to pee, even when there's very little urine in the bladder; and cloudy, foul-smelling, or bloody urine. Call your caregiver if you have any of these symptoms because an untreated bladder infection can lead to a kidney infection and premature labor.

Signs that the infection has spread to your kidneys – and that you need medical attention immediately – include a high fever, often with shaking, chills, or sweats; pain in your lower back or in your side just under your ribs, on one or both sides (and possibly in your abdomen as well); nausea and vomiting; and possibly pus or blood in your urine.

What Causes Abdominal Cramping?

Abdominal cramping is a painful condition caused by contractions of the muscles in and around the abdomen. The pain can be acute and sudden or chronic and gradual. Though most cases are caused by minor illnesses, severe cramping can sometimes be a sign of a more serious condition. Mild to moderate abdominal discomfort is generally a symptom ofdigestive problems or menstruation, but more severe pain may be caused by cancer, inflammation of an organ, or pregnancy-related disorders.

Digestive Conditions

Many cases of abdominal cramping are caused by things like diarrhea, food poisoning, constipation, lactose intolerance, or excessive gas. More serious problems with the digestive system such as Irritable Bowel Syndrome (IBS), ulcers, diverticular disease, bowel obstructions, or hernias may also cause cramps. Inflammation of the pancreas, Crohn's disease, and ulcerative colitis frequently cause abdominal discomfort as well.

Women-Specific Disorders

Women may experience abdominal cramping because of conditions affecting the ovaries anduterus. Menstrual cramps are one of the most common causes of abdominal pain for women, but other disorders may also cause a similar sensation. These include endometriosis, a condition in which cells from the uterus start to grow in other parts of the body, and uterine fibroids, which are benign tumors in the walls of the uterus. Some women also experience pain from ovarian cysts, which are small sacs of fluid that are generally benign, but may cause pain if they get too big.

Pregnant women are generally prone to gas and constipation, which makes them likely to get cramps, but they can also experience pain as the stomach ligaments stretch to accommodate the baby. Most of the time, abdominal cramps during pregnancy are nothing to worry about, but sharp pain and bloody discharge can be a sign of an ectopic pregnancy, miscarriage, or labor. Preeclampsia and placental abruption can also cause severe abdominal pain. Any situation in which a woman experiences sudden, prolonged abdominal pain, particularly with a headache, nausea, or bloody discharge, should be immediately addressed by a medical professional.

Referred Pain

People sometimes get abdominal cramps because of problems with organs that are near the abdominal cavity. This is known as referred pain because the discomfort is being transferred to the abdomen from another area of the body. Some common causes of this type of pain include kidney stones, gallbladder disease, and urinary tract infections. People may also get referred pain from conditions in the chest, like heart disease or pneumonia.

Less Frequent Causes

Some forms of cancer may lead to abdominal cramping, particularly in the later stages. This is particularly common with cancers of the liver, stomach, and reproductive organs. Another less usual cause is somatization disorder, an emotional condition primarily found in children that causes symptoms such as abdominal pain and strep throat. In rare cases, pain in the abdomen may be an indication of a medical emergency, such as when an organ ruptures. When this occurs, additional symptoms often include a stomach that is stiff to the touch, fever, and nausea or vomiting. This happens the most often with the appendix, but can occur with other organs too.

Treating Abdominal Cramps

The treatment for abdominal cramps almost always involves addressing the underlying cause. It's generally safe to treat mild to moderate symptoms with over-the-counter painkillers like acetaminophen and ibuprofen, though they are not safe for people with certain conditions, including ulcers and liver disease. Pain from indigestion or gas can often be relieved with antacids. People also commonly use heating pads or hot water bottles to relieve abdominal pain, particularly that from menstrual cramps. For conditions with no cure, like IBS, doctors usually prescribe an antispasmodic or antidiarrheal medication. Anyone experiencing severe or prolonged cramping, vomiting, constipation, or bloody discharge or stool should see a medical professional.

Reasons for Chronic Abdominal Pain

Chronic abdominal pain describes persistent or recurrent pain anywhere in the abdomen, which includes the area from the lower edge of the rib cage to the pelvic bone. The digestive organs, including the stomach, liver, gallbladder, pancreas, small intestine and colon, occupy the abdominal cavity. Infections, inflammation, tumors or other abnormalities of the abdominal organs can cause chronic abdominal pain.

Inflammatory Bowel Diseases

Inflammatory bowel diseases are chronic, relapsing disorders affecting the small intestine and colon. The Cleveland Clinic explains that the two variants of inflammatory bowel disease--ulcerative colitis and Crohn's disease--typically cause episodic, chronic abdominal pain. The pattern of pain mirrors the level of activity of the disease and the areas of intestinal involvement. Ulcerative colitis characteristically affects the colon and rectum. Crohn's disease may affect any area of the digestive tract, with the small intestine most frequently involved. The Crohn's and Colitis Foundation of America says that up to 1 million Americans are living with inflammatory bowel disease.

