What is Round Ligament Pain & How Long does it Last?

Pregnancy is, of course, a wonderful time for many reasons, some couples even calling it “magical” time of their life. However, one who has gone through the process of holding the child in the uterus for nine months will tell you that there are more than a few minor inconveniences. From morning sickness to mood swings, there are plenty of unwanted side effects that tag along with the growth of a miracle or life in uterus. The result is the birth of a healthy child. Few pregnant females may suffer from Round Ligament Pain and Aches during a few weeks of nine months of pregnancy.

What is Round Ligament Pain?

What is Round Ligament?

The right and left Round Ligament originates at the anterior surface of the uterus horn. Uterus horn is the section of the uterus where the fallopian tube originates. The ligament is a sturdy cord like a rope.1 Round ligament passes through the inguinal canal and attaches to labia majora and mons pubis. Round ligament supports the uterus and stabilizes the backward tilt of uterus. The round ligament shrinks once the infant is delivered. The round ligament slowly shrinks to the size that was present during non-pregnant anatomy. Occasionally such abrupt change also causes pain.

Is Round Ligament Pain Dangerous to The Baby or Me?

Round ligament pain is not harmful to you or infant growing in your uterus. The pain disappears after delivery, and all newborn babies born healthy.

What Causes of Round Ligament Pain?

  • Pregnancy,1
  • Round ligament varicosities,2
  • The detachment of round ligament3 and
  • Endometriosis of round ligament.4

Round ligament pain originates in round ligaments. The stretching of ligaments causes contraction of ligaments and cramping that results in pain. The cramping pain is associated with pulling sensation. Round ligament becomes soft and stretched during the second and third trimesters. During pregnancy, the soft round ligament stretches with the growth of uterus into the abdominal cavity. In a few cases, a tight, thick cord of round ligament stays stiff and resist to expand. Pain is caused by a stretched round ligament and also irritation or pinch of an adjacent sensory nerve. The anterior pull of round ligament by uterus aggravates pain. Most pregnant mothers are concerned and worried when pain is felt in the abdomen, groin, or back during pregnancy. Pregnant females hope for a healthy pregnancy and delivery. The pregnant females during pregnancy are worried about a tiny infant in the uterus and become concerned when sudden pain is felt in the abdomen or groin. Such pain is considered a normal physiological response originates in round ligament during pregnancy. The round ligament pain in the majority of patients lasts for a few weeks during the second or third trimester and then disappears. Pain is intermittent and mild to severe in intensity. Continuous pain needs to be further evaluated to rule out other diseases that may be causing pain during pregnancy. Varicosities around round ligament occasionally cause round ligament pain.2 Such pain is mostly localized in the groin and often pain misdiagnose as inguinal hernia. The round ligament pain in the groin is also caused by detachment of ligament and spread of Endometriosis along the round ligament. Both of these conditions cause pain in the groin.

Signs and Symptoms of Round Ligament Pain

Round ligament pain is felt in the abdomen and pelvis during pregnancy and occasionally also felt in the groin or inguinal area in a female who is not pregnant.

Abdominal Pain– Usually, the main signs and symptoms of round ligament pain are a sharp, sort of stabbing pain on either side of the uterus that lasts for a few seconds to several minutes. Pain may be continuous or intermittent. Fortunately, in most cases, round ligament pain is rare during the first three months. The pain begins in the middle of the second trimester when the uterus starts growing rapidly in the abdominal cavity. Although it is possible to experience round ligament pain in the first trimester, this is not very common.

Groin pain– The veins around round ligament gets more prominent in diameter and tortuous, resulting in pain in the groin or inguinal regions. The condition is known as varicosities of the round ligament. Groin pain is observed in the inguinal region when caused by Endometriosis spreads along the round ligament.

Abdominal tenderness- The palpation of the lateral side of the uterus during the third trimester causes pain that radiates along the lateral side of the abdomen to pelvis. The pain is caused by applying pressure over its attachment to the uterus.

