The sudden, sharp pain felt in the abdomen or side when coughing, sneezing, or laughing is a common complaint as pregnancy progresses. This discomfort is typically a harmless symptom of the body adjusting to the growing baby. The pain is triggered by an abrupt increase in intra-abdominal pressure, which puts sudden tension on the ligaments and muscles supporting the expanding uterus. Experiencing this sharp, transient pain, especially in the second and third trimesters, is frequent.
Understanding Round Ligament Pain
The most frequent cause of this sudden abdominal pain is the stretching of the round ligaments. These thick, fibrous cords run from the uterus down into the groin, helping to hold the uterus in place within the pelvis. As the uterus enlarges, these ligaments are stretched and become taut.
A sudden movement, such as a cough, sneeze, or rolling over in bed, causes the uterus to move quickly. This forces the already-stretched round ligaments to contract or stretch rapidly. This rapid movement results in a sharp, shooting, or stabbing pain, often described as a “stitch,” in the lower abdomen or groin.
The pain is often felt more intensely on the right side of the abdomen, though it can occur on the left or both sides. This is because the right round ligament is generally under more tension as the uterus shifts slightly right during growth. The sensation is typically brief, lasting only a few seconds, which distinguishes it from more serious types of pain.
Secondary Musculoskeletal Contributors
Beyond the round ligaments, the forceful contraction of abdominal muscles during a cough can strain other supporting structures. The rectus abdominis muscles are stretched and separated by the growing uterus, a condition called diastasis recti.
A violent cough can strain these weakened abdominal muscles or the connective tissue holding them together. This muscular pain is felt as a dull ache or tenderness that is more localized and persistent than round ligament pain.
Intercostal Muscle Strain
The act of coughing involves the intercostal muscles located between the ribs. The increase in abdominal pressure from the uterus pushing upward, combined with the exertion of a cough, can strain these muscles or temporarily shift a rib out of alignment. This can cause sharp pain high up in the rib area, which is exacerbated by deep breaths, twisting, or continued coughing.
Techniques for Pain Relief
Proactive movement adjustments can reduce the severity of pain caused by sudden increases in pressure. The most effective technique is to “brace” or protect the abdomen just before the cough or sneeze occurs. This involves bending and flexing your hips by pulling your knees toward your chest or leaning forward from a seated position.
This positional change shortens the round ligaments and engages the core muscles, which minimizes the sudden stretch and spasm. You can also use your hands to support the lower abdomen while coughing.
For persistent, dull aches, rest and the application of heat can soothe strained areas. Taking a warm bath or using a heating pad on a low setting may help relax overworked muscles and ligaments. Wearing a supportive maternity belt or belly band can also provide consistent external compression and stability to the core area during daily activities.
Recognizing Warning Signs
While most sudden pain from coughing is benign, certain accompanying symptoms suggest the need for immediate medical consultation.
Contact a healthcare provider immediately if you experience any of the following:
- Pain that is severe, constant, or lasts longer than a few minutes after resting or changing position.
- Pain accompanied by fever, chills, or pain during urination (potential infection).
- Vaginal bleeding, a sudden gush of fluid, or a noticeable decrease in the baby’s movement.
- Cramping or contractions before 37 weeks (potential preterm labor).
- Upper abdominal pain, particularly on the right side, paired with blurred vision or a severe, persistent headache.