Pain in the right side in pregnancy: sharp, aching, pulling, stabbing, under the ribs, when walking

Pain in the right side during pregnancy is the appearance of unpleasant sensations that can occur at any time. There can be many reasons for such pain, so it is worth taking seriously any painful sensations during pregnancy, because we are talking about two lives. To be absolutely sure that nothing threatens the mother and child, you need to consult a doctor.

Causes right flank pain in pregnancy

There can be many reasons for the development of pain in this localization during pregnancy. First of all, you need to know the gestational age. Pain in the side on the right, as a sign of pregnancy, is very common. They occur after the fertilized egg is implanted in the uterine cavity. This most often happens in the right horn of the uterus, which is accompanied by the process of dissolution of the endometrium for normal implantation. Nerve endings can be involved in this process, so when a woman has a little physical activity, she can feel pain in the right side - the site of implantation of the egg. Therefore, this can even be one of the indirect signs of pregnancy itself, if the woman does not know about it yet.

As for other etiological factors of the appearance of pain in the right side during pregnancy, they depend on the gestational age. During pregnancy, the uterus increases with each week to a certain size, which can cause compression of the internal organs and provoke the appearance of various symptoms. The liver, gallbladder, small and large intestines, right kidney, and appendix are located in the right lateral flank of the abdomen. The pathogenesis of the appearance of symptoms is associated with the fact that the enlarged uterus presses on these organs, which is the cause of the appearance of certain unpleasant sensations. When these organs are compressed, blood circulation and normal innervation can be disrupted, and various symptoms appear, combined with such a pain syndrome. This condition occurs in the third trimester of pregnancy, when the uterus reaches such a size that it can cause compression.

Among other causes of such pain, inflammatory diseases can be named first. During pregnancy, all chronic diseases tend to become active due to a decrease in immune protection. Therefore, pregnancy itself is a risk factor for exacerbation of chronic cholecystitis. Then the pain is caused by inflammation of its wall and irritation of the peritoneum. If cholecystitis is calculous, then often a change in the location of the gallbladder due to compression by the uterus can cause movement of stones, therefore, the etiological factor of acute pain in such a localization can be hepatic colic. If a woman has problems with the liver, then during pregnancy this can also lead to pain. The liver performs the load for both the child and the mother, therefore, with additional physical exertion, its capsule can become tense, which causes pain in the right side.

Violation of peristalsis and normal bowel function can also manifest itself as pain in the right side. After all, compression of the small and large intestines leads to the fact that not only their peristalsis is disrupted, but also the biocenosis over time - which subsequently affects the symptoms. Intestinal inflammation after poisoning in the form of acute enteritis or enterocolitis often causes similar pain in the right side, since the enlarged uterus displaces the intestines. Therefore, the pain has exactly this localization.

During pregnancy, the kidneys and ureters are displaced, they rise higher, so inflammatory or mechanical disorders in these organs can lead to irradiation of pain. Often, right-sided pyelonephritis in pregnant women is accompanied by right-sided pain as the first sign of the disease. At the same time, the kidney capsule also stretches and this leads to the appearance of pain in the side. It is also worth excluding renal colic as a cause of such pain.

The most serious reason in terms of possible complications is considered to be inflammation of the appendix – acute appendicitis. It is localized in the initial part of the cecum, which is located in the right iliac region. But this intestine does not have a large mesentery, so it is very dynamic. Often in pregnant women, the appendix changes its location and can be under the liver, and even near the right kidney. But the pain radiates with irritation of the peritoneum and is always located on the right, so do not forget about appendicitis, because pregnancy itself does not exclude the possibility of acute appendicitis, but on the contrary predisposes to it.

In late pregnancy, there may be premature placental abruption, caused, for example, by preeclampsia. This condition is accompanied by an increase in blood pressure in women, which is often complicated by placental abruption. If this occurs in the right side of the uterus, it can cause pain in the side.

An ectopic pregnancy that develops in the right fallopian tube may manifest itself with symptoms of right-sided pain if it ruptures. This is important to consider, because sometimes a woman may not yet know about the pregnancy.

Risk factors

Given the diversity of causes of pain in the right side in pregnant women, it is necessary to carefully diagnose all symptoms in order to accurately determine the etiology of this pain and determine the need for treatment. The main risk factors should be taken into account even during prevention:

1. Chronic calculous cholecystitis in a woman before pregnancy should be treated prophylactically even during the period of planning a child;
2. liver disease in women;
3. urolithiasis;
4. chronic enteritis and enterocolitis;
5. late gestosis of pregnancy.

