What does round ligament pain feel like?
Most people describe round ligament pain as sharp, triggered by movement, and located deep within one or both sides of the lower abdomen or groin.
Round ligament pain is a common pregnancy symptom, affecting between 10 and 30 percent of pregnant women. It can be uncomfortable but is harmless. Many women begin to experience it in the second trimester.
In this article, learn more about what round ligament pain feels like and how to get relief.
What is round ligament pain?
Round ligament pain is one of the most common pregnancy discomforts.
The round ligaments are two ropelike cords of connective tissues that support the uterus on each side.
These ligaments connect the uterus to the groin and pubic region. As the uterus grows during pregnancy, the round ligaments can stretch.
When a pregnant woman moves, it can cause the round ligaments to spasm painfully.
Round ligament pain is considered rare in women who are not pregnant, but may occur in those with endometriosis.
How does it feel?
Round ligament pain feels like a deep, sharp, stabbing or stretching sensation that begins or worsens with movement. Some triggering movements may include rolling over in bed or taking a step.
The pain may travel upward or downward, from the hips into the groin.
Pregnant women usually experience round ligament pain on the right side of the lower abdomen or pelvis. However, some experience it on their left side or both sides.
When a person is not pregnant, the round ligaments that support the uterus are shorter and firm but flexible.
During pregnancy, these ligaments lengthen, thicken, and stretch, much like a rubber band.
In people who are not pregnant, the ligaments stretch and contract slowly. During pregnancy, they are under so much tension that they may stretch and contract rapidly, causing a ligament to spasm or pull on nerve endings.
Certain movements commonly trigger round ligament pain in pregnant women, such as:
- rolling over in bed
- standing up quickly
- other sudden movements
Most of the time, round ligament pain goes away on its own. However, people can take some steps to prevent it.
To avoid triggering round ligament pain, try:
- resting on one side, with the knees bent and pillows between the legs and under the belly
- changing positions slowly
- soaking in a warm (not hot) bath
- applying a heating pad
- wearing a maternity support belt
- taking acetaminophen
- practicing prenatal yoga
Some people find that changing their daily routine to include more rest and fewer sudden movements helps alleviate round ligament pain.
If a person experiences this pain frequently, they can speak to a doctor, who may recommend stretches and gentle exercises to help relieve discomfort.
Round ligament pain should resolve completely after childbirth.
When to see a doctor
Most of the time, a person will not need to see a doctor for round ligament pain.
However, sometimes pain in the lower abdomen and groin during pregnancy requires a doctor’s attention.
Pregnant women should speak to a doctor if they experience any of the following symptoms:
- sharp lower abdominal pain that lasts for more than a few seconds or does not go away after changing positions
- premature uterine contractions
- pain or burning during urination
- pain accompanied by cloudy or foul-smelling urine
- bleeding or spotting
- an increase or any other change in vaginal discharge
- fever or chills
- nausea and vomiting with abdominal pain
- an increase in pelvic pressure
- difficulty walking
These symptoms can indicate that the pelvic pain is unrelated to the round ligaments.
Other issues that can cause pain in the area include:
During pregnancy, round ligament pain is a common complaint that often begins in the second trimester.
Most of the time, the pain is sharp, short-lived, and located in the side of the lower abdomen or groin. Round ligament pain generally resolves on its own or after resting.
A person can take steps to reduce round ligament pain, including moving slowly, resting, and wearing a support band.
If severe pain in the lower abdomen does not resolve on its own or with rest, it is best to speak to a doctor.
6 Similarities Between Pregnancy & Period Symptoms That Are Just Downright Infuriating
Before I got an IUD, I used to be able to spot my period from a mile away. I dealt with mood swings, cravings, cramps, and more, and each time one of the symptoms happened, I'd know my period was on its way. This isn't exactly a wrong line of thought, except for the fact that, technically, the onset of pregnancy is very similar, symptoms-wise, to your period. In fact, when you're comparing pregnancy vs. period symptoms, you may be surprised to realize you're almost looking at the same exact list.
