The parametrium belongs to the uterus and originates in the uterine horns (the points where the fallopian tubes enter the uterus).
The round ligament exits the pelvis through the deep inguinal ring, passes through the inguinal canal, and continues to the labia majora, where its fibers extend and mix with the tissue of the mons pubis.
It is a remnant of the embryonic gubernaculum. The round ligament can be a source of pain during pregnancy due to the greater force exerted on the ligament by expanding the uterus.
Abdominal pain during pregnancy is joint. Frequently, it is a result of the stretching of the round ligaments.
The pain of the round ligament is due to the regular physiological changes that take place as your body is transformed by pregnancy.
There are other causes of pain, abnormal but treatable, that your health care provider may want to evaluate. Therefore, any new or significant pain should be reported to your doctor.
The round ligament’s function is to maintain the anteversion of the uterus (a position where the fundus of the uterus is turned forward at the junction of the cervix and the vagina) during pregnancy.
Usually, the cardinal ligament is the one that supports the uterine angle (anteversion angle). When the uterus grows during pregnancy, the round ligaments can stretch, causing pain.
Embryology of the round ligament
The round ligament develops from the gubernaculum that unites the gonad with the labioscrotal slits in the embryo.
The round ligament is supplied by the artery of the round ligament, also known as the ” Sampson’s artery. “
What is the pain of the round ligament?
Round ligament pain is a common symptom of pregnancy during the second trimester. Pain may take him by surprise, but it is considered a regular occurrence. There is no reason for the alarm.
Around your pelvis, a couple of ligaments keep your uterus in place. Some women do not have problems with their round ligaments until they become pregnant.
As the size of the belly increases during pregnancy, the round ligaments stretch in response to growth.
Non-pregnant women have thick, short, round ligaments. However, pregnancy can cause these ligaments to become long and tense. Round ligaments usually contract and loosen slowly.
Pregnancy exerts extra pressure and puts pressure on the ligaments so that they can become strained, like a stretched elastic band.
Sudden and rapid movements can cause your ligaments to tense too quickly and pull on the nerve fibers. This action triggers acute pain and discomfort.
Symptoms of pain
The severity of the discomfort is different for everyone. If it is your first pregnancy, you may fear that this pain is due to a bigger problem.
Your concerns are understandable, but recognizing the symptoms of round ligament pain can alleviate your worries.
The most recognizable symptom of round ligament pain is an intense and sudden spasm in the abdomen or hip area.
The pain usually occurs on the right side. Some pregnant women experience discomfort from round ligaments on both sides.
The good news is that the pain of the round ligament is temporary. It usually stops after a few seconds or minutes, but the pain may be intermittent and return. Certain activities and movements can cause pain.
While your doctor may recommend light exercise during pregnancy, it is essential to remember that some forms of physical activity can trigger or worsen your pain.
Other triggers of round ligament pain include:
- Cough or sneeze
- Turning in his bed.
- Get up too fast.
- Other sudden movements.
You are more likely to experience discomfort during physical activity because the movement causes the stretching of the ligaments. However, you can adjust to alleviate your discomfort once you identify the activities that cause you pain.
For example, if you are prone to round ligament pain while you roll over in bed, turning at a slower pace can ease or reduce the pain.
The pain when stretching the uterine ligaments can be severe and confused with external causes of the pregnancy. Pregnant women often feel acute abdominal pain when the reason is something more serious, such as the following:
Appendicitis: Inflammation of the appendix located in the lower right part of the abdomen. Initially, it has little appetite, nausea, vomiting, and fever, and the pain worsens as the inflammation progresses.
As you progress further in your pregnancy, appendicitis pain will be felt in the upper abdomen instead of the lower abdomen because the growing uterus pushes the appendix up into the stomach.
Pain in the ovaries or ovarian cysts: the ovary in this area may be twisted, or an ovarian cyst may rupture, causing sudden and severe abdominal pain. The rupture of an ovarian cyst can also cause pain.
Abnormal growths in the abdominal area. Twisting of a fibroid tumor (benign) that can interrupt the blood supply to the injury and cause pain.
Abdominal cramps due to constipation caused by slow digestion by pregnancy (these emanate from the colon and ascending caecum, located in the lower right quadrant of the abdomen).
Causes of round ligament pain
Round ligament pain refers to a type of cramping caused by stretching. This type of pain most commonly occurs on the right side of the pelvis because the uterus typically turns to the right as the pregnancy begins to grow.