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Epidemiology

The epidemiology of the spread of pain syndrome during pregnancy is very wide. About 96% of pregnant women feel abdominal pain in the third trimester of pregnancy, and 65% of such pain is localized in the right side. Such pain is not always caused by an organic disease, only 72% is a pathology. Among these diseases, the first place is taken by liver and gallbladder pathology, the second place is taken by acute appendicitis, as well as chronic bowel diseases. However, differential diagnostics must be carefully carried out, because all these pathologies can be complicated.

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Symptoms

To know what is the cause of such pain in a pregnant woman, it is necessary to take into account not only the pain in the right side, but also other manifestations that accompany this pathology. After all, already at the survey stage, it is possible to make a preliminary diagnosis and determine the treatment.

If the discomfort in the right side is caused by the physiological enlargement of the uterus, then such pain is not expressed all the time and is not very intense, it occurs after overeating or a certain load. At the same time, the general condition of the woman does not change, and there are no other symptoms. This indicates that such pain is a physiological condition and if it does not bring any other pronounced symptoms, then there is no need to worry.

Chronic non-calculous cholecystitis is an inflammation of the gallbladder, which is accompanied by thickening of its wall and irritation of the peritoneum. This is characterized by the appearance of a dull right-sided pain, which is often provoked by fatty foods. Such pain appears gradually, it is not very pronounced and is localized under the right rib. Symptoms that may be associated with this are a feeling of bitterness in the mouth, stool disorders, nausea or vomiting. Such inflammation may be accompanied by intoxication syndrome - there may be a slight increase in body temperature.

Severe and sharp pain on the right can also be caused by hepatic colic. If a pregnant woman had calculous cholecystitis, then the movement of stones can cause exactly this sharp pain. This is accompanied by severe anxiety, the woman cannot sit still - such is the severity of the pain. The first signs of the disease can begin with vomiting, which does not bring relief. This condition requires immediate action, since the tone of the uterus can increase and premature labor can begin.

Aching pain on the right side in pregnant women often develops against the background of a diaphragmatic hernia. Then the pain is persistent and often accompanied by dyspeptic disorders. Increased pressure in the abdominal cavity causes these symptoms and after childbirth such a hernia can go away on its own.

A stabbing pain in the right side can be caused by renal colic. Then it starts in the lumbar region and radiates to the right flank and genitals. Acute right-sided pyelonephritis is also accompanied by pain in the right side, but such pain is less pronounced and has a constant nature. In case of kidney pathology and urolithiasis, there are always disturbances in the urination process. There may be a burning sensation or pain along the ureters, as well as frequent urination or false urges to urinate.

Pain in the right side in pregnant women can be initiated by acute enteritis. After certain foods, there may be a mild inflammatory process in the intestines, which is accompanied by pain and stool disorders. Symptoms develop gradually and are always associated with the intake of certain foods.

Pain in the right side below during pregnancy is always alarming in terms of acute surgical pathology. Acute appendicitis is always accompanied by inflammation of the peritoneum. The characteristic symptoms of this disease are that the pain begins in the epigastrium under the sternum, and then it moves down the abdomen on the right. Then another symptom appears - Shchetkin-Blumberg, when the peritoneum is irritated in this place.

Premature placental abruption begins with a sharp pain in the right side where the placenta is detached and is accompanied by bleeding. The area of the detached placenta leaks blood, normal fetal blood circulation is disrupted, which is accompanied by symptoms from the fetus. Then the heartbeat may increase or decrease and hypoxia occurs, which entails serious consequences.

Thus, many causes of pain in the right side during pregnancy require careful diagnosis with the determination of all symptoms and additional research methods.

Diagnostics right flank pain in pregnancy

Diagnosis of any pain syndrome during pregnancy should exclude conditions that threaten the life of the child and mother. Therefore, all additional tests should be carried out to ensure normal development of the fetus.

It is important to find out all the anamnestic data with the definition of the nature of the pain, its intensity, and its connection with food. It is necessary to find out whether the woman has chronic diseases such as cholecystitis, enteritis, or urolithiasis. It is also necessary to ask about other symptoms, whether they are associated with pain and whether the woman took painkillers. If the woman had an appendectomy, this diagnosis can be easily excluded.

When examining a pregnant woman, you must first study the child's reaction to this pain. You must determine the fetal heartbeat and movements, its condition with such symptoms. To exclude liver and gallbladder pathology, you must determine all the symptoms. Positive symptoms of Ortner, Mussi, Murphy, or at least some of them, give grounds to suspect an exacerbation of cholecystitis.