The idea of actually being pregnant when you just think it's your period, is possibly the scariest plot line any millennial woman can face. And it seems like it's actually a more probable reality than you might have thought, given that most of the symptoms of pregnancy can mask themselves as especially nasty bouts of PMS.
The best way to be sure that your symptoms are period-related is to be meticulous about how and what you're using as a form of contraception. But even contraception isn't 100 percent foolproof all the time, so the best thing you can do is keep a close eye. There's an obvious timeline to this: If you don't get your period, and you continue to have these weird symptoms for weeks on end, it might be time to see a doctor and set the record straight. Here are six pregnancy and period symptoms that are so similar, you might not be able to tell them apart.
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Round ligament pain plagues a fairly large number of pregnant people, if the complaints we hear in our office are any indication. The round ligaments are normally small bands that connect your uterus to other pelvic structures, and during pregnancy, they stretch and grow right along with the uterus. This stretching creates a perfect environment for these ligaments to cramp – thus causing the much-bemoaned round ligament pain. As miserable as it can be, round ligament pain is quite normal.
People often describe round ligament pain as a sudden intense cramp on one or both sides of the uterus, or even in the groin, and it usually comes and goes fairly quickly. The pain can be quite sharp, or can be mild or dull. It can happen just once or twice during a pregnancy, several times a day, or not at all. It most often occurs after a change in position, such as rolling over in bed or getting in and out of a car, or a sudden movement, such as a cough or sneeze.
So what can you do about it? Some people have success with the following:
- heating pad or warm rice bag held to the area
- applying support with hand during a cough or sneeze
- taking a warm bath
- gentle stretching daily, such as with prenatal yoga
- wearing a support belt, such as these
- massage therapy
- chiropractic care (ask us for a referral to one who works with our pregnant clients)
While round ligament pain is completely normal, make sure to notify your maternity healthcare provider if you experience any of the following:
- intense cramping that feels like menstrual cramps
- regular contraction activity
- dull back ache
- severe pain
- fever or chills
- vaginal bleeding
As with any of the other normal aches and pains of pregnancy, we welcome you to discuss your round ligament pain with us at your next visit so that we can help you find a way to manage your symptoms.
Cramping During Pregnancy: Normal or Something More?
Pregnancy gets you accustomed to a small amount of discomfort all over, from tender breasts to an achy back. But if you experience abdominal cramps and pain at any point when you’re expecting, you might be a bit concerned.
Some abdominal discomfort during pregnancy is normal, but it can sometimes signal a problem that warrants medical attention. Here's how to tell when cramps during pregnancy are likely nothing to worry about — and when they might be linked to something more serious.
Are cramps during pregnancy normal?
Some abdominal cramping and stomach pain in pregnancy is common. Early pregnancy cramps can be linked to many run-of-the-mill pregnancy symptoms, including constipation or increased blood flow to the uterus.
Later on in pregnancy, pregnancy pains could be linked to normal symptoms like Braxton Hicks contractions or round ligament pain.
Sometimes, however, abdominal pain during pregnancy can be a sign of a condition that requires medical attention, like a urinary tract infection, miscarriage, preterm labor or preeclampsia. It’s always safest to call your doctor about any symptom that concerns you.
The following are common causes of abdominal pain and cramps during pregnancy that can occur during any trimester:
Gas and bloating are a common pregnancy complaint due to elevated levels of progesterone, a hormone that relaxes the smooth muscles in your digestive tract.
As a result, your digestion slows down. This can lead to pregnancy-related bloating as well as constipation — both of which can bring on crampy feelings in your abdomen.
Your discomfort is probably digestion-related if passing gas or having a bowel movement provides some short-term relief. You can help prevent gastrointestinal issues by eating fiber-rich foods, having several small meals a day instead of three larger ones, taking your time when eating, and drinking plenty of water.