The uterus is usually the size of a pear. Round ligaments are thick bands of fibromuscular tissue that tend to support the uterus inside the abdomen.
As the uterus grows in size and weight, these ligaments lengthen, soften, and stretch like elastic bands.
Ligaments pull on nearby nerve fibers and sensitive structures, causing pain. The severity of the pain can be problematic. Although the pain of the round ligament is uncomfortable, it is also widespread and usually benign.
A spasm of the ligaments, an involuntary contraction, or a cramp usually triggers a sharp pain. These spasms are found more frequently on the right side than on the left because of the normal tendency of the uterus to turn to the right.
You can wake up at night in pain after suddenly turning around while you sleep. Pain can also be caused by exercise.
When to seek medical attention?
Describe your pain and any other symptoms to your health care provider, who will evaluate whether or not you send it to a hospital emergency department. Do not hesitate to seek emergency care if any following symptoms occur.
- Pain when urinating.
- Difficulty in walking.
How is the pain of the round ligament diagnosed?
There are no specific tests to diagnose the pain of the round ligament. If this is your first pregnancy and you are not familiar with this type of pain, ask for an appointment with your doctor to talk about your symptoms if you are worried.
In most cases, your doctor can diagnose round ligament pain based on a description of your symptoms. They can perform a physical exam to ensure that another problem does not cause pain.
Even if you know how the round ligament pain feels, it is essential to notify your doctor if the pain in your round ligament does not resolve after a few minutes or if you have severe pain accompanied by other symptoms. These include:
- Pain with bleeding
- Pain when urinating.
- Difficulty in walking.
The pain of the round ligament occurs in the lower abdomen, so you may think that any pain you feel in this region is due to the ligaments that stretch.
However, this is not always the case. You could have a more severe condition that requires a doctor’s care.
Severe stomach pain during pregnancy can occur for several reasons, including the detachment of the placenta. Other diseases that can cause low stomach pain include appendicitis, a hernia, and problems with the liver or kidneys.
In the case of severe pain, your doctor may rule out premature labor. Preterm birth can feel like the pain of round ligaments.
However, unlike the pain of round ligaments that stops after a couple of minutes, the pain of preterm delivery continues.
Tests and exams
If you need to go to the emergency department, the emergency doctor will examine you to rule out a life-threatening condition. If you have low abdominal pain, evaluating both the abdomen and pelvis is likely needed.
Although the examination can be uncomfortable, significant physical diagnostic findings can help the doctor decide which laboratory tests to order.
Ultimately, this can improve your understanding of your condition by your doctor and help you perform more tests and treatments.
The doctor can also order some basic laboratory tests, which will help evaluate the overall health of you and your baby.
A complete blood count (CBC) is a blood test that detects anemia or a possible infection. Often, pregnant women will be mildly anemic.
Your white blood cell count may be slightly higher than the anticipated average level seen in a non-pregnant patient. A urine sample can be analyzed.
Pregnant women with lower abdominal pain may have a urinary tract infection. This could put you and your unborn baby at risk for severe prenatal complications.
Often, severe flank pain may represent the passage of a kidney stone. Finding blood in the urine can help make this diagnosis.
The doctor may perform an ultrasound of the pelvis if you are unsure of the exact date of your last period of pregnancy or when you conceived. It can also help diagnose miscarriages and ectopic pregnancies.
Ectopic pregnancy is still the most threatening to the life of the disorders at the beginning of pregnancy.
Ovarian cysts are expected at the beginning of pregnancy and tend to break or twist. When a fractured cyst releases blood in the pelvis, it can be challenging to distinguish bleeding from an ovarian cyst from a ruptured ectopic pregnancy.
An ultrasound may occasionally help diagnose appendicitis, but a CT scan will often be necessary to rule out or establish this diagnosis.
After your condition has been evaluated and a diagnosis is made, your health care provider will formulate a treatment plan.
If all acute emergencies have been ruled out completely, they can be safely sent home with strict follow-up care instructions.
Round ligament pain is joint during pregnancy, but there is much you can do to reduce discomfort. Making adjustments to avoid sudden movements is a way to reduce pain.
Your doctor may recommend other treatments, which include:
- Stretching exercises.
- Yoga prenatal.
- OTC medication such as acetaminophen.
- Bend and flex the hips when sneezing, coughing, or laughing.
- A thermal pad.