It is necessary to check Pasternatsky's symptom; if it is positive on at least one side, then this is a probable kidney pathology.

Diagnosis of acute appendicitis in a pregnant woman is a little complicated, since the enlarged uterus can change the position of the appendix. But the characteristic symptom of pain first in the epigastrium, and then in the lower right abdomen is very common. When examining such a woman, it can be determined that the maximum pain occurs when the doctor takes his fingers away from the abdomen, and not when he touches it. To accurately exclude acute abdominal pathology, additional studies are always necessary.

The tests that need to be taken should also be carried out for the purpose of differential diagnostics. It is necessary to take a general blood test, a general urine test and determine the blood glucose level. Further, special tests are needed that exclude one or another pathology. If appendicitis is suspected, the blood test will show significant leukocytosis with a shift in the formula to the left and an acceleration of ESR. The same changes are characteristic of cholecystitis. If there is a suspicion of liver pathology, then a biochemical blood test is needed to determine the level of bilirubin, its fractions and cytolytic enzymes.

If all laboratory parameters are within the normal range, it is necessary to conduct an instrumental examination to exclude or confirm a certain diagnosis. The main method of instrumental diagnostics during pregnancy can be considered an ultrasound examination. This method is not so harmful to the child and can have a greater diagnostic value for establishing most diagnoses. According to the results of the ultrasound, it is possible to say about inflammation of the gallbladder - then its wall thickens and there will be a fuzzy dependence in the cavity. It is possible to determine a stone in the gallbladder or ureter and confirm colic. Acute right-sided pyelonephritis can also be determined as an expansion of the renal pelvis.

If acute appendicitis is suspected, a rectal examination is performed. The diagnosis is supported by sharp pain in the rectal wall in the projection of the appendix during palpation. This is a very serious symptom that confirms acute pathology.

In addition to the mother's condition, ultrasound allows you to assess the condition of the fetus. It is possible to exclude placental pathology and other pregnancy complications, which is important for differential diagnostics. If the disease occurs in the third trimester, then in addition to ultrasound of the fetus, a cardiotocogram is required to determine the child's condition and the risk of complications. Then it is possible to determine irregular heartbeat, increased uterine tone and premature birth, which can be the cause of pain in the right side with the same probability as other pathologies.

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Differential diagnosis

Differential diagnostics of pathology that causes pain in the right side during pregnancy is aimed primarily at determining the cause. First of all, it is necessary to differentiate an attack of acute appendicitis and right-sided renal colic. These pathologies have similar manifestations, but with appendicitis there is an increase in temperature and other signs of inflammation, and colic can be accompanied by vomiting and nausea without an increase in temperature.

It is equally important to differentiate the pathology of internal organs directly from the causes of pregnancy itself. Premature placental abruption has a clinical picture with a similar pain syndrome, especially if the placenta has separated on the right. But at the same time, bloody discharge is often observed, and it can be confirmed by ultrasound examination - retroplacental blood accumulation is determined. This is an urgent situation that requires immediate action, so in a pregnant woman, first of all, it is necessary to differentiate this condition from other pathologies.

Correct diagnosis and cause of the disease is necessary in order to begin treatment in time, before complications arise.

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Treatment right flank pain in pregnancy

Treatment of a pregnant woman sets the main task of eliminating the cause of pain, but first of all it is necessary to reduce the severity of the pain syndrome so that there is no premature birth and other complications. If we are talking about acute surgical pathology, then drug treatment is only part of the preparation for the operation.

If the cause of acute pain is renal or hepatic colic, then pain relief must be administered immediately, since the severity of the pain syndrome is very strong.

1. Baralgin is a universal combination drug used to treat colic. The drug contains metamizole, which has an analgesic effect, as well as fenpiverine and pitofenone, which have an antispasmodic effect. Due to this composition, an analgesic effect occurs, and it also has a good effect on the tone of the uterus. Method of administration - intravenous or intramuscular. The dosage of the drug for one dose is from two to five milliliters. Side effects that may be - hyperemia of the skin, fever, chills, increased t ° body, weakness, rapid heartbeat, arterial hypotension headache, dizziness, insomnia, nausea, constipation, vomiting, local reactions at the injection site. Precautions - use during pregnancy is decided individually and only under the supervision of the woman and fetus.
2. Diclofenac sodium is a non-steroidal anti-inflammatory drug that relieves colic pain and can be used as an alternative in case of contraindications to others. Dosage - 50 mg once after meals. Side effects - dyspeptic disorders, dizziness, hepatitis, erosive and ulcerative lesions of the stomach, duodenum, allergic rash (rare), "aspirin asthma". Given the strong effect on the gastrointestinal tract, it is advisable to take the drug under the cover of proton pump inhibitors.

