Round ligament pain (RLP) is a common, sharp sensation in the lower abdomen that many women experience during pregnancy. This pain is generally harmless and is frequently triggered by sudden movements like coughing, sneezing, or quickly changing position. The sensation is a temporary spasm in the structures that support your expanding uterus, and it is a normal part of the body’s adaptation to pregnancy. RLP typically begins in the second trimester when the uterus starts to grow more rapidly.
Anatomy and the Mechanism of Pain
The round ligaments are two cord-like structures that help hold the uterus in place within the pelvis. Each ligament extends from the upper sides of the uterus down through the groin area, acting somewhat like guy wires for support. In a non-pregnant body, these ligaments are relatively short and thick, but they must lengthen dramatically as the uterus expands. This stretching and thickening accommodates the growing weight and size of the baby. This gradual, sustained tension is the cause of round ligament discomfort, which may sometimes present as a dull ache.
Why Coughing Causes Sharp Pain
The sharp pain associated with coughing or sneezing results from a rapid, involuntary movement that catches the stretched ligaments off guard. These sudden actions cause an immediate, forceful contraction of the abdominal muscles. When the abdominal muscles contract quickly, they pull sharply on the already taut round ligaments. This sudden tug causes the ligaments to contract faster than normal, resulting in a brief but intense spasm. The pain is often felt more intensely on the right side of the lower abdomen because the uterus naturally rotates slightly to the right as it grows, placing greater tension on the right round ligament.
Strategies for Immediate Relief and Prevention
You can often mitigate sharp pain by preparing your body for sudden movements. When you feel a cough or sneeze coming on, immediately flex and bend your hips toward your abdomen, a technique sometimes called the “Couching Curl.” This action shortens the distance between the uterus and the pelvis, relieving tension on the round ligaments before the abdominal muscles contract.
For prevention, always move slowly when changing positions, such as when getting out of a chair or rolling over in bed. Supporting the lower abdomen with your hands when expecting a sudden movement is also helpful. Other preventative measures include:
- Wearing an external support garment, like a maternity belt, to provide gentle compression and lift to the uterus.
- Engaging in gentle stretching, such as prenatal yoga or pelvic tilts, to ease muscle tension and improve flexibility.
- Applying a warm compress or taking a warm bath to relax the muscles and ligaments in the abdominal area.
- Staying well-hydrated, which supports circulation and the elasticity of connective tissues.
When Pain Signals a Need for Medical Attention
While round ligament pain is a normal pregnancy symptom, certain accompanying signs indicate a need for medical consultation. RLP is typically brief and resolves quickly with rest or position changes. You should contact a healthcare provider if the pain is severe, constant, or does not subside after several minutes of rest. Immediate attention is warranted if the pain is accompanied by symptoms that suggest other complications, such as preterm labor or infection. These red flags include:
- Fever, chills, or persistent nausea and vomiting.
- Vaginal bleeding, spotting, or a noticeable change in vaginal discharge.
- Pain that radiates to the back or a feeling of increased pelvic pressure.
- Pain or burning during urination.