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Dear Doctor,
I am in the middle of my second pregnancy and I have been getting recurrent low abdominal pains. Simple painkillers are of no help. What should I do?
Answer
Would men be able to handle childbirth better than women??Low abdominal pains, or just general pelvic aches and pains, are pretty common symptoms in pregnancy. In the vast majority of cases, the pains are innocent in nature and the pregnancy progresses without any untoward effects either to the mother or the developing baby.
As pregnancy advances, there are progressive structural changes within the lower abdomen and pelvis. Nearly every pelvic organ is involved in some changes, including the muscles, joints and their connecting structures. Pelvic joints may separate slightly, consequently contributing to pain during movements or changes in posture.
Changes in the urinary and bowel systems may also contribute to some pelvic symptoms. Very rarely, low abdominal pains may be early signs of a miscarriage or premature labor, or other serious conditions.
If you have lingering pain that is cause for concern, a thorough medical assessment is warranted. Your obstetrician or midwife will initially carry out a physical exam to look out for any specific telltale signs. Any suspicion of miscarriage or premature labour would necessitate an internal exam. You may end up with some tests to exclude specific things like a urine infection, or other more serious conditions. A fetal assessment will be done at the same time, and may include a scan.
Most women will not be diagnosed with anything serious. Specific diagnoses, like a urine infection, will be treated appropriately. In the rare scenario where uterine contractions are suspected, further interventions may be warranted depending on the stage of the pregnancy.
Attempts to prolong the pregnancy to allow further fetal maturity may be instituted. But if preterm labor ensues very early, the pregnancy may not be salvageable.
If the cause of your pains is thought to be related to changes in the pelvic joints and muscles, you may have to contend with lingering discomfort till the end of the pregnancy. There is no real cure for such pains. But supportive measures may help to ease the discomfort.
So called obstetric belts may ease direct pressure on the pelvic region and provide some relief. Some will need an occasional painkiller. It helps to be reviewed by a physiotherapist in order to get advice on appropriate physical activities, posture or even other novel musculo-skeletal therapies.
Keep a watch on other danger signs of pregnancy. Your obstetric team should already have given you a list of danger signs to be aware of. If your pains are associated with other danger signs, that raises the urgency for review and exclusion of more serious conditions.
Nevertheless, it's likely that your symptoms are just innocent in nature, and your pregnancy should progress all the way to term.
Dr Alfred Murage is a consultant gynecologist and fertility specialist. [email protected]
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