Pregnancy | Causes of abdominal cramping and pain

According to the American Pregnancy Association (APA), abdominal pain can be a normal part of pregnancy as your body changes to accommodate your growing baby. Often, abdominal cramping and pain are associated with everything from constipation and increased blood flow to the uterus during the first trimester, to Braxton Hicks contractions or round ligament pain in the second and third trimesters.

While there are many harmless causes of abdominal cramping and pain when you’re expecting, there can be more concerning causes, which should be checked out by your caregiver as soon as possible.

ALSO SEE: 10 pregnancy warning signs to look out for

Here’s how to tell when the pains are nothing to be concerned about, and when they’re more serious.

Harmless causes of abdominal cramping and pain

Implantation bleeding

Early in your pregnancy, even before you know you’ve conceived, you may experience menstrual-like cramping around the time your period is due. As soon as the fertilised egg implants in the womb, studies show about 20% of women will experience some cramps resembling period-type pain and implantation bleeding. Rest assured this discomfort will only last a day or so.

Gas and bloating

It’s common for expecting moms to experience gas and bloating during pregnancy. This is the result of elevated levels of progesterone, a hormone that relaxes the muscles in your digestive tract and results in your digestion slowing down. A fibre-rich diet including beans and lentils, fresh fruit and vegetables, oats, nuts and seeds can help boost your bowel movements during pregnancy. Drinking enough water, as well as gentle exercise, can also help move things along. If you feel your diet isn’t helping to ease your abdominal cramping and pain, ask your doctor to recommend a stool softener that’s safe to use during pregnancy.

Cramps after an orgasm

If you have an uncomplicated pregnancy, it’s completely safe to enjoy sex throughout. The foetus is safely contained within a fluid-filled amniotic sac that essentially acts as a shock absorber. The entrance to your cervix is sealed by a mucous plug during your pregnancy, so, in the absence of complications, there really isn’t much to worry about. “Cramping during and after an orgasm (sometimes paired with lower backache) is common and harmless in a low-risk pregnancy,” says pregnancy and parenting website “The cramping can also be due to increased blood flow to the pelvic area or normal uterine contractions during orgasm.”

ALSO SEE: 5 important things you should know about sex during pregnancy and after birth

Round ligament pain

Round ligament pain is one of the most common complaints during pregnancy, and is often felt during the second trimester. This is completely normal. “It can be characterised by a sharp stabbing pain when you change positions, or an achy, dull, lingering pain. Round ligament pain is caused by the two large ligaments that run from your uterus to your groin. As the uterus grows, these ligaments are stretched and create discomfort,” explains the APA. You’ll often notice this pain when you make any sudden movements, like getting out of bed, sneezing, coughing, laughing or during exercise. According to, this feeling can last from a few seconds to a few minutes. Get plenty of rest and change positions slowly when you experience this.

Braxton Hicks contractions

Sometimes called “false contractions”, Braxton Hicks are nothing to be concerned about. “Most moms experience them irregularly and they never last longer than a minute,” says Dr Antoinette du Preez, senior lecturer in midwifery at the School of Nursing Science at North-West University. She says first-time moms usually experience these “false contractions’ during the last four weeks of pregnancy (from 36 weeks), but you may also feel them as early as the second trimester of pregnancy, says the APA. “Braxton Hicks usually occur when the baby turns to get ready to move into the pelvis for labour,” says Dr du Preez. They can also be brought on by strenuous exercise, sexual intercourse or lifting heavy objects. Unlike true labour, Braxton Hicks contractions are usually not painful, they don’t occur at regular intervals, they aren’t close together, they may stop when you move positions or stop the activity you are busy with, and they don’t get longer as they go on, or feel stronger over time.

Try the following tips to ease the discomfort of Braxton Hicks:

  • Take a walk as the contractions often stop when you move or change positions.
  • Take a nap or rest for a while if you’ve been very active.
  • Do something relaxing, like taking a warm bath. This will relax your ligaments and ease the pain.
  • Get a pregnancy massage.