Continue Reading Below
If these changes don’t help, your doctor may recommend a stool softener for constipation.
Cramps after orgasm
Cramping during and after orgasm (sometimes paired with a lower backache) is normal and harmless in a low-risk pregnancy. It’s due to increased blood flow to the pelvic area and normal uterine contractions that happen when you orgasm.
Worried about orgasm hurting the baby during sex? It absolutely won’t. Post-sex cramps are absolutely not a reason to stop enjoying sex, if you’re feeling up to it and your practitioner has given you the green light.
To relieve the cramps, try lying down for a while or taking a nap.
Blood flow to the uterus
During pregnancy, your body sends more blood than usual to your uterus. This can result in a feeling of pressure in the area. Lying down to rest or soaking in a warm bath may help relieve these pregnancy pains.
Urinary tract infection (UTI)
An infection in the urinary tract can be symptomless, but often it causes pain or pressure in the pelvic area. Other symptoms include foul-smelling, cloudy or bloody urine, pain and burning when urinating, fever, or the need to pee more often.
A UTI can become serious if left untreated. Fortunately, a short round of antibiotics usually takes care of the infection.
Dehydration can cause Braxton Hicks contractions, or practice contractions that usually start midway through pregnancy and are very normal. Being thirsty is usually no big deal, but it’s important to drink up, since some research does suggest extreme dehydration may potentially increase the risk of preterm labor.
Drinking enough water during pregnancy means aiming for about eight to 10 glasses a day. You’ll you know you’re hydrated if urine is pale yellow or colorless and you’re making frequent bathroom breaks.
Cramping during the first trimester of pregnancy
Very early on in your pregnancy, you may experience menstrual-like cramping. These implantation cramps happen around the time your period is due, before you even know for sure that you’ve conceived.
Slight twinges and light implantation bleeding are a result of a fertilized egg attaching to the uterine wall, which happens about 6 to 12 days after fertilization and lasts only a day or so at most. A little R&R usually eases the discomfort.
An ectopic pregnancy — when a fertilized egg implants somewhere other than the uterus, usually a fallopian tube — can cause first trimester cramps, usually in the lower abdomen.
It may begin as a dull ache and progress to spasms or cramps that may worsen with time. Ectopic pregnancies often also cause vaginal bleeding, shoulder pain, lightheadedness and faintness.
If you think you may be experiencing an ectopic pregnancy, see a doctor right away. Ectopic pregnancies are diagnosed with ultrasounds and blood tests around week 5 to 6 of pregnancy.
So if you’ve already had your first trimester ultrasound and everything looked normal, an ectopic pregnancy isn’t the cause behind your cramping.
What do miscarriage cramps feel like? First trimester cramping during pregnancy that’s linked to a miscarriage can be dull or similar to bad period cramps. It usually occurs in the abdomen, lower back and/or pelvic area and is accompanied by bleeding. Although most miscarriages happen in the first trimester, they can occur in the second trimester as well.
It can be difficult to tell if your early pregnancy cramps are a miscarriage — or simply implantation or your uterus expanding. The most important miscarriage symptom to look out for is bleeding. Unlike implantation cramping, miscarriage cramping is usually accompanied by bleeding that continues for several days and often gets heavier with time.
If you’re concerned that you may be miscarrying, it’s always a good idea to call your practitioner.
Cramping during the second trimester of pregnancy
Round ligament pain
Round ligaments are bands of tissue that hold the uterus in place. As pregnancy progresses, these ligaments stretch, which can cause aches and cramps or sharp pain that occurs on one or both sides of the lower abdomen.
Round ligament pain usually starts in the second trimester but can occur any time in the second half of pregnancy. It often occurs during exercise; after you get out of bed, sneeze, cough or laugh; or when you move suddenly. These cramps during pregnancy can last for anywhere from a few seconds to a few minutes. For relief, get plenty rest and try to change positions slowly.