Inguinal swelling- Varicosities of a round ligament cause swelling over the inguinal region and groin. The inguinal swelling is in many cases are misdiagnosed as an inguinal hernia.

Pelvic and vaginal pain- Detachment of round ligament causes pelvic pain5 and also vaginal pain. The round ligament is attached to pelvic bone and vagina.

Increase intraabdominal pressure and abdominal pain- Pain intensity increases during coughing and sneezing because of increase intraabdominal pressure that stretches round ligament.

Lower back pain– Round ligament stretch causes back pain in a pregnant female who is suffering from overstretching of the round ligament.

Tests to Diagnose Round Ligament Pain

Intermittent round ligament pain is normal during the second and third trimester. In most cases, treatment is not necessary. Pain in the inguinal region or groin is misdiagnosed as an inguinal hernia and must be evaluated with an ultrasound examination. Diagnosis involves detailed history taking, examination, and lab studies.

History of Pain and Examination-

Periodic examination by Obstetrician is necessary to rule out any other cause of pain. Back muscle spasm and vertebral column deformity are the cause of lower back pain. Such conditions are evaluated by history and examination.

Radiological Examination-

X-Ray and CT scan are avoided during the first and second trimester. If necessary, an MRI examination of the abdomen is performed to look at the condition of the round ligament. A selective soft tissue MRI study can help to look at the ligaments.6

Ultrasound Examination-

Ultrasound examination is performed if a patient is complaining of vaginal bleeding and abdominal bruises to rule out vaginal as well as uterine causes of bleeding. Selective ultrasound examination is performed to evaluate the condition of round ligament.6

Treatment for Round Ligament Pain

There is no specific treatment for round ligament pain. The pain symptom is treated with either conservative therapy or pain medications.

Conservative Treatment-

Heat Therapy- Warm wet towel or rubber bag is applied over the abdomen to relieve some of the acute pain.

Lie Down In Warm Tub- Severe pain not responding to Tylenol often feels less severe when the pregnant mother lies in a warm tub for 20 to 30 minutes. The therapy is recommended twice a day if the pain is severe.

Cold Compression- Cold compression may not be as effective as heat therapy. The trial of cold therapy is recommended if the pain is continuous and prolonged. Pack of ice covered in rubber or plastic bag is applied for 20 to 30 minutes over the most painful abdominal wall. If pain relief is satisfactory, then the treatment is repeated 2 to 3 times a day.

Rest- Bending backward or sudden twisting of the lower back causes stretch of the round ligament that follows moderate to severe pain. Thus, rest prevents abdominal pain caused by round ligament stretching.

Soft Massage- Soft massage of the groin and lower abdomen may reduce the pain intensity. Such therapy is repeated 3 to 4 times a day.

Avoid Prolonged Standing- Prolonged standing causes pull of uterus towards pelvic cavity that may stretch the round ligament. If abdominal pain is observed following prolonged standing or abdominal pain intensity increases with prolonged standing, then avoid such activities.

Exercises to Stretch Back and Abdominal Muscles- The back and abdominal muscle stretching prevents the abdominal pain caused by stretched round ligament during the first trimester.

Medications-

Tylenol- Moderate to severe pain is treated with Tylenol pills. The pills are avoided during the first trimester. The medications should be taken for 3 to 5 days. Tylenol pills are discontinued if pain intensity is tolerable.

NSAIDs– Non-steroidal anti-inflammatory (NSAIDs) medications are avoided during pregnancy. The abdominal or groin pain is treated with NSAIDs if pain continues following the delivery of the fetus. Such pain may be caused by round ligament inflammation, varicocele of round ligament or Endometriosis of round ligament. These conditions do respond to NSAIDs therapy.

Home Remedies for Round Ligament Pain

Medication is avoided during pregnancy to protect the infant, and severe pain may need medications like Tylenol.