If the pain in the right side, according to the exact data of the ultrasound examination, is caused by right-sided pyelonephritis, then it is necessary to use complex treatment, the main element of which is the restoration of urine outflow. In pregnant women, pyelonephritis is secondary due to the fact that the uterus compresses the ureters, so a mandatory element of treatment is stenting with the restoration of urine outflow. Then it is necessary to prescribe an antibiotic that can be used by pregnant women. Such approved antibacterial agents include unprotected aminopenicillins and cephalosporins. If we are talking about an exacerbation of chronic cholecystitis, then it is necessary to use an antibiotic in the treatment. Antipyretic and antispasmodic drugs can be added to the complex treatment.

1. Cefpodoxime is a third-generation beta-lactam antibiotic, especially effective against gram-positive and gram-negative flora bactericidally. The drug has a bactericidal effect on possible anerobic pathogens of urinary tract infections, so it can also be used for cholecystitis. The dosage of the drug is 200 mg twice a day for at least ten days. Side effects are possible when affecting the stomach - colitis or dysbacteriosis develops, which is manifested by bloating, stool disorders. Precautions - the drug cannot be used if you are allergic to penicillin antibiotics, as well as with congenital enzyme deficiencies.
2. If the phenomenon of abdominal pain is associated with intestinal compression, then stool disorders and dyspepsia often occur, which leads to irrational nutrition of the woman. Therefore, the use of probiotics in the treatment of such conditions can solve all the problems.

Lactobacterin is a drug that contains lactobacilli that produce lactic acid and prevent pathogenic bacteria from multiplying. Due to this, the drug creates favorable conditions for the development of beneficial intestinal microflora. These properties of the drug help to relieve intestinal spasms and reduce pain if the cause is physiological changes. The dosage sufficient to restore microflora and intestinal peristalsis is one dose of the drug once a day. Side effects include diarrhea or a feeling of heaviness and fullness in the abdomen, which goes away after a while. Precautions: if there are symptoms of food poisoning, the drug should be taken in consultation with a doctor.

Vitamins can be used by women to treat pain and discomfort caused by functional intestinal spasms. In this case, preference should be given to complex vitamin products with an increased amount of magnesium.

Physiotherapeutic treatment is possible only if it is not contraindicated for a pregnant woman and will not harm the child. For example, during an exacerbation of chronic cholecystitis, thermal procedures cannot be used.

Surgical treatment of pain in the right side during pregnancy is the main method if a woman has acute appendicitis. In this case, general anesthesia is administered, taking into account the minimum harm to the child, and the operation begins. Surgical access depends on the gestational age and the degree of enlargement of the uterus. In most cases, a classic approach is performed in the right iliac region and the inflamed appendix is removed bypassing the uterus.

If the cause of pain is premature placental abruption, the woman should be immediately hospitalized in a maternity hospital and the need for delivery determined.

Folk remedies for pain in the right side during pregnancy

Traditional methods of treating such pain are widely used if there is no organic pathology. If a woman has chronic cholecystitis or urolithiasis, they use agents that reduce the formation of stones. If bowel function is impaired, they also use agents to improve peristalsis and normalize digestion.

1. Tincture of calamus root with walnuts has excellent detoxifying and antioxidant properties, which reduces the amount of harmful substances and speeds up digestion. This helps not only to reduce intestinal pain, but also neutralizes nausea and heartburn. To prepare a medicinal tincture, you need ten grams of calamus root and the same amount of walnut shells, pour half a liter of water, and then after it has been infused for twenty minutes, strain and drink. Dosage - you need to drink a teaspoon three times a day, preferably freshly prepared.
2. Viburnum with sugar has a very good effect on the general condition of a woman, improves blood circulation in the placenta and has antioxidant and immunomodulatory properties. For this, it is enough to take viburnum ground with sugar throughout the pregnancy. This is also an additional source of vitamin C.
3. Grape leaves contain many useful tannins and due to this they exhibit their antispasmodic properties well. Therefore, for severe spasmodic pain caused by gallbladder pathology, use a tincture. To do this, pour three large grape leaves with liquid fresh honey and leave to infuse for a month. The tincture should be stirred periodically and at the end of the term add a few drops of olive oil. Take this tincture for pain, one teaspoon at a time, it neutralizes the pain syndrome and does not harm the child.
4. To speed up the removal of kidney stones, it is recommended to drink green tea with milk. To do this, boil a liter of milk and add a tablespoon of any green tea leaves. You can drink it hot or cold several times a day.

