Some amount of abdominal discomfort during pregnancy is common and only to be expected considering the body goes through wide ranging changes during pregnancy but lower left abdominal pain during pregnancy should be carefully watched to see if there is an exacerbation. This is because the pain could be caused by a wide range of causes, many of them insignificant, but some could be serious ones too that need to be investigated.
Abdominal pain could be grouped under causes like gynecologic, obstetric, gastrointestinal, urinary or vascular. Some of the causes may be intimately linked to pregnancy but some may require imaging to arrive at a diagnosis. For doctors too arriving at a diagnosis is difficult during because of anatomic and physiologic changes.
Imaging As a Diagnostic Tool to diagnose Lower left abdominal pain during pregnancy
Delaying diagnosis can be life threatening for both the mother and the fetus. Imaging can remove some of the confusion caused by the pregnancy. Ultrasound can be the procedure of choice because it is readily available at most hospitals and it does not expose the patient to radiation. Ultrasound plays an important role in being able to clarify underlying gynecologic or obstetric causes if any. However it may be of limited use in evaluating the pancreas, the bowel and the ureter partly due to the presence of air.
MRI can also be conducted if the situation warrants it. There are no reports of MRI causing any harm to the fetus since no ionizing radiation is involved. MRI is of special use in diagnosing acute appendicitis which is a common cause of lower left abdominal painduring pregnancy though it may present itself in later stages as pain exclusively on the right side.
Pain during different trimesters need to be evaluated differently. In the first trimester the most likely causes of abdominal pain are ectopic pregnancy and pregnancy failure. During the next two trimesters the pain could indicate preterm labor and in rare cases, placental abruption and its complications. Uterine rupture does occur and that can cause intense pain but it is a rare case.
10-12% of pregnancies end in spontaneous abortions during the first trimester. While some patients remain asymptomatic, there are frequent reports of vaginal bleeding and abdominal pain during a miscarriage. Ultrasound is the best diagnostic tool for a patient who complains of lower left abdominal pain during pregnancy. Vaginal bleeding present during a miscarriage may precede the pain by a few days. If bleeding occurs that may be copious or scanty, call your doctor. The pain may be mild, severe or may come as cramps or low back ache.
Here are a few causes of lower left abdominal pain during pregnancy:
1. Ectopic Pregnancy –
Ectopic pregnancy is often associated with sudden onset of abdominal pain during the first trimester. This could be on the left side or the whole abdomen could be involved. Cases of ectopic pregnancies are becoming very frequent and this needs to be kept in mind when a patient complains of lower left abdominal pain during pregnancy. Ectopic pregnancies are commonly associated with assisted reproductive techniques. Ectopic pregnancies could cause pain on either side depending on which fallopian tube is involved.
Ectopic pregnancies happen when a fertilized egg is implanted outside the womb often in any of the two fallopian tubes. Since this occurs early in the pregnancy often before the patient realizes she is pregnant, the pain is not associated with pregnancy. If neglected, an ectopic pregnancy can lead to the death of the patient. The symptoms to watch out for are: abdominal and pelvic pain, pain in the shoulder, bleeding from the vagina that may be just spotting or copious or intermittent, colored brown or red, pain that worsens with activity or with coughing. More serious symptoms like clammy skin, fast pulse or dizziness indicate medical emergencies. Call for medical help immediately.
2. Preterm Labor –
When uterine contractions occur between 20 and 36 weeks’ gestation it is called preterm labor. These contractions should lead to cervical dilations. This condition also causes lower left abdominal pain during pregnancy that can be distinguished as contractions. Preterm labor is often accompanied by some bleeding. Any change in the nature of vaginal discharge should alert the woman to the possibility of preterm labor. Low back ache is also frequently reported. Pain may be mild or severe enough to cause discomfort.
3. Placental Abruption –
Placental abruption is a medical emergency where the placenta separates from the womb fully or partially before the baby is born. Here too lower left abdominal pain during pregnancy should not go unnoticed. Watch out for sudden bleeding that could be copious or slight at the beginning. The whole abdomen could feel hard and stay that way. There could be a reduction in the baby’s activity. Placental abruption is a medical emergency.
4. UTI –
Apart from the above mentioned medical issues, abdominal pain could be caused by urinary tract inflammation or infection. Apart from pain, there could be burning while urinating, frequent urge to urinate even the bladder is empty and cloudy bad smelling urine. Fever is frequently present. Untreated urinary infection could lead to preterm labor. This infection could spread to the kidneys too which is a more serious issue. The fever could be high and accompanied by rigor and vomiting.
5. Flatulence and Poor Digestion –
The commonest cause of pain on the left side during pregnancy is due to flatulence and poor digestion. The release of hormones can play havoc with your stomach and you may find that late evenings leave you feeling achy and bloated. The growing uterus will exert pressure and push up the diaphragm causing pain in the abdomen. This is always on the left side.
6. Ligament pain –
This is often noticed in the lower abdomen on either side as ligaments that are holding your uterus stretch as your baby grows. This may a sharp high intensity pain that lasts barely for a few seconds. This happens invariably after a sudden physical movement like getting off the bed, getting up from a chair, turning over in bed or walking briskly. For most pains that are not serious, having a warm leisurely bath or a slow relaxing walk will be beneficial. Drink plenty of fluids and get plenty of fresh air.
Lower left abdominal pain during pregnancy need not be alarming but do not ignore it either. Seek medical help if lower abdomen pain is accompanied by other alarming symptoms like spotting, nausea and fever.
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