Braxton Hicks contractions
These so-called “practice contractions” can begin at around 20 weeks of pregnancy and are your body’s way of warming up for real labor. Braxton Hicks contractions are relatively short (only seconds to a couple of minutes) and irregular.
When you experience a Braxton Hicks cramping during the second trimester of pregnancy onwards, change positions. Sit or lie down if you’re standing (and vice versa), for example, and it should subside.
Keep in mind that placental abruption, preeclampsia and preterm labor can occur during the second trimester as well. Keep reading below for more information on these conditions.
Cramping during the third trimester of pregnancy
If the placenta separates (partially or completely) from the uterine wall before a baby is born, it can cause a severe and persistent abdominal pain as well as back pain and vaginal bleeding.
Placental abruption is most common in the third trimester, but it can occur in the second trimester. If you’re experiencing abdominal pain with bleeding any time in the second half of pregnancy, it’s important to get immediate medical attention.
Preeclampsia develops in the second half of pregnancy, usually in the third trimester, and is characterized by sudden high blood pressure and protein in the urine.
It can cause upper abdominal pain along with severe headaches that don't go away with painkillers, severe swelling in the face and hands, sudden weight gain that’s unrelated to eating, vision changes, nausea or vomiting, and shortness of breath.
It’s important to see your doctor right away if you’re experiencing any of the above symptoms. Left untreated, preeclampsia is dangerous for both you and your baby, since it can decrease the amount of oxygen and nutrition that flows to a fetus and increase the risk of placental abruption. If it’s caught early and treated, you have excellent odds of having a healthy pregnancy.
Labor contractions come at regular intervals, last between 30 to 70 seconds, get closer together and stronger over time and don't go away when you change positions. Other signs of labor include feeling pressure in the pelvic area (like your baby is pushing down) and a change in vaginal discharge (leaking fluid or light bleeding).
Your doctor should have told you when to call if you experience cramping during the third trimester of pregnancy that you think may be labor contractions. Always be sure to call if you’re bleeding, your water breaks or you have signs of preeclampsia like sudden swelling or blurry vision.
If you experience these symptoms before 37 weeks, you could be experiencing preterm labor. If you think you’re in preterm labor, contact your doctor even if you're not sure or go to the hospital right away.
How to relieve pregnancy cramps
Pregnancy cramp relief depends on the cause behind the pain you’re experiencing. These tips can relieve the most common causes of abdominal cramps during pregnancy:
- Lie down and relax for a while, which can relieve pregnancy cramps related to implantation, orgasm, increased blood flow to the uterus and round ligament pain
- Drink plenty of water, which may ease any cramping related to dehydration, bloating or constipation
- Soak in a warm bath, which can help ease pregnancy cramps related to increased uterine blood flow
- Wear a belly band, which can help relieve abdominal cramps linked to round ligament pain in the second half of pregnancy
- Change positions (lie down if you’re standing, for example) if you think you’re having Braxton Hicks contractions
When to call your doctor
When should you be concerned about cramps during pregnancy? To be on the safe side, always contact your practitioner if you’re worried about pregnancy pains including cramping.
Be sure to get in touch with your practitioner right away if you’re experiencing:
- Severe lower abdominal pain in the center or on one or both sides that doesn’t subside (even if it isn’t accompanied by bleeding)
- A sudden increase in thirst, accompanied by a decrease in urination, or no urination for a full day
- Severe headache that won't go away, vision changes, sudden swelling and/or unexplained weight gain (which are symptoms of preeclampsia)
- Fever or chills
- Heavy bleeding, or bleeding with cramps or severe pain in the lower abdomen
- Bloody diarrhea
- Pain or burning during urination, difficulty urinating or blood in your urine
- Dizziness or feeling faint
- More than four contractions in one hour (especially if it happens before 37 weeks of pregnancy), as it may be a sign of labor
From the What to Expect editorial team and Heidi Murkoff, author of What to Expect When You're Expecting. What to Expect follows strict reporting guidelines and uses only credible sources, such as peer-reviewed studies, academic research institutions and highly respected health organizations. Learn how we keep our content accurate and up-to-date by reading our medical review and editorial policy.