Celiac Disease

, also known as gluten-sensitive enteropathy, is a disorder of the small intestine in which ingestion of gluten-containing foods provokes an aggressive immune response. The absorptive structures of the small intestine sustain damage, leading to a markedly reduced capacity to absorb nutrients. Abdominalpain and gas, weight loss and bloating result. Foods containing wheat, rye or barley contain gluten, as do certain medicines and over-the-counter supplements and vitamins. Complete elimination of dietary gluten permits healing of previous intestinal damage and restoration of normal nutrient absorption. The National Institute of Diabetes and Digestive and Kidney Diseases reports that an estimated one out of 133 people in the United States has gluten-sensitive enteropathy.

Chronic Cholecystitis

Repeated gallbladder attacks among people with gallstones may lead to unrelenting gallbladder inflammation, a condition termed chronic cholecystitis. Inflammation causes scarring of the gallbladder wall and shrinkage of the organ. According to "The Merck Manual for Healthcare Professionals," episodic attacks of gallbladder pain, usually in the right upper region of the abdomen, typify chronic cholecystitis. Nausea and abdominal tenderness may occur, but fever is notably absent. Surgical removal of the gallbladder remains the definitive treatment for chronic cholecystitis

Abdominal hernia and the facts

Abdominal hernia and the facts

• Symptoms of a hernia include pain or discomfort and a localizedswelling somewhere on the surface of the abdomen or in the groin area.
• There are many different types of hernias.
• Serious complications from a hernia result from the trapping of tissues in the hernia (incarceration), which can result in the damage or death of the tissue.
• Hernia repair and the treatment of hernia complications require surgery.
• Lumps and swelling in the abdominal area should be examined by a doctor.

What is an abdominal hernia?

A hernia is a general term that refers to a bulge or protrusion of a body tissue or organ through the structure that normally contains it. For example, brain tissue can herniate as can discs in the spine. A common herniation in people is an abdominal herniation. The following article will discuss these hernias.

An abdominal hernia is an opening or weakness in the muscular structure of the wall of the abdomen. The peritoneum (lining of the abdominal cavity) protrudes through the opening and this defect causes a bulging of the abdominal wall. This bulging is usually more noticeable when the abdominal muscles are tightened, thereby increasing the pressure in the abdomen. Any activities that increase intra-abdominal pressure can worsen a hernia; examples of such activities are lifting, coughing, or even straining to urinate or have a bowel movement. Imagine a barrel with a hole in its side and a balloon that is blown up inside the barrel. Part of the inflated balloon would bulge out through the hole. The balloon going through the hole is like the tissues of the abdomen bulging through a hernia.

When the lining protrudes it can contain intra-abdominal contents such as the intestines and omentum (the layer of fat that covers abdominal organs). Serious complications from a hernia can result from the trapping of tissues in the hernia -- a process called incarceration. Trapped or incarcerated tissues may have their blood supply cut off, leading to damage or death of the tissue. The treatment of an incarceration usually involves surgery.

About 10% of the population will have an abdominal hernia during their lifetime. The hernias may occur in infants, children, and adults -- both inmales and females. However, the majority of abdominal hernias occur in males.

Where are abdominal hernias located?

The most common location forhernias is the groin (or inguinal) area. There are several reasons for this tendency. First, there is a natural anatomical weakness in the groin region which results from incomplete muscle coverage. Second, the upright position of human posture results in a greater force that pushes toward the bottom of the abdomen, thereby increasing the stress on these weaker tissues. The combination of these factors over time breaks down the support tissues, enlarging anypreexisting hole, or leads to a tear, resulting in a new hole.

Several different types of hernia may occur, and frequently coexist, in the groin area. These include indirect, direct, and femoral hernias, which are defined by the location of the opening of the hernia from the abdomen to the groin. Another type of hernia, called a ventral hernia, occurs in the midline of the abdomen, usually above the navel (umbilicus). This type of hernia is usually painless. Hernias can also occur within the navel (umbilical hernia).

What are abdominal hernia symptoms and signs?

Symptoms of a hernia include pain or discomfort and a localized swelling somewhere on the surface of the abdomen or in the groin area. A hernia can also be painless and only appear as a bulging. The pain may be intermittent or constant and the swelling may decrease or be absent, depending on the amount of pressure in the abdomen. Constant, intense pain at a bulge site may indicate a medical emergency and should be evaluated immediately by a doctor.

What are the different types of abdominal hernias?