ALSO SEE: How to tell the difference between true labour and false labour

Other discomforts

There are several other causes of abdominal discomfort during pregnancy that are generally non-threatening and harmless. These include:

  • Your growing uterus
  • Viruses
  • Kidney stones
  • Fibroids
  • Food sensitivities.

When it’s more serious

Ectopic pregnancy

An ectopic pregnancy occurs in about 2% of all pregnancies, with a recurrence rate of 25%. An ectopic pregnancy involves the fertilised egg implanting outside the uterine cavity, usually in a fallopian tube, cervix, ovaries or abdominal cavity. This happens because the fertilised egg is unable to work its way down the fallopian tube and into the uterus quickly enough due to an infection or inflammation that may have partially or entirely blocked the fallopian tube. The infection or inflammation in the tubes can result from pelvic infections like chlamydia or tuberculosis, past surgery in the area »
or endometriosis. Unfortunately, an ectopic pregnancy can’t continue to term and needs immediate medical attention. According to the APA, you may experience intense pain and bleeding between week six and 10 of pregnancy.

Placental abruption

A placental abruption causes the placenta to partially, or completely, separate from your uterus before your baby is born. This condition can be dangerous for both you and your baby. The detached areas of the placenta are unable to deliver oxygen and nutrients to your baby, who is then dependent on the remaining placental unit, which may or may not compensate for the loss in function. The APA says one symptom of placental abruption is constant pain that causes your stomach to stay hard for an extended period of time without any relief.

Other signs include:

  • Bloody fluid or premature breakage of your waters
  • Uterine tenderness
  • Rapid contractions and possible premature labour.

ALSO SEE: 3 placenta problems explained


Preeclampsia occurs in about 7 to 10% of all pregnancies and is one of the most common causes of maternal deaths in South Africa. It’s a serious blood pressure disorder that develops after the 20th week of pregnancy, but it can be managed and treated successfully if caught in time. “Upper abdominal pain, usually under your ribs on the right side, can accompany other symptoms used to diagnose preeclampsia. Nausea, vomiting and increased pressure on your abdomen are additional symptoms that will affect your abdomen,” explains the APA. The pregnant mother usually experiences symptoms such as headache, facial oedema (swelling), pulmonary oedema, epigastric pain over the liver area, kidney impairment and oedema of the legs and feet. These severe symptoms are associated with high maternal mortality rates in developing countries.

Urinary tract infection

Urinary tract infections can complicate up to 20% of pregnancies and are responsible for 10% of all antenatal admissions. While easily treated during pregnancy, a UTI can cause complications. “Most often recognised by pain, discomfort or burning when you urinate, UTIs can also produce lower abdominal pain.
Should you notice pain in your lower back, under your rib cage or above your pelvic bone accompanied by fever or nausea, it’s possible the UTI has spread to your kidneys. If this is the case, seek medical attention as soon as possible,” recommends the APA.

ALSO SEE: How to spot a urinary tract infection during pregnancy


According to the Infertility Awareness Association of South Africa, 15% to 20% of all pregnancies end in miscarriage. Of these, 75% occur in the first 12 weeks of pregnancy. According to, cramping associated with a miscarriage usually occurs in the abdomen, lower back and/or pelvic area and is accompanied by bleeding. Other signs of a miscarriage include true contractions (every five to 20 minutes), bleeding with or without cramps, tissue or clot-like material passing from your vagina and a sudden decrease in other signs of pregnancy.

ALSO SEE: 7 ways to reduce your risk of miscarriage

When to see your doctor

Dr du Preez says the following symptoms are cause for concern:

  • Any form of spotting or vaginal bleeding
  • Severe headache
  • Blurred vision
  • Light headedness
  • Fever and chills
  • Epigastric pain (a pain or discomfort right below your ribs in the area of your upper abdomen). This could be associated with high blood pressure
  • Excessive nausea and vomiting
  • Any vaginal discharge
  • Contractions (especially when you’re not supposed to be in labour yet).
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