The use of herbs also has a good effect on the spasmodic gall bladder and intestines, improves the outflow of bile, and normalizes digestion. For this purpose, various herbal infusions and teas are used.

1. Rosehip infusion cleanses the liver well and normalizes appetite, so this infusion can be used to treat pain caused by liver pathology. To do this, you need to boil the rose hips in water and let it brew. Before taking, you can add sugar and citric acid.
2. Yarrow is a plant that reduces inflammation in the gallbladder and reduces the tone of the sphincter muscles, so bile flows better. The medicine is used in women with chronic cholecystitis in the form of an infusion. For a better antispasmodic effect, you need to pour 30 grams of yarrow and eucalyptus herbs with cold water and leave for three days. Then, before use, you need to strain the decoction and boil it, only after that you can take twenty grams in the morning and evening.
3. You need to take 200 grams of dandelion and plantain grass, make tea from two liters of water and drink in small sips throughout the day. The course of treatment is four weeks after the manifestation of nagging pain, then all processes should normalize and the symptoms will pass.

Homeopathy can be used for many processes in the intestines and gall bladder, and there is no harm to the child. Homeopathic remedies can be combined in such a way as to act on many processes in the body of a pregnant woman, which expands the possibilities of using this group of drugs.

1. Sanguinaria is a homeopathic remedy that has a composition of organic agents and helps to normalize the liver, gall bladder and pancreas with a mild analgesic effect, which eliminates the severity of functional pain in the left hypochondrium. The method of application of the drug is in drops and a dosage of four drops twice a day half an hour before meals at the same time. The course of treatment is three months. No side effects have been identified. Contraindications for taking are hypersensitivity to the components of the drug.
2. Bryonia album is a homeopathic remedy consisting of herbal preparations that are more effective in patients with pain that is localized on one side of the abdomen or migrates from one side to the other, causing weakness and asthenia. The method of administration of the drug is three drops three times a day, under the control of the heartbeat - if tachycardia occurs, the dose can be reduced. No side effects have been identified. Precautions - do not take if allergic to lilies.
3. Brom is a homeopathic preparation from the group of inorganic preparations. It is used to treat pain in the right side, which is caused by dysfunction of the gallbladder and has a strong spasmodic nature. The drug is most effective in patients who are very nervous and have poor sleep. Method of application - two homeopathic granules three times a day. Side effects are possible in the form of hyperemia of the skin of the hands and feet, as well as a feeling of heat. Precautions - do not use in combination with sedatives, as there may be a summation of the effect.
4. Carbonia compositum is a homeopathic remedy of natural origin. This remedy is used to treat pain in pregnant women caused by chronic pyelonephritis or kidney dysfunction. It has a diuretic effect and removes toxins. The drug is dosed two grains three times a day. Side effects are rare, but may include nausea and bloating. Precautions - use of the drug in the acute period of intestinal infection is not recommended.

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Complications and consequences

The consequences of pain in the right side can be very serious, especially if we are talking about acute surgical pathology. Complications of acute appendicitis can be in the form of the process spreading to the peritoneum and the development of purulent peritonitis. This is a very serious complication not only for the mother, but also for the child. The consequences of untimely diagnosis of pain syndrome can be very serious, especially if we are talking about diseases such as cholecystitis. Then there may be empyema of the gallbladder and the spread of infection with the formation of subhepatic abscesses. A consequence of untimely diagnosis of placental abruption can be a large retroplacental hematoma, which will ultimately lead to the need to remove the uterus.

Given such complications, it is necessary to diagnose diseases in a timely manner.

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Prevention

Prevention of pain in the right side during pregnancy is non-specific, since this condition is difficult to predict. To avoid complications and exacerbations of chronic diseases, you need to be carefully examined and prevent these symptoms before planning a pregnancy. For normal pregnancy, you need to follow a regimen, food should be fresh and healthy. You need to take maximum care of the health of a pregnant woman to avoid various infections.

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Forecast

The prognosis for a normal pregnancy and the birth of a healthy child is favorable even if the pain is caused by acute appendicitis, but timely treatment was carried out. Therefore, the main element is the timeliness and adequacy of treatment.

Pain in the right side during pregnancy can often indicate an inflammatory process in the gallbladder, intestines, or acute appendicitis. Therefore, when such symptoms appear, it is necessary to first exclude such serious diseases, especially if there are other symptoms. All conditions are treated well and there is no need to worry about the life of the unborn child, because the prognosis is favorable with timely treatment.

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