Pregnancy pains, starting at the first trimester

Pregnancy pains, front or back, can be a continuation of troubles from before the pregnancy.

Have you ever been thought to have pelvic inflammatory disease, such as from chlamydia?

Have you had times when you were generally unwell and had a lot of abdominal pain?

PID can be difficult to diagnose anytime. There is more information on the pelvic pain page of this site.

I've had the impression at times, that lower abdomen pain in early pregnancy, has been due to previous PID flaring up, although acute PID is rare now.


Cystitis is inflammation of the wall of your urinary bladder, usually due to infection.

Acute haemorrhagic cystitis causes pain on passing blood stained urine, and needing to do this every few minutes.

Involvement of your bladder is obvious, but it is really important to know if your kidneys are also infected.
The progesterone hormone which protects your foetus from being expelled by the uterus, also weakens the muscle of your urinary passages.
Urine moves through more slowly and can get infected.

I examine all infected urine samples under the microscope, and often see leukocyte casts when a persons symptoms suggest only a bladder infection. These casts have to be from the kidney, indicating infection there.

Kidney infection is more serious and takes longer to eradicate.


Miscarriage is likely to be inevitable if there are cramping period-like pains as well as heavy bleeding. This requires urgent medical attention, as there may be products of conception caught in the cervix. These need to be removed to stop the bleeding.



Appendicitis is the commonest reason for needing an operation for abdomen pain now, that has nothing to do with being pregnant. You would suddenly be quite ill enough to know you needed urgent medical attention.
This can happen at any stage of pregnancy actually.


Adnexal torsion When the ovary is twisted around on its attachment so as to strangle itself is another reason for sudden pain and illness (from the pain,) usually if the ovary is enlarged from IVF treatment or a benign tumour. This also needs urgent surgery, to untwist it.


Retroversion Is when the uterus is tipped backwards instead of the usual forwards.
At the end of the first trimester (third of preganacy) there is another uncommon possibility, which needs urgent attention.
If your womb has stayed tipped backwards, it has now grown to the point where it is caught in your pelvis. It now presses forwards on your urinary passage, blocking it so you can't pass urine.


Middle of pregnancy pains

A lot of stretching is going on. Your uterus grows to 20 weeks, then just stretches for the rest of the pregnancy.

A cord like structure runs from the top of your uterus on each side, down to inside the groin. The uterus is usually twisted a little, so one of these will be closer to the front.
You can sometimes twang this "round ligament" under your finger, it is so tight.
Some sharp pains on movement, can come from this structure.



Abdomen and back pain in the third trimester

Your uterus is always contracting, and this escalates progressively throughout pregnancy.
Labour is said to start when one has regular painful contractions, but this point is not obvious on a trace of uterine activity.

If you have to phone for advice at this stage, it's helpful if you time a few contractions first (minutes from the start of one to the start of the next pain.)


Posterior position
This refers to the baby, head first, facing towards your front instead of the back.
This delays the onset of labour and then causes pain at the base of your spine with each contraction.



Accidental haemorrhage
Sudden onset of continuous pain, rather than repeated brief pains, may be due to concealed accidental haemorrhage. The bleeding is from separation of part of the placenta, called concealed if there is no vaginal bleeding.
Prevention is important. Folic acid supplements are often needed in pregnancy and may help with fatigue as well as this.



Back pain in pregnancy
Acute onset of backache is often due to a hitched joint in the spine, and mobilization then offers a quick fix.

If the relief is only temporary, one may find the same joint or another, hitched again. The problem may be due to the weight of the pregnant uterus plus softening of the joint ligaments.

The hormone Relaxin softens your (collagen) ligaments in preparation for childbirth.
Women with severe pelvic girdle pain in pregnancy have higher levels of relaxin than those who are pain free¹, suggesting that increased joint laxity may be part of the problem.

Abdominal strengthening exercises are very important anytime, and especially to avoid these pregnancy pains.

Pelvic girdle pain may be helped by a sacroiliac belt, such as the one shown here²...

SEROLA Sacroiliac Belt


References for pregnancy pains page

1. MacLennan A.H. et al Serum relaxin and pelvic pain of pregnancy. Lancet 1986;ii:243-5.

2. SEROLA Sacroiliac Belt

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From pregnancy pains page back to abdominal pain diagnosis




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Leukocyte casts are white blood cells (pus cells) jammed together in little rod like structures, which have been flushed out of tiny collecting tubules in the kidney.

Products of conception seen are usually the start of the placenta and amniotic baby sac.

If you are interested in a home study course on examination of the spine, please send me your e-mail address by the contact form.