- A hot bath
Wearing a maternity belt can also remedy the pain of round ligaments. These abdominal support garments are worn under your clothes.
The belts help support your blow and relieve the pain and pressure from a growing stomach.
The maternity belt not only provides relief for round ligament pain but also helps relieve:
- Low back pain
- Sciatic pain.
- Hip pain.
A maternity belt can provide additional support if you are pregnant with multiple babies. You may be advised to return to the emergency department or doctor’s office if the pain worsens or persists despite essential therapy with acetaminophen (Tylenol).
You may also be asked to change your daily activity level and avoid positions that may worsen your symptoms.
Home remedies for round ligament pain
Taking a good hot bath helps relax the muscles and relieve tension in the body. Adding Epsom salts to the tub gives the body a good dose of relaxing magnesium. The combination of heat and magnesium is perfect for soothing the pain of the round ligament.
You can also add some essential oils of lavender, chamomile, or marjoram to obtain additional softening properties. If you do not have time to bathe, you can still benefit from the use of heat to relax the pain.
A heating pad or a hot water bottle can be used safely during pregnancy, provided some precautions are followed.
Do not use a high-temperature setting. Only leave the heating pad in the area for 10-15 minutes.
It may seem contradictory to stretch a stretched muscle, but it can be a good strategy. Specific pelvic exercises help strengthen the abdominal muscles and keep the uterus, pelvis, and baby in proper alignment.
Yoga for pregnancy and strengthening exercises at the center focusing on the transverse abdomen can also help. The abdominals exert too much pressure on the area and should be avoided.
Swimming is a gentle but effective strengthening exercise during pregnancy and water helps relieve pressure on the ligaments.
While stretching during a round ligament spasm can help relieve tension, it is good to be regular with your exercise regimen. Constant exercise relieves pain and eliminates the triggers to reduce painful episodes.
Lying on your left side for a while will reduce the pressure. Put a pillow between your knees to keep the pelvis aligned, and use another pad under the stomach if necessary. Placing the knees towards the chest also helps.
It is essential to keep the pelvis balanced during pregnancy for several reasons. When we stand with our hips sticking out to the side, push the pelvis, or push it forward, this can misalign us.
Sitting is as essential as standing. Concentrate on sitting on the bones and not allow the pelvis to tilt to the side or back. You may find it helpful to sit on an exercise ball where your hips are a little higher than your knees.
Wearing flat, comfortable shoes that do not squeeze the foot is also crucial for correct alignment and pelvic posture. Chiropractors can help; they are instrumental in round ligament pain.
If one of the hip bones becomes misaligned and the opposite hip bone swings forward, the sacrum, which connects those two hip bones, may tip over. This pulls the round ligaments of the uterus.
Establishing and massaging the ligament area can help relax and calm the tension. Use firm but gentle pressure and concentrate on the sides of the groin and uterus. Applying a little bit of lotion or magnesium oil can increase the benefits of massage.
The use of slower movements can also be beneficial. If you find that your workouts are causing round ligament pain, switch to a milder form of exercise, at least for now.
Avoid sudden movements, such as shooting from the bed or turning quickly to turn around. Take small steps when turning instead of moving the leg outwards. Move a little more slowly and take things slow.
The pain of round ligaments is a common symptom, and there is little you can do to prevent it from happening. Once you have ensured that you are in good health, you should refrain from specific activities that trigger this pain.
However, once you start experiencing pain, you can take steps to relieve the discomfort. Lying on the opposite side and applying warm baths early can alleviate pain.
Your healthcare provider should advise you about acetaminophen (Tylenol). It is essential to understand your triggers.
If you can not prevent or relieve pain, it can stop on its own as you move into your third trimester. Talk to your doctor about your concerns. Not all women who are pregnant will experience round ligament pain.
One thing is for sure: when you are pregnant, you will experience changes in your body. The round ligaments that were thickened structures in the form of a band before pregnancy are now elongated and stretched slightly as they support the uterus.
This change is caused by the release of progesterone and the enlargement of the fetus within the uterus. These changes, although natural, are inevitable. As a result, there are no proven preventive exercises or remedies for this pain.
If your doctor has seen you and knows that your pregnancy is not ectopic, is not associated with bleeding, and is not accompanied by uterine contractions, you will likely experience one of the most common discomforts of pregnancy.
For most women, the pain will disappear simply by changing daily activities. Except in rare cases, the pain may last throughout pregnancy’s second and third trimesters.