Cramps

Early pregnancy cramps are relatively common. Around 1 in 4 women will experience pain and/or bleeding in their first 12 weeks of pregnancy. In the majority of women, light cramping is nothing to be worried about, and improves without doing anything special. Early pregnancy cramps and cramps later in pregnancy can be due to different reasons.

Occasionally, uterine cramping is a sign of complications, so it is always worthwhile to be checked by a health care practitioner.

Women who have had problems getting pregnant can be particularly anxious about early pregnancy cramps. Previous miscarriage or a complicated pregnancy means every little niggle can be alarming. It's worth remembering though, that each pregnancy is its own unique event.

What causes early pregnancy cramps?

Muscles and ligaments which support the uterus are stretched as the uterus expands to accommodate the growing baby. This can cause pain, aches and discomfort, particularly in the first trimester. The veins supplying the uterus with blood become engorged, adding to feelings of heaviness and discomfort. Sexual intercourse and wind pain can also cause pregnancy cramps.

Many pregnant women experience leg cramps as well as uterine cramping. These occur towards the end of the day and after standing for long periods of time. Weight gain, extra blood flow and hormonal changes all contribute to the likelihood of leg cramping.

What causes cramps later in pregnancy?

Cramps later in pregnancy can be due to the weight of the baby and pressure in the uterus. Round ligament pain is caused by the uterus stretching. Cramps can also be a sign of labour. See your healthcare practitioner if you're having regular, painful cramps or, are concerned.

Causes for abnormal pregnancy cramps

• Appendicitis.
• Ectopic pregnancy.
• Gall bladder stones or infection.
• Ongoing epigastric pain can be a sign of heart problems or in later pregnancy, toxaemia.
• Urinary tract infection (UTI) or infection of the kidneys.
• Pancreatitis.

Most commonly, normal muscular cramping is felt low in the abdomen, on either one or both sides. Women describe the cramps in a variety of ways. For example sharp, stabbing, dull, heavy or just annoying .

Pregnancy cramps are similar to period pain, when the uterus is contracting and there is a heavy, dragging feeling in the pelvis. Cramps can be experienced more after standing for long periods or at the end of the day. They can also be more noticeable when the pressure in the abdomen rises suddenly, for example, when sneezing, coughing or laughing.

Some health care practitioners use the analogy of early pregnancy cramps as being a form of growing pains of the uterus. Although the growth of the baby in the first trimester is relatively slow, the blood supply and hormonal changes within the mother's pelvic organs are significant.

When do I need to get checked?

• If you are worried, concerned or just need reassurance.
• If you have any vaginal bleeding or spotting which does not stop, or increases.
• If you develop any acute, strong pain in your abdomen or, in the tips of your shoulders.
• If your temperature is elevated or you feel generally unwell.
• If you are having problems passing urine. You may have the urge to wee but are having problems starting or stopping mid-flow.
• If your pregnancy symptoms are less noticeable.

What's the worry with pregnancy cramps?

Although cramping can be completely normal, it can also be an early sign of miscarriage. Unfortunately, there is little which can be done to stop miscarriage from occurring if it is inevitable. It is estimated that around one in four pregnancies end in miscarriage; due, in many cases to chromosomal abnormalities or a problem with the embryo embedding into the lining of the uterus.

Occasionally, cramping is due to an ectopic pregnancy. This happens when the fertilised egg has nestled down somewhere else in the pelvis other than the uterus. Most commonly, this is in one of the fallopian tubes. Because the fallopian tubes are narrow and only wide enough for the microscopic egg to migrate along, they cannot expand in the same way as the uterus. The uterus is made of muscle which is capable of enlarging.

When will the cramps stop?

Generally there is improvement as the uterus enlarges and is better supported by the bones in the pelvis. Until then, the ligaments and muscles need to bear the weight of the uterus and like any muscles, they can ache and become fatigued.

Relief for cramps

• Changing position. Lying on the other side, getting up and going for a walk, stretching and moving around can help.
• Warm showers or baths and loosening any tight clothing.
• A gentle tummy massage.
• Going to the toilet. A full bladder or bowel can cause pregnancy cramping.
• Avoiding constipation. Drinking plenty of water, eating lots of fresh fruits and vegetables and avoiding highly processed, starchy foods.
• Sitting or lying down and making a conscious effort to relax.
• Elevating the feet.
• Having a drink of water or fruit juice.

Remember it's always worth getting checked by your health care professional if you are having pregnancy cramps.

Written and reviewed by Jane Barry, midwife and child health nurse on 19/01/20.