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Round Ligament Pain

Round Ligament Pain and Pregnancy: What You Need To Know

As you may have already learned during your first session of prenatal massage therapy, the lower abdomen has many ligaments which must stretch during pregnancy to accommodate the growing baby within your uterus. While many of these ligaments that cause pain are located on the back of the body and therefore accessible with the patient lying prone (on her tummy), there are also important ligaments on the front of the body that often causes pain during pregnancy.

Yes; we're talking about the round ligaments, a set of left and right cord-like structures supporting the uterus, suspending it in place like two rubber bands at either side, connecting the upper uterus to the labia majora. This is where the ligamentous fibers branch out and spread within the tissue of the mons pubis, creating a strong anchor for the uterus, like how a suspension bridge has many cables that start at the top of the tower and then anchor to many different points in the roadway below. The round ligaments of the uterus originate at the uterine horns and pass through the inguinal canal.

THe Floating Uterus: Held In Place With Ligaments

The uterus sort of floats in the lower abdomen, tethered to the "ground" of your body via various ligaments and fascia. This allows the uterus to move, and move it does! When you're sexually aroused, the uterus changes positions. This is due, in part, to the actions of the round ligaments. This means that the uterus can move and flow, and its position also changes with your hormonal changes during the month, when not pregnant.

When you're not pregnant, the cardinal ligament, another major ligament of the uterus, keeps the uterus in place. During pregnancy, the uterus begins to angle forward at the top. As the angle of the uterus positioning changes from upright to angled, the round ligaments of the uterus must stretch significantly and also thicken. A hormone called relaxin produced by the ovaries and the placenta helps relax these ligaments so stretching can more easily happen. Typically,a non-pregnant woman will have a round ligament that is about 10-12 cm long and 1 cm wide, but by the end of the pregnancy, the round ligaments can stretch to about 30 or 40 cm long!

As Baby Grows,. The Round Ligament May Strain

Also, the increasing weight of the baby and placental fluid places increasing strain on the round ligaments as your pregnancy progresses. As so much weight and pressure is placed on these ligaments, they are quite strong, even sheathed within another ligament called the broad ligament, a double flat peritoneum sheet. These are some heavy-duty uterine tethering lines! Even so, sometimes they get inflamed or nerves associated with the round ligament get impinged upon. Or, the stretching itself causes painful sensations.

Round ligament pain during pregnancy is perfectly normal and nothing to be concerned about. It's often experienced as dull or sharp ache in the hips, groin, and lower belly. Some women experience this pain in the vulva, and rarely, vagina. Some women say it's a lot like menstrual cramps. Often, the pain is described as being in the groin, where the legs meet the abdomen. Some women call the round ligament pain "horseback riding soreness" because it feels similar.

You may feel a sudden, sharp, stabbing spasm, or shooting pain, only lasting a few seconds before quickly subsiding. You may also feel pins-and-needles or a sort of pulling pain in the pelvic area. Round ligament pain is more commonly experienced on the right side, as the uterus is often oriented toward the right side of the body, rather than being perfectly centered in the lower abdomen, as you might expect.

Round Ligament Pain: 12 Weeks Is When You Can Expect It

It's common for round ligament pain to begin after 12 weeks, once you've begun the second trimester as the uterus stretches to accommodate the growing baby, continuing well into the third trimester. Once you give birth, round ligament pain will, in most cases, subside completely. RLP may also occur in women who are not pregnant, but it's most common in pregnant women.

A pain that does not come and go, but is continuous, may actually be due to labor, which will also include tightness in the belly. There's also the possibility of infection, especially if pain is felt on the sides or over the kidneys, and there's a burning sensation when urinating. If you're having unusual vaginal discharge or bleeding, it's time to schedule a visit to your ob-gyn. There's even the possibility of appendicitis, and so addressing abdominal pain is imperative. Your massage therapist is qualified to refer you to a physician if they feel it's not RLP (Round ligament pain), however they cannot make a formal diagnosis.

RLP And Massage Therapy: Yes, It Can Help

Therapeutic Massage can help with RLP. Your therapist can palpate the round ligaments and help these bands to relax by manual manipulation of your soft tissues. You can even administer self-massage. Find the point mid-way between the protuberance on the top of your pelvis (the ASIS or anterior superior iliac spine) and your belly button. Massage in an arc toward the center of the belly. About half-way to the center, you will find the round ligament. You can also follow the round ligament down to the pubis as you massage in small circles. After a few attempts, you should be able to feel the round ligaments on either side.

Applied heat is often also helpful. A hot compress, or even a warm soak in the tub, might work wonders. Of course, if you're still working, this is not practical, but after the work day's done, you should seriously consider a hot bath. Epsom Salts may also help, as MgSO4 is absorbed directly through the skin, and the Magnesium helps contractures in the body to release.

Staying too long in one position can also cause this, and that includes your sleep position. Ironically, in your attempts to avoid keeping the same position too long can also aggravate RLP. Sudden movements can cause the round ligament to hurt. And so, change positions with care, slowly and deliberately.

Unfortunately, even sneezing or coughing may set you up for a bout of RLP. The round ligament is temperamental during pregnancy in the second and third trimesters, as it's taut and stretched. If you're about to sneeze, bend and flax the hips repeatedly. This can keep the round ligament from hurting as well.

Round Ligament Pain: What Helps

Rest can also be helpful, however, staying too long in one position can be counterproductive and just end up generating more pain.

Exercise and yoga can help. Walking or hiking is wonderful, and so we recommend that you walk as many days of the week as is convenient. Just don't over-do it. Hatha yoga is also a great option, and there are books, videos, and YouTube channels dedicated specifically to pregnancy massage, however, even customary Hatha yoga would suffice.

There are a couple of specific exercises that may help. Sitting cross-legged and pushing the knees down toward the floor can help immensely. The pelvic tilt exercise has also been demonstrated to help. This is performed by kneeling with hands and knees on the floor, and slowly lower your head to the floor, while keeping your posterior and midsection high in the air, alternativng with raising the head and dropping the midsection toward the ground.

Making sure that you remain properly hydrated can work wonders. As it's easy and risk-free, and the only side-effect is more frequent trips tot he bathroom, it's always a good option.

There are also maternity support bands specifically made for pregnancy. Of course, talk with your health care provider managing your pregnancy before using one of these devices. It's like a "bra for the belly" and can keep the pressure off the round ligaments, but must not be worn too tightly.

Round ligament pain may be a disturbing condition during pregnancy, especially when you're not expecting it. It's normal to become fearful, wondering what's going on down there. Don't worry; in most instances it's just the pesky round ligament that's causing your agony. RLP is normal, and is not indicative, in any sense, that anything is amiss, even though it feels like it's a sign of something of concern.





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