Cramping during pregnancy

Are cramps during pregnancy normal?

Occasional mild cramps during pregnancy are usually nothing to worry about – although you'll want to mention them to your healthcare provider. If your cramps or abdominal pain are severe or persistent or happen alongside other symptoms, though, they may signal a problem.

Early in pregnancy, for example, it's common to have a small amount of cramping and bleeding. Usually the symptoms stop, and the pregnancy proceeds normally. Sometimes, though, early cramping or pain can be a sign of something amiss, such as an infection, an ectopic pregnancy, or a miscarriage.

Later in pregnancy, too, cramps might have a harmless cause, such as Braxton-Hicks contractions or round ligament pain. Or they may signal a problem, such as preterm labor or placental abruption.

Call your healthcare provider if:

• Your cramping doesn't go away after several minutes of rest
• The cramping or pain is severe
• You have other symptoms, such as fever or dizziness
• You have pain in the upper abdomen, or your abdomen is unusually sensitive to touch, especially when pressure is released (This could signal a serious abdominal infection.)

Early pregnancy cramps

Possible causes of early pregnancy cramps and minor abdominal pain include:

Implantation cramps

About 6 to 12 days after conception, when the fertilized egg implants in the uterus, you may have some light bleeding and light cramping. This is called implantation bleeding, and it usually lasts no more than a day or two.

The cramping and bleeding are less than you would feel with a normal period, and you might also experience:

• Nausea
• Breast tenderness
• Lower back pain
• Mood swings
• Headaches

Implantation bleeding is perfectly normal, and it happens to about 15 to 25 percent of pregnant women.

Gas and bloating

You're much more likely to have gas pain and bloating during pregnancy because of hormones that slow your digestion and the pressure of your growing uterus on your stomach and intestines. Gas and bloating cause intestinal discomfort more than cramping or pain, however, so call your healthcare provider if your discomfort is painful.

Also call if you have any of these symptoms:

• Blood in your stool
• Severe diarrhea

Constipation

Pregnancy hormones that slow down your digestion and the pressure of your growing uterus on your rectum can lead to constipation. So can dehydration. (If you're drinking enough, your urine will be clear or pale yellow.)

Call your healthcare provider if your constipation is severe or if you also have:

• Abdominal pain
• Diarrhea
• Mucus or blood in your stool

Cramping during orgasm

You may notice a bit of cramping during or right after an orgasm. That's because the uterus naturally contracts when you have an orgasm. As long as it's mild and short-lived, it's perfectly normal and nothing to be alarmed about.

Call your healthcare provider if you have more than mild cramping that doesn't go away after a few minutes or if you have:

• Pain
• Bleeding
• Discharge

Miscarriage

Miscarriage is the loss of a pregnancy in the first 20 weeks. Symptoms of an early pregnancy loss might include:

• Vaginal bleeding or spotting
• Abdominal cramps. The pain may be mild or sharp, intermittent or constant. Cramping might feel like the cramps you have with a menstrual period. It may also feel more like lower back pain or pelvic pressure.
• Passing of tissue or clot-like material from the vagina

Call your provider if you have signs of a miscarriage. If you have severe pain or heavy bleeding, you need to be seen immediately.

Ectopic pregnancy

An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, typically in one of the fallopian tubes. It may cause cramping in early pregnancy and other symptoms.

Left untreated, an ectopic pregnancy can be life-threatening. Call your provider immediately if you have any of the following symptoms:

• Abdominal or pelvic cramping or pain or tenderness (especially sharp, sudden pain that happens only on one side)
• Vaginal spotting or bleeding
• Pain that gets worse during physical activity or while moving your bowels or coughing
• Low back pain

If the fallopian tube ruptures, it's a medical emergency. Go to an emergency room immediately or call 911 if you have any of the following symptoms:

• Shoulder pain in addition to abdominal pain (This is from a buildup of blood under your diaphragm caused by the ruptured fallopian tube.)
• Sudden, severe pain in the abdomen or pelvis
• Weakness, dizziness, or fainting

Urinary tract infections

Being pregnant – at any stage – makes you more susceptible to urinary tract infections of all kinds, including kidney infections. It's important to call your provider if you think you might have a bladder infection, because it can lead to a kidney infection, which can cause serious illness and premature labor if left untreated. Most UTIs can easily be treated with antibiotics.

