Managing Round Ligament Pain in Pregnancy
Round ligament pain is amongst the more common pains experienced by pregnant people and it can start surprisingly early in pregnancy. People most often begin to experience round ligament pain in the second trimester, and while in some cases the pain improves with time, others are left dealing with round ligament pain through the remainder of their pregnancy. In this blog post, we’re going to cover what the round ligament is, what round ligament pain feels like, why this pain occurs during pregnancy, and what you can do to reduce abdominal and groin pain associated with the round ligament through pregnancy.
What is the round ligament and what does it do?
The round ligament is a cord like structure that supports your uterus and tethers your uterus to your pelvis. There is a right and left round ligament that are each about 10-12 cm long. These ligaments originate at the uterine horns, or along the front/side wall of the uterus. They travel through the inguinal canal and insert into the mons pubis and labia majora through broad fascial connections. These two ligaments help your uterus maintain position within your pelvis and keep your uterus anteverted.
What does round ligament pain feel like?
Round ligament pain can vary but often feels like some combination of:
aching and cramping in the low abdomen, typically one sided
pulling around the pubic symphysis
sharp stabbing lower abdominal or groin pain with sudden movement
vaginal tugging
Any sharp or stabbing pain is typically transient, passing once the movement is completed.
Why does the round ligament hurt during pregnancy?
Because of the role the round ligaments plays in supporting the uterus, the stress on the ligaments increases as the baby grows in the uterus. Additionally, as the uterus grows, the ligaments get less support from the musculature in the abdominal wall, further stressing the ligaments. These two factors contribute to round ligament pain in pregnancy.
What can you do to address abdominal and groin pain associated with the round ligament through pregnancy?
Now onto the good stuff. While round ligament pain can be persistent, there are a number of things you can do to address this pain during pregnancy! Here are my top 4 recommendations for managing round ligament pain:
1. See a pelvic floor physical therapist.
Pain is often multifactorial. Determining the cause of and factors contributing to pain during pregnancy helps you determine the most effective treatment plan for your pain. A pelvic floor PT will be able to evaluate the tissues surrounding your pain to offer you the clearest picture of what’s going on with your body and what you can do about it. Round ligament pain is not the only pain that can cause abdominal aching or sharp twinges and it’s important to rule out other potential causes of similar pain before attempting to treat the pain. Other potential causes of similar symptoms include pubic symphysis dysfunction, lumbar radiculopathy, injuries to the hip or hip flexor, braxton hicks and diastasis recti.
2. Massage your labia and mons pubis
Because of the insertion point into the labia major and mons pubis, the tissue in this region can become tight and sensitized in folks experiencing round ligament pain. Massaging the tissue to relax the surrounding muscles and bring blood flow into this tissue can help improve tissue mobility and reduce pain. When I do this with my patients in the clinic, I typically use light pressure for a few minutes on each side. Depending on soreness, I sometimes recommend icing the vulva after treatment. Check out this instagram reel for a demo of the pinch and lift technique for mobilization.
3. Strengthen your abdominals
Like I said earlier, your abdominal muscles support your round ligament. But as your belly grows, these muscles tend to turn off. When that happens, the extra stress on your round ligament can contribute to pain. Working on deep core strengthening can make a big difference! First, you want to learn how to activate your deep core muscles. Then you want to progress!
Check out this blog post for more on abdominal strengthening in pregnancy and if you’re still experiencing round ligament pain after childbirth, check out Baby Steps Fitness, our 6 week core strengthening program for postpartum recovery.
4. Consider a belly band
Because strengthening takes time, a belly band can be a helpful intermediary. If you use a belly band in pregnancy, you want the band to be relatively light, ensuring that it’s not limiting your ability to breathe in any way. You also want to be mindful of any increased pressure through your pelvic floor while wearing the band as this may be a sign it’s too tight. I’m a big fan of Bao Bei’s support bands because they’re gentle and thin!
And as always, if you’re experiencing pain that’s not getting better or getting worse, please contact your medical provider.
If you’re in Central Texas, come see us in our Austin clinic! Contact us here to learn more about working with our physical therapists.
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.