Round ligament pain (RLP) is a common sensation experienced during pregnancy, often beginning in the second trimester as the uterus expands rapidly. Although the feeling can be sudden and alarming, RLP is a normal physiological occurrence and rarely indicates danger to the pregnancy.
What the Round Ligament Is
The round ligament is a pair of cord-like, fibro-muscular connective tissue structures located within the pelvis. These ligaments originate on the upper sides of the uterus (uterine horns). Each ligament travels downward and forward, passing through the inguinal canal before attaching to the connective tissue in the groin area (labia majora and mons pubis).
The primary function of these structures is to support the uterus in its forward-leaning position within the pelvic cavity. As pregnancy progresses, the growing uterus places increasing tension on these ligaments. The pain is caused by the rapid stretching, thickening, and occasional spasm of the ligament fibers as they accommodate the expanding size and weight of the womb. Sudden movements cause the already-stretched ligament to contract too quickly, resulting in a momentary jolt of discomfort.
Where the Pain Is Felt and How It Presents
Round ligament pain is typically felt deep in the lower abdomen and pelvis, often radiating toward the sides. It commonly presents as a sharp, sudden, or stabbing pain that can extend down into the groin or pubic area. The pain often traces the trajectory of the ligament, moving from the side of the uterus down toward the crease where the thigh meets the torso.
Although the pain can occur on both sides, it is frequently more pronounced on the right side of the body. This is likely due to the uterus naturally tilting and rotating slightly to the right during growth. The pain is often triggered by an increase in intra-abdominal pressure or a quick change in body position. Common triggers for a brief, intense flare-up include coughing, sneezing, laughing, standing up quickly from a seated or lying position, or rolling over in bed.
A typical RLP episode is momentary, lasting only a few seconds as the ligament relaxes after the sudden stretch. While the sharp, stabbing sensation is the most distinct symptom, some people may experience a dull, longer-lasting ache after increased physical activity. The pain is specific to the lower lateral abdomen and groin, which helps distinguish it from other pregnancy-related pain.
Strategies for Managing Discomfort
Managing round ligament discomfort focuses mainly on prevention and slowing down movement to allow the ligaments to adjust gradually. One effective strategy is to avoid abrupt changes in posture, such as standing up or sitting down quickly. When anticipating a sneeze, cough, or laugh, gently flexing the hips or bending forward slightly can help. This action shortens the distance between the ligament’s attachment points, reducing sudden tension on the stretched fibers.
Applying gentle heat can help relax the muscles and alleviate the ache. A warm bath or a heating pad set to a low temperature provides soothing relief to the lower abdominal area. Many individuals find relief by wearing a maternity support belt or girdle. These garments provide external support to the growing abdomen, lessening the load and the pull on the round ligaments.
Incorporating gentle stretching or prenatal yoga may help maintain the flexibility of the hip and pelvic muscles. When resting, lie on your side with a pillow placed between the knees and another under the abdomen for comfortable support. While movement is helpful, it should be controlled, and any activity that consistently triggers sharp pain should be modified or temporarily avoided.
When to Contact Your Healthcare Provider
While round ligament pain is a normal part of pregnancy, certain accompanying symptoms may indicate a more serious condition. Contact a healthcare provider if the pain is severe, constant, and does not quickly resolve with rest or position changes. Normal RLP is typically brief, lasting only a few seconds or minutes.
Symptoms that accompany abdominal pain require immediate medical evaluation. These include fever or chills, vaginal bleeding, spotting, or a noticeable change in vaginal discharge. Persistent pain localized only in the back or felt as rhythmic contractions should also be reported promptly. Pain or a burning sensation during urination suggests a possible urinary tract infection, which requires treatment.