- What to Expect When You're Expecting, 5th edition, Heidi Murkoff.
- BMC Pregnancy and Childbirth, Associations between hydration state and pregnancy complications, maternal-infant outcomes: protocol of a prospective observational cohort study, February 2020.
- American College of Obstetricians and Gynecologists, Preeclampsia and High Blood Pressure During Pregnancy, October 2019.
- WhatToExpect.com, Cramps and Contractions After Sex During Pregnancy, August 2020.
- WhatToExpect.com, Are You Drinking Enough Water During Pregnancy?, October 2019.
- WhatToExpect.com, UTIs During Pregnancy, November 2019.
- WhatToExpect.com, Preterm Labor, August 2018.
- WhatToExpect.com, Spotting or Bleeding During Pregnancy, March 2019.
- WhatToExpect.com, Bloating and Gas During Pregnancy, March 2019.
- WhatToExpect.com, Ectopic Pregnancy, May 2019.
- WhatToExpect.com, Miscarriage and Pregnancy, May 2020.
- WhatToExpect.com, Placental Abruption During Pregnancy, November 2018
- WhatToExpect.com, Preeclampsia, April 2019.
- WhatToExpect.com, Round Ligament Pain, July 2018.
- WhatToExpect.com, Labor Contractions, January 2020.
- WhatToExpect.com, 10 Signs of Labor, February 2020.
- WhatToExpect.com, Braxton Hicks Contractions, October 2020.
- WhatToExpect.com, What Is Implantation?, September 2020.
- WhatToExpect.com, Is It Implantation Bleeding — or Just My Period?, November 2020.
- Mayo Clinic, Ectopic Pregnancy, February 2020.
- Mayo Clinic, What Causes Round Ligament Pain During Pregnancy, April 2020.
- Mayo Clinic, Placental Abruption, January 2020.
- American College of Obstetricians and Gynecologists, Urinary Tract Infections, February 2020.
- American College of Obstetricians and Gynecologists, Ectopic Pregnancy, February 2018.
- American College of Obstetricians and Gynecologists, How to Tell When Labor Begins, May 2020.
- American Academy of Family Physicians, Urinary Tract Infection, October 2018.
- American College of Obstetricians and Gynecologists, Early Pregnancy Loss, August 2015.
- American College of Obstetricians and Gynecologists, Problems of the Digestive System, January 2014.
- Mayo Clinic, Symptoms of Pregnancy: What Happens First, May 2019.
- Mayo Clinic, Molar Pregnancy, December 2017.
- Mayo Clinic, Signs of Labor: Know What to Expect, May 2019.
- National Institutes of Health, National Library of Medicine, Hydatidiform Mole, September 2018.
- National Institutes of Health, National Institute of Child Health and Human Development, What Are the Risks of Preeclampsia & Eclampsia to the Mother? November 2018.
- Stanford Children’s Health, The First Trimester, 2020.
- UpToDate.com, Pregnancy Loss (Miscarriage): Risk Factors, Etiology, Clinical Manifestations, and Diagnostic Evaluation, June 2020.
During pain period ligament round
Round ligament pain
Round ligament pain (RLP) is pain associated with the round ligament of the uterus, usually during pregnancy. RLP is one of the most common discomforts of pregnancy and usually starts at the second trimester of gestation and continues until delivery. It usually resolves completely after delivery although cases of postpartum RLP (that is, RLP that persisted for a few days after delivery) have been reported. RLP also occurs in nonpregnant women.
The round ligament of the uterus goes from the pelvis, passes through the internal abdominal ring, and runs along the inguinal canal to the labia majora. It is the structure that holds the uterus suspended inside the abdominal cavity. There are at least 2 other round ligaments in the human body, the round ligament of the liver (ligamentum teres hepatis) and the round ligament of the head of the femur (ligamentum teres femoris).