Epigastric, umbilical, incisional, lumbar, internal, inguinal, hiatal, and Spigelian hernias all occur at different sites of the abdomen in areas that are prone to anatomical or structural weakness. With the exception of internal hernias (within the abdomen), these hernias are commonly recognized as a lump or swelling and are often associated with pain or discomfort at the site. Internal hernias can be extremely difficult to diagnose until the intestine (bowel) has become trapped and obstructed because there is usually no external evidence of a lump.

How is an abdominal hernia repaired and treated?

A hernia repair requires surgery. There are several differentprocedures that can be used for fixing any specific type of hernia. In the open surgical approach, following appropriate anesthesia and sterilization of the surgical site, an incision is made over the area of the hernia and carried down carefully through the sequential tissue layers. The goal is to separate away all the normal tissue and define the margins of the hole or weakness. Once this has been achieved, the hole is then closed, usually by some combination of suture and a plastic mesh. When a repair is done by suture alone, the edges of the defect are pulled together, much like sewing a hole together in a piece of cloth. One of the possible complications of this approach is that it can put excessive strain on the surrounding tissues through which the sutures are passed. Over time, with normal bodily exertion, this strain can lead to the tearing of these stressed tissues and the formation of another hernia. The frequency of such recurrent hernias, especially in the groin region, has led to the development of many different methods of suturing the deep tissue layers in an attempt to provide better results.

In order to provide a secure repair and avoid the stress on the adjacent tissue caused by pulling the hole closed, an alternative technique was developed which bridges the hole or weakness with a piece of plastic-like mesh or screen material. The mesh is a permanent material and, when sewn to the margins of the defect, it allows the body's normal healing process to incorporate it into the local structures. Hernia repair with mesh has proved to be a very effective means of repair.

After the hernia repair is 

completed

, the overlying tissues and skin are surgically closed, usually with absorbable sutures. More and more of hernia repairs are now being done using laparoscopic techniques.

What is laparoscopic abdominal hernia repair surgery?

A number of factors have led to the development of a new method of repair called laparoscopic hernia repair. This technique is an extension of a traditional mesh repair method that was used in patients who may have already experienced several hernia recurrences at the same site. Previously, this mesh repair approach had required a separate incision somewhat removed from the target area. However, with the progressive development of the instruments and techniques for laparoscopic surgery, the same procedure can now be done with several relatively small incisions. This allows the surgeon to enter the space behind the hernia defect and place the mesh with minimal injury to the surface of the abdomen. The advantages of this method include coverage of all the potential sites of groin hernia, which reduces the risks of recurrence while also decreasing the amount of postsurgical pain.

What about the use of a laser in abdominal hernia repair?

This is a relatively common question. It arises because, for a time, there were some surgeons marketing "laserhernia repair." While a laser may have been used to make the incision and to separate the tissues, the laser has no 

application

 in the repair of a hernia. It is impossible to perform the necessary structural repair with a laser, which functions essentially as a cutting tool. There has been no evidence that incisions by lasers will decrease pain or decrease healing time.

What kind of anesthesia is used for abdominal hernia surgery?

Most hernia repairs can be done with a variety of anesthetic methods. With modern general anesthetic techniques and monitoring, general anesthesiacan be very safe. However the surgery can also be performed under local anesthesia or regional anesthetics, often using sedation medications at the same time to help relax the patient. The specific type of anesthetic for an individual patient is selected after careful evaluation of the patient's general health and individual concerns.

Can strengthening the muscles make an abdominal hernia go away?

Unfortunately, exercising to improve a hernia is likely to aggravate the condition. The hernia exists because of a localized absence of muscle and supporting structure. Exercise can strengthen the surrounding muscles, thereby worsening the localized weakness and increasing the pressures inside the abdomen. The result is that more tissue can be forced through the defect and enlarge the hernia.

What can be done to prevent an abdominal hernia?

Most of the factors that lead to the development of hernias are beyond the control of the individual. Some of those factors are inherited and develop as the individual grows. The arrangement of the local tissues and their thickness and strength may greatly affect the relative risk of developing a hernia over a lifetime. However, that risk can be increased by failure to use good bodymechanics when lifting, poorabdominal support posture, and weight-control problems.

Are abdominal hernias inherited?

Since genetics dictate inherited features and structure, there is a significant risk of inheriting the anatomical features that may predispose to a hernia. There may also be inherited factors that result in tissue weakness, which ultimately allows the deterioration of the supporting structures and leads to the formation of a hernia. However, this does not necessarily imply that the offspring of an individual with a hernia will ultimately develop the problem. However, some infants are born withcongenital defects that lead to hernia development.

Do abdominal hernias usually develop on both sides of the body?

Groin hernias are somewhat more likely to develop on both sides. This is probably because the structural elements develop symmetrically, and the stresses on the body that occur over time are similar on both sides. When a patient becomes aware of a groin swelling on one side, examination by a doctor will often identify a small hernia on the opposite side.