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

Pain in the right side during pregnancy is the appearance of unpleasant sensations, which can be at any time. The reasons for this pain can be many, so it is worth taking seriously any painful sensations during pregnancy, because it's about two lives. To be absolutely sure that nothing mom and child is not threatened, you need to consult a doctor.

Causes of the pain in the right side during pregnancy

The reasons for the development of pains such a localization when bearing a child can be very much. First of all, you need to know about the period of pregnancy. Pain in the side to the right, as a sign of pregnancy, happens very often. They arise after a fertilized egg is implanted in the uterine cavity. This is more often in the right horn of the uterus, which is accompanied by the process of dissolution of the endometrium for normal implantation. In this process, nerve endings can be involved, so when a woman has a small physical load, she can feel pain in her right side - the place of implantation of the egg. Therefore, this may even be one of the indirect signs of pregnancy itself, if the woman does not yet know about it.

As for the 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 every week to a certain size, which can cause compression of internal organs and provoke the appearance of various symptoms. In the right lateral flank of the stomach is liver, gallbladder, small and large intestine, right kidney, appendix. The pathogenesis of the appearance of symptoms is due to the fact that the enlarged uterus presses on these organs, which is the reason for the appearance of certain unpleasant sensations. With the compression of these organs, blood circulation, normal innervation, and various symptoms associated with such a pain syndrome may be disrupted. 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 called the first place. In pregnancy, all chronic diseases have a property to activate due to a decrease in immune defense. Therefore, pregnancy itself is a risk factor for exacerbation of chronic cholecystitis. Then the pain is caused by inflammation of the wall and irritation of the peritoneum. If cholecystitis is calculous, then often the change in the location of the gallbladder due to compression by the uterus can cause movement of the stones, so the etiological factor of the acute pain of such localization may be hepatic colic. If a woman has problems with the liver, then during pregnancy it can also lead to pain. The liver performs the load for both the baby and the mother, so with additional physical activity the capsule can strain, which causes pain in the right side.

Violation of peristalsis and normal bowel activity can also be manifested with pain in the right side. After all, the compression of the small and large intestine leads to the fact that not only their peristalsis is disturbed, but in due course also the biocenosis - which subsequently affects the symptoms. Inflammation of the intestine after poisoning in the form of acute enteritis or enterocolitis often causes similar pain in the right side, as the enlarged uterus displaces the intestine. Therefore, pain has just such a localization.

In pregnancy, the location of the kidneys and ureters is disturbed, they rise higher, so inflammatory or mechanical disorders in these organs can lead to the irradiation of pain. Often right-sided pyelonephritis in pregnant women is accompanied by right-sided pain, as the first sign of the disease. In this case, the capsule of the kidney is also stretched and this leads to the appearance of pain in the side. It is also necessary to exclude renal colic as the cause of such pain.

The most serious cause in terms of the appearance of possible complications is inflammation of the appendix - acute appendicitis. It is localized at the initial part of the cecum, which is located in the right ileal region. But this gut 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 irradiates 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 rather predisposes to it.

In later pregnancy, premature detachment of the placenta may be caused, for example, by preeclampsia. This condition is accompanied by an increase in blood pressure in a woman, which is often complicated by detachment of the placenta. If this occurs in the right side of the uterus, then it can cause pain in the side.

Ectopic pregnancy, which develops in the right fallopian tube, with its rupture can manifest symptoms of right-sided pain. This is important to consider, because sometimes a woman still may not know about pregnancy.

Risk factors

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

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

[1]

Epidemiology

Epidemiology of the spread of pain during pregnancy is very wide. About 96% of pregnant women experience abdominal pain in the third trimester of pregnancy, and 65% of this pain is localized in the right side. Not always such pain is the cause of organic disease, only 72% is pathology. Among these diseases, the pathology of the liver and gall bladder comes first, on the second - acute appendicitis, as well as chronic diseases of the intestine. But nevertheless, you need to carefully carry out differential diagnosis, because all these pathologies can be complicated.