The most common symptoms of RLP are:
- Sudden pain in the lower abdomen, usually in the right side of the pelvic area that can extend to the groin.
- Shooting abdominal pain when performing sudden movements or physical exercise. Pain is sudden, intermittent and lasts only for a few seconds.
The pathogenesis of RLP is varied. Although very common during pregnancy, non-gestating women can also experience RLP. The most common causes of RLP are as follows:
- RLP may be caused by a spasm or cramp when the ligament contracts involuntarily. The ligament pulls on nerve fibers and sensitive structures of the female reproductive system. Since the uterus tends to be oriented towards the right side of the body, the pain is also often felt on the right side. This leads to frequent confusion with appendicitis.
- During pregnancy, the uterus expands to accommodate the growing fetus. This increase in size and weight of the uterus puts stress on the ligament that holds it, causing it to stretch. During physical exertion or sudden movements, the ligament is overly stretched, causing pain.
- Varicosities, e.g. enlargement of the blood vessels of the round ligament can occur during pregnancy, causing pain and swelling. The varicocoele starts at the veins draining the round ligament and the inguinal canal and is associated with engorgement of the veins of the ovaries and the pelvis during pregnancy.
- Endometriosis that infiltrates or borders the uterine round ligament can cause RLP in fertile, non-gestating women.
- Other pathologies that involve the uterine round ligament can cause RLP.
Abdominal pains during pregnancy may be due to various pathologies. RLP is one of the most common and benign of these pains. However, diagnosis of RLP is problematic. Some of the conditions that may present symptoms similar to those of RLP are appendicitis, ectopic pregnancy, kidney stones, urinary tract infection, uterine contractions, inguinal hernia, ovarian cysts, and endometriosis. If abdominal pain is continuous and accompanied by vaginal bleeding, excessive vaginal discharge, fever, chills, or vomiting, then it is most unlikely to be RLP and immediate consultation with a health care provider is warranted.
Physical examination, ultrasonography, and blood and urine tests may be able to pinpoint the actual cause of abdominal pain. In some cases, however, RLP was only diagnosed during exploratory surgery.
In many cases, RLP is confused with other conditions that cause abdominal pain. Described below are some problematic diagnoses related to RLP.
- RLP and appendicitis
A 22-year-old pregnant woman presenting abdominal pains was initially diagnosed with RLP and was discharged. Subsequent symptoms and further tests revealed acute non-perforated appendicitis that required surgery. Appendectomy was successful but premature labor occurred 7 days after discharge, leading to spontaneous abortion.
- RLP and inguinal hernia
Several cases of varicosity, of the round ligament during pregnancy leading to RLP have been reported although they were frequently misdiagnosed as inguinal hernia.
In one case, a woman in the 28th week of gestation developed a lump in the left pubic area. The swelling was prominent when standing but not in the supine position and has a cough impulse. Ultrasonography revealed varicosities on the uterine round ligament.
In another case, a woman at 22 weeks gestation was diagnosed with inguinal hernia and underwent surgery. Explorative surgery did not locate a hernia but revealed varicosities of the round ligament. Resection of the uterine ligament was successfully performed and no perinatal and postpartum complications were reported.
- Postpartum RLP
Several cases of postpartum RLP have been reported. In one case, a 27-year-old woman presented with abdominal pain 24 hours after normal vaginal delivery. Another case was that of a 29-year-old woman who presented with RLP 3 days after delivery. In both cases, initial diagnosis was inguinal hernia. In the first case, emergency surgery did not locate any hernia but found the round ligament of the uterus to be edematous and filled with thrombosed varicose veins. The thrombosed part was excised and the patient recovered without sequelae.
Another case report described a 37-year-old woman presenting with inguinal mass 6 days after normal vaginal delivery. CT and MRI revealed thrombosed blood vessels along the inguinal course of the uterine round ligament that extended towards the labia majora.