Symptoms of a bladder infection may include:

• Pain, discomfort, or burning when urinating
• Soreness or pain in the lower abdominal pain (often just above the pubic bone), back, or sides
• A frequent or uncontrollable urge to pee, even when there's very little urine in the bladder
• Cloudy, foul-smelling urine, or urine tinged with blood

Seek medical attention immediately if you have any of the following signs that the infection might have spread to your kidneys:

• A high fever, often with shaking, chills, or sweats
• Pain in your lower or mid-back, abdomen, or side, just under your ribs
• Nausea and vomiting with any of the above urinary symptoms
• Pus or blood in your urine

Cramping in the second and third trimester

In later pregnancy, cramping and abdominal pain can be due to some of the same issues as earlier (like gas and bloating, constipation, and sex). But it can also be caused by:  

Round ligament pain

Round ligament pain is generally a brief, sharp, stabbing pain or a dull ache that you may feel on one or both sides of your lower abdomen or deep in your groin. It can begin as early as 10 to 12 weeks but is more commonly felt in the second trimester when the ligaments in your pelvis that support your uterus stretch and thicken to accommodate its growing size. It might be worse on one side than the other.

You may feel a short, sharp pain if you suddenly change position, such as when you get out of bed or up from a chair or when you cough, roll over in bed, or get out of the bathtub. Or you may feel a dull ache after an especially active day. Call your provider if this discomfort continues even after you've rested.

Braxton Hicks contractions

After midpregnancy, you may start to feel a tightening sensation in your uterus from time to time. Before 37 weeks, these Braxton Hicks contractions should be infrequent, irregular, and essentially painless. You may notice them more when you're dehydrated, when you have a full bladder, at the end of the day, and/or during or after physical activity and sex. (Once you're close to your due date, this type of cramping during pregnancy can be an early sign of labor.)

Call your provider if:

• The contractions are accompanied by lower back pain.
• You feel more than six contractions an hour (even if they don't hurt).
• The contractions are coming at regular intervals.
• You also have vaginal discharge or bleeding.
• You have any other signs of premature labor.

Preterm labor

You're in preterm labor, also known as premature labor, if you start to have contractions that efface or dilate your cervix earlier than 37 weeks of pregnancy. Call your provider right away if you have any of the following symptoms before then:

• A dramatic increase in the amount or type of vaginal discharge (It may be watery, mucous, or blood-tinged.)
• Vaginal spotting or bleeding
• Abdominal cramps, including what feels like period cramps (with or without diarrhea)
• Regular or frequent contractions (even if they don't hurt)
• A rush or trickle of watery fluid from your vagina (ruptured membranes)

In addition, while some pelvic or lower abdominal pressure and lower backache is normal, call your provider if you have these symptoms in addition to any of the above or if the pain or pressure is constant and new to you.

Placental abruption

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

Symptoms can vary widely but include:

• Sudden bleeding
• Leaking bloody amniotic fluid
• Severe back pain
• Frequent painful contractions. Your uterus might contract and stay hard (like a cramp or contraction that doesn't go away) or feel tender. You might also notice that your baby's activity becomes less frequent.

Call your healthcare provider immediately if you experience any of these symptoms. Placental abruption is a medical emergency.

Ovarian cyst

An ovarian cyst doesn't usually cause any symptoms or problems during pregnancy. But if you have an ovarian cyst that ruptures or that twists (called ovarian torsion), it may cause:

• Sudden, severe pain (rupture)
• Intermittent lower abdominal pain on one side (ovarian torsion)
• Fever
• New onset nausea and/or vomiting
• Faintness or weakness

Ovarian torsion is a medical emergency. Go to the ER right away If you have a known ovarian cyst and suddenly develop abdominal pain.

Other causes of cramps during pregnancy

Many other conditions can cause cramping, whether you're pregnant or not. Some of the most common causes of cramping or abdominal pain during pregnancy include:

• Stomach virus
• Food poisoning
• Appendicitis
• Kidney stones
• Hepatitis or acute fatty liver
• Gallbladder disease
• Pancreatitis
• Fibroids
• 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.

Is there anything I can do to relieve cramps during pregnancy?

If you have minor pain and no symptoms of anything more serious, try these tips to relieve abdominal pain:

• Move around or do some gentle exercises to relieve gas pain and constipation. Ask you healthcare provider about taking simethicone to help the gas move through.
• Take a warm (not hot) bath or shower.
• Bend toward a pain for relief.
• Drink plenty of fluids.
• Try lying down. This might relieve pain caused by Braxton Hicks contractions.
• Consider taking acetaminophen according to package directions. (It's a good idea to talk with your healthcare provider before taking any medications, even over-the-counter meds, during pregnancy.)

When to call the doctor for cramps during pregnancy: A visual guide

If you're trying to decide whether your cramps warrant a call to the doctor, walk through the questions in this flow chart. Of course if you have any doubts about what to do, err on the side of caution and call your health provider.

Learn more:

• Prenatal massage to ease pregnancy aches and pains
• Pregnancy symptoms you should never ignore
• Stretching exercises for pregnancy