Pelvic, lower abdominal and back pain

In the pelvis there is a progressive softening, stretching and hypertrophy of the ligaments, and as the axis of the uterus changes, the positional relationship with the uterus and each other are altered leading occasionally to severe round ligamentary pain in the mid-trimester. The pubic symphysis, sacro-coccygeal and sacro-iliac joints are affected by the softening of the fibro-cartilage which occurs in response to pregnancy. The pubic symphysis gradually widens and there is an increased tendency to separation and instability of gait especially in the third trimester. These conditions may be associated with intense pain. As a result of the protrusion of the gravid uterus there is a compensatory increase in lumbar lordosis. It is believed that the combination of all these factors contributes to the backache that is a frequent complaint among pregnant women.

Management

In pregnancy, abdominal pain is a common presenting symptom of a urinary tract infection. Constipation, musculoskeletal strain, uterine contractions or indeed labour, placental abruption, are but some of the possible causes. In most cases, a good history and examination will identify the probable source of the pain, allowing appropriate action to be taken. Regular toning exercise, e.g. swimming, Pilates and yoga can all help you cope with the strain of pregnancy. Physiotherapy, osteopathy and massage may also help for specific or persistent problems.