- RLP and endometriosis
Several cases of inguinal endometriosis, that infiltrates the round ligament of the uterus have been reported in fertile, non-pregnant women. In the majority of these cases, diagnosis was problematic. In some cases, definitive diagnosis of round ligament endometriosis was only possible during exploratory surgery.
- RLP and myoma
Cases of myoma-like growth occurring on the uterine round ligament have been reported.
- RLP and IVF
Gonadotropin stimulation during in vitro fertilization can induce cyst development in certain parts of the female reproductive system. A case report documented the development of a mesothelial cyst on the uterine round ligament of a woman after IVF stimulation.
Once RLP has been diagnosed, there are many ways to reduce the pain without jeopardizing the pregnancy.
- Analgesics. Acetaminophen or paracetamol is safe to take during pregnancy, thus is the most commonly prescribed pain reliever for pregnant women with RLP.
- Heat application. Applying a hot compress to the area of pain may give some relief. Hot soaks and hot baths may also help.
- Modifications in movements and position. Triggering factors that can cause RLP are sudden movements, (e.g. sitting up and down, standing up, sneezing, coughing), physical exertion, and long periods in the same resting position. A change in daily activities can help find relief and prevent worsening of the condition. Avoid sudden movements that can cause spasms of the ligament. When about to sneeze or cough, brace yourself by bending and flexing the hips to minimize the pull on the ligaments.
- Rest. Resting is one of the best remedies against RLP. When lying down, changing position slowly and regularly is recommended.
- Physical exercises. Daily stretching exercise may be recommended by a gynecologist. An example of such an exercise is kneeling with hands and knees on the floor, then lowering your head to the floor, and keeping your bottom up in the air. The so-called pelvic (hip) tilt exercise also appears to help in reducing pain intensity and duration.
- Surgery. In RLP pathologies involving endometriosis and ademyosis, surgery may be necessary to perform resection of the ligament or removal cysts and myoma.
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What Does Round Ligament Pain Feel Like: Symptoms, Diagnosis, Treatment
There are no specific tests to diagnose round ligament pain. If this is your first pregnancy and you’re unfamiliar with this type of pain, make a doctor’s appointment to discuss your symptoms if you’re concerned.
In most cases, your doctor can diagnose round ligament pain based on a description of your symptoms. They may conduct a physical examination to ensure the pain isn’t caused by another problem.
Even if you know what round ligament pain feels like, it’s important to notify your doctor if your round ligament pain doesn’t resolve itself after a couple of minutes, or if you have severe pain accompanied by other symptoms. These include:
- pain with bleeding
- pain with urination
- difficulty walking
Round ligament pain occurs in the lower abdomen, so you may think that any pain you feel in this region is due to stretching ligaments. But this isn’t always the case. You could have a more serious condition requiring a doctor’s attention.
Severe stomach pain during pregnancy might occur for a number of reasons, including placental abruption. Other illnesses that can cause lower stomach pain include appendicitis, a hernia, and problems with your liver or kidneys.
In the case of severe pain, your doctor may need to rule out preterm labor. Preterm labor can feel like round ligament pain. But unlike round ligament pain which stops after a couple of minutes, preterm labor pain continues.
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Anatomy, Abdomen and Pelvis, Uterus Round Ligament
In some rare cases, the gubernaculum may fail to adhere to the uterus. This may cause the ovaries to descend through the inguinal canal into the labia majora. This abnormal position of the ovaries may resemble the testes.
During the reproductive years, pelvic endometriosis may penetrate round ligaments. Endometriosis is defined as the presence of ectopic endometrial glands and stroma outside the uterus. This may lead to severe dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility. Pelvic endometriosis can affect the uterosacral ligaments, rectum, vagina, cul-de-sac, and urinary bladder. The pelvic endometriosis may infiltrate the round ligaments of the uterus when it is deep and extensive. Magnetic Resonance Imaging (MRI) is helpful for the diagnosis of the round ligament lesions. If medical therapy fails, surgery remains the best therapeutic treatment for advanced endometriosis.
