What to know about rib pain during pregnancy

By | June 11, 2019
Women can often experience a wide range of uncomfortable symptoms during pregnancy. One common complaint is rib pain, which has several possible causes that vary by trimester.

In most cases, the cause of rib pain is harmless. The growing fetus often causes aches and pains around the ribs due to their position in the womb. Less commonly, medical complications can cause rib pain, so it is important to know the warning signs.

In this article, we look at what can cause rib pain in pregnancy, how to relieve the pain, and when to see a doctor.

Causes and trimesters

The most common causes of rib pain during pregnancy vary by trimester. In this section, we look at the possible causes and why they occur.

Pressure from the growing fetus

Pregnant woman sitting on sofa experience back and rib pain.
The position of the fetus in the womb can cause rib pain.

In the late second trimester and third trimester, the uterus expands upward to accommodate the developing fetus. As the fetus gets larger and larger, they may start to press against the ribs.

Carrying the extra weight of the fetus can also place more strain on the muscles around the abdomen, which can, in turn, put pressure on the rib muscles, causing muscle aches.

This pain is usually mild to moderate. If the pain is severe, it is best to see a doctor.

The position of the fetus

Usually, close to the end of the second trimester, the fetus changes position and turns upside down so that the head is facing down and the feet are pointing toward the ribs.

In this new position, the fetus can put pressure on the ribs. Their movements also begin to affect the woman’s body. Their arm and leg movements, especially kicks, can cause aches and pains in the ribs and elsewhere.

A pregnant woman will generally feel this type of rib pain just under the breast on the side where the baby is. Learn more about baby positions in the womb here.

Round ligament pain

Round ligament pain is a common pregnancy complaint. The round ligaments are a pair of fibrous tissue cords that connect the front of the uterus to the groin. As the uterus grows during pregnancy, it can put pressure on the round ligaments, and this can cause sharp pain when moving.

Round ligament pain can occur anytime from around the start of the second trimester onward. Women may feel pain around the ribs, back, or pelvis.

Gallstones

Pregnant women have a higher risk than other people of developing gallstones because of rising estrogen levels and difficulty emptying the gallbladder.

According to one study, approximately 12% of pregnant women will develop gallstones.

Gallstones may or may not cause symptoms. When they do, people typically experience pain in the upper right abdomen.

Gallstones can occur anytime during pregnancy. Some women may need surgery to remove them following their pregnancy.

Urinary tract infection

A woman's risk of developing a UTI increases during pregnancy.
A woman’s risk of developing a UTI increases during pregnancy.

Women have a higher risk of developing a urinary tract infection (UTI) when they are pregnant, especially during the third trimester.

Pregnancy can change the bacteria in the urinary tract, and women may have more difficulty emptying the bladder if the fetus places pressure on it. Both of these factors increase the risk of UTIs.

Without treatment, a UTI can cause pain in the kidneys, which can feel like rib pain.

A person should see a doctor if they have the following symptoms, as they may have a UTI:

Heartburn

During pregnancy, the body produces a hormone called relaxin. This natural hormone is responsible for helping the muscles and ligaments prepare for the birth.

Relaxin can cause pain in different areas of the body, including around the pelvis and under the ribs. This pain can sometimes be due to heartburn. Relaxin causes heartburn because it relaxes the esophagus, the tube that carries food from the mouth to the stomach, allowing stomach acid to rise further than usual.

Heartburn can start as early as the first trimester and may last throughout the pregnancy.

Constipation

Constipation causes abdominal pain and infrequent or delayed bowel movements that can be hard when they occur. Sometimes, a pregnant woman may feel constipation-related pain in the upper abdomen, under the ribs.

Learn more about constipation in pregnancy here.

Preeclampsia

Preeclampsia and HELLP syndrome, which doctors consider to be a variant of preeclampsia, are two complications that can occur during pregnancy and cause pain under the ribs.

The upper right quadrant pain that preeclampsia and HELLP syndrome can cause is liver pain. People experience liver pain in many different ways. Some experience it as shoulder pain, while others feel pain near the bra line, or have serious heartburn that does not respond to antacids.

Both preeclampsia and HELLP syndrome occur in the later second trimester and third trimester.

Signs and symptoms include:

  • protein in the urine
  • high blood pressure
  • headaches that do not respond to medication
  • malaise
  • return of nausea
  • severe heartburn
  • difficulty urinating
  • swelling in the hands and face
  • sudden weight gain
  • visual disturbances, including seeing spots called eye floaters
  • pain in the upper right quadrant of the abdomen

Preeclampsia and HELLP syndrome are dangerous pregnancy complications that can be life-threatening for both the woman and baby. These issues need prompt medical attention.

If a woman has preeclampsia, a doctor may recommend early delivery if the benefits outweigh the risks. If symptoms such as high blood pressure do not go away, the woman may need to take blood pressure medications after the birth.

Diagnosis

A doctor may perform a physical examination to assess rib pain during pregnancy.
A doctor may perform a physical examination to assess rib pain during pregnancy.

A doctor will often carry out a physical examination to help them diagnose the cause of rib pain.

They will also ask questions about the woman’s symptoms, her concerns, her due date, and other factors. In most cases, they will check the woman’s blood pressure.

Depending on the stage of the pregnancy, the doctor is likely to monitor the fetus for a short while to make sure that their heart rate is consistent.

If a doctor suspects a UTI or another infection or condition, they may request a urine sample. If they are still not sure what is causing the pain, they may order a blood test.

How to relieve rib pain

Some rib pain may be an unavoidable consequence of the baby pressing against or kicking the ribs. In these cases, taking warm baths and pain-relieving medication, with a doctor’s approval, can help. Gentle exercise can also often combat pregnancy-related pains.

The treatment for rib pain depends on the cause. For example, women with a UTI can take antibiotics to treat the infection. If gallstones are the issue, a woman may need surgery to remove them after delivery.

Other steps that a woman can take to treat rib pain at home include:

  • Exercising regularly and gently. Stretching is especially useful. Women can try some pregnancy exercises using an exercise ball to stretch out the back and chest muscles. Learn more about exercising during pregnancy here.
  • Using a heat pad. As long as it is not too warm, a heating pad should be a safe way to relieve pain during pregnancy. Learn more here.
  • Talking to a chiropractor who specializes in pregnancy. They can suggest exercises, postural changes, and other ways to relieve musculoskeletal pain.
  • Trying yoga. Yoga is a gentle, effective way to stretch out the muscles and joints during pregnancy. This stretching can alleviate a range of aches and pains, including back, rib, and joint pain.
  • Wearing loose fitting clothes. Tight or restrictive clothing can make pregnancy aches worse.

Outlook

Like many aches and pains during pregnancy, rib pain is normal and usually not a cause for concern. If the pain occurs alongside other symptoms, such as fever, high blood pressure, or spots before the eyes, a woman should see her doctor as soon as possible.

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