Periodic Deep Breathing– Individual suffering with abdominal pain caused by round ligament stretch may be able to reduce the intensity of pain by periodic deep breathing in lying down position. The deep breathing slowly stretches the round ligament as the diaphragm pushes the expanded uterus towards the pelvis. The exercise is performed 3 to 4 times a day for 10 minutes.

Avoid Abrupt Movement- Individual suffering with round ligament pain must try to avoid activities that trigger the pain. An abrupt movement like getting in and out of bed in a hurry, rapid walking, or frequent bending stretches the ligament and triggers the pain. Such movement should be avoided, or such movements should be performed at a slow pace.

Straight Leg Raises Exercise- One must lie supine (on the back) and raise one leg at a time. Repeat the same exercise with the opposite leg. Such exercise is performed for 10 to 15 minutes 3 to 4 times a day. Raising the leg up helps to build strength in the abdominal and pelvic muscles. The straight leg raise exercise also helps to relieve the round ligament stretch. Exercise helps to relieve pain.

Leg Flexion & Knee Touching Abdomen- Individual is advised to lie on her back and bend the leg at knee and hip joint, so knee lies against the abdominal wall. Exercise helps to relax the round ligament and relieve the stretch that causes pain.

Pelvic Tilt Exercises- The forward, backward and side tilt of pelvis helps to relieve groin as well as abdominal pain caused by round ligament stretch.7

Prevention of Round Ligament Pain

The best way to prevent round ligament pain is to prevent the stretching of the ligament. The stretching exercise of abdominal and back muscle prevents round ligament pain. Pain is also prevented by careful movements of the back while bending and twisting. In most cases, one should avoid abrupt movement of the abdomen and back.

How Long Does Round Ligament Pain Last?

In most cases, the pain subsides in a few days after the delivery of the fetus. In a few individuals, round ligament pain may last for several weeks after childbirth. The pain following delivery may be associated with ligament inflammation. In such cases, NSAIDs (anti-inflammatory medications) help to relieve pain and cure ligament inflammation. Occasionally ligament stretch lasts for several weeks, and in such cases exercise, and Tylenol pills help to relieve pain. If pain continues, then consult obstetrician or primary care physician to rule out any other cause of abdominal pain.

When to Consult Physician

Experience obstetricians should evaluate abdominal pain during pregnancy. One should not take opioids or volunteer for surgery for round ligament pain. The physician should rule out any other major cause of abdominal, groin, or back pain.

References:  

  1. Anatomy, Abdomen and Pelvis, Uterus Round Ligament

    Shazia R. Chaudhry; Khalid Chaudhry.

    https://www.ncbi.nlm.nih.gov/books/NBK499970/

  2. misdiagnosed as inguinal hernias.

    Yonggang H1, Jing Y2, Ping W1, Guodong G1, Chenxia M3, Xiaojing X3, Fangjie Z1, Hao W1., Hernia. 2017 Dec;21(6):901-904. doi: 10.1007/s10029-017-1670-3. Epub 2017 Oct 3.

  3. Partial detachment of round ligament found at laparoscopy for chronic pelvic pain in a female adolescent.

    Baraldi R1, Ghirardini G., J Pediatr Adolesc Gynecol. 1998 Nov;11(4):189-90.

  4. [Endometriosis in the round ligament of the uterus as a cause of inguinal pain].

    [Article in Dutch]

    Wijnen MH1, Peters HM, Roumen RM., Ned Tijdschr Geneeskd. 1997 Oct 25;141(43):2073-5

  5. Pregnancy-related pelvic girdle pain: an update

    Nikolaos K Kanakaris,1 Craig S Roberts,2 and Peter V Giannoudis 3, BMC Med. 2011; 9: 15.

  6. Tendon and ligament imaging

    R J Hodgson, BM, PhD, P J O’Connor, MB, ChB, and A J Grainger, BM, PhD, Br J Radiol. 2012 Aug; 85(1016): 1157–1172.

  7. Use of pelvic tilt exercise for ligament pain relief.

    Andrews CM1, O’Neill LM., J Nurse Midwifery. 1994 Nov-Dec;39(6):370-4.

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