Round Ligament Varices (RLV) are conditions where veins become tortuous and twisted. This condition develops during pregnancy. Venous blood from the round ligament and the inguinal canal is drained into the inferior epigastric vein. During pregnancy, there is an increase of blood volume and cardiac output. An enlarged gravid uterus increases pressure leading to stagnation of blood in these veins. The increased amount of progesterone contributes to venous dilatation and smooth muscle relaxation. Increased venous return and engorgement of veins and tributaries progress to Round ligament varices (RLV). The patient may present with bilateral asymptomatic inguinal swellings during pregnancy. Ultrasound examination may help diagnose and differentiate Round ligament varices (RLV) from an inguinal hernia. Multiple dilated vessels without bowel contents may be visualized on ultrasound examination. There is conservative management, and close monitoring is recommended throughout pregnancy. After pregnancy, the hormonal effects of progesterone and the pressure of the gravid uterus are relieved, leading to spontaneous resolution during the postpartum recovery period.
Round Ligament Pain
The round ligaments of the uterus increase in diameter and length during pregnancy. During mid-trimester, the round ligaments may cause cramping and pain due to stretching and contractions of the round ligaments. At times, this pain may be sharp and can cause pulling sensations. This pain is considered to be physiological in normal pregnancy. Usually, the pain of the round ligaments is temporary and resolve spontaneously by resting. The round ligaments pain is not considered a symptom of any disease. If pain persists, immediately follow up is recommended to rule out other causes of pain during pregnancy. There is a sharp reduction of hormones levels after delivery. After the postpartum period, the uterine size is reduced to the normal non-pregnant state. The hypertrophic round ligaments of the uterus also shrink to the normal, non-pregnant state. Following postpartum recovery, the round ligaments pain may happen, but it is unlikely to happen because of sudden movements of pelvic organs.
In a non-pregnant female, the round ligaments pain may happen, but it is unlikely. In a non-pregnant female, the round ligament is a firm and flexible structure. Sudden movements of pelvic organs may not cause any symptoms.
Warm compresses to the area may relieve pain. Acetaminophen is safe to take during pregnancy.
Acetaminophen is the most prescribed analgesic during pregnancy.
Rest during pregnancy is one of the best remedies for the round ligaments Pain.
Sudden active movements are discouraged to prevent worsening of the round ligaments Pain.
Prolonged standing and heavy lifting should be avoided to prevent worsening of the round ligaments Pain.
Daily stretching exercise may be helpful. Bending and flexion of the hip joint may reduce the pulling sensations and discomfort from stretching.
Pregnant patients are encouraged to find pain triggers and to avoid those discovered triggers.
Uterus Ligaments, Mesosalpinx, Mesovarium, Ovarian Artery, Ovarian Vein, Suspensory Ligament, Uterine Tube, Ovary, Broad Ligament, Round Ligament, Ovarian Ligament, Cardinal Ligament, Uterosacral Ligament, Vagina. Contributed Illustration by Beckie Palmer (more...)
Kaniewska M, Gołofit P, Heubner M, Maake C, Kubik-Huch RA. Suspensory Ligaments of the Female Genital Organs: MRI Evaluation with Intraoperative Correlation. Radiographics. 2018 Nov-Dec;38(7):2195-2211. [PubMed: 30422765]
Simó Alari F, Caveriviere P, Gutierrez I, Gillon C. Laparoscopic excision of round ligament endometrioma. BMJ Case Rep. 2018 Jun 29;2018 [PMC free article: PMC6040546] [PubMed: 29960956]
Bellier A, Cavalié G, Marnas G, Chaffanjon P. The round ligament of the uterus: Questioning its distal insertion. Morphologie. 2018 Jun;102(337):55-60. [PubMed: 29731327]