[2], [3], [4], [5], [6], [7]

Symptoms

To know what causes this pain in a pregnant woman, you need to take into account not only pain in the right side, but also other manifestations that accompany this pathology. After all, at the stage of the survey, you can put a preliminary diagnosis and determine the treatment.

If the unpleasant sensations in the right side are caused by a physiological increase in the uterus, then this pain is not expressed all the time and not very intense, it occurs after overeating or a certain load. However, the general condition of a 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 expressed symptoms, then you should not restless.

Chronic non-calculous cholecystitis is an inflammation of the gallbladder, which is accompanied by a thickening of its wall and irritation of the peritoneum. This is characterized by the appearance of blunt right-sided pain, which is often provoked by fatty foods. Such pain appears gradually, it is not strongly pronounced and localized under the right rib. Symptoms that may be there are a bitter taste in the mouth, stools, nausea, or vomiting. This inflammation can be accompanied by an intoxication syndrome - there may be a slight increase in body temperature.

A severe and acute 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 just such a sharp pain. This is accompanied by strong restlessness, a woman can not sit still - this 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, as the uterus tone may increase and premature birth may begin.

Aching pain on the right side of pregnant women often develops against the background of a diaphragmatic mushroom. Then the pain is persistent and often accompanied by dyspepsia. Elevated pressure in the abdominal cavity causes these symptoms and after a birth such a hernia can pass by itself.

Pain in the right side of the stitching can be caused by renal colic. Then it begins in the lumbar region and irradiates into the right flank and genitals. Acute right-sided pyelonephritis is also accompanied by pain in the right side, but this pain is less pronounced and has a permanent character. With kidney pathology and urolithiasis, there are always violations of the process of urination. There may be pain or pain along the ureters, as well as frequent urination or false urges to it.

Pain in the right side of pregnant women can be initiated by acute enteritis. After a certain food, there may be a slight inflammatory process in the intestines, which is accompanied by pain and stool disruption. Symptoms develop gradually and there is always a connection with the reception of a certain food.

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

Premature detachment of the placenta begins with a sharp pain in the right side, where the placenta exfoliates and is accompanied by bleeding. The region of the detached placenta flows blood, normal fetal circulation is disturbed, which is accompanied by symptoms from the fetal side. Then the heart rate may increase or decrease and hypoxia may occur, which has serious consequences.

Thus, many causes of pain in the right side during pregnancy require a thorough diagnosis with the definition of all the symptoms and the conduct of additional research methods.

Diagnostics of the pain in the right side during 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 performed to ensure the normal development of the fetus.

It is important to find out all the anamnestic data with the definition of the nature of pain, its intensity, its connection with food. It is necessary to find out whether the woman has chronic diseases, such as cholecystitis, enteritis, urolithiasis. One should also ask about other symptoms, whether they are related to pain and whether the woman has taken painkillers. If a woman has undergone apneectomy, then this diagnosis can easily be ruled out.

When examining a pregnant woman, one must first study the child's reaction to this pain. It is necessary to determine the heartbeat and movements of the fetus, its condition with such symptoms. To exclude the pathology of the liver and gallbladder, you need to identify all the symptoms. The positive symptoms of Ortner, Mussie, Murphy, or at least some of them, give grounds to suspect an exacerbation of cholecystitis.

It is necessary to check the symptom of Pasternatsky, if he is positive on at least one side, then this is the probable pathology of the kidneys.

Diagnosis of acute appendicitis in a pregnant woman is slightly complicated, since an enlarged uterus can change the position of the appendix. But the characteristic symptom of the appearance of pain first in the epigastrium, and then in the right lower abdomen is very often. When you look at such a woman, you can determine that the maximum soreness occurs when the doctor takes his fingers off the stomach, and not when touched. To accurately exclude acute abdominal pathology, additional studies are always needed.

Analyzes that must be submitted must also be conducted for the purpose of differential diagnosis. It is necessary to give a general blood test, a general urine test and determine the level of blood glucose. Further, special tests are needed, which exclude this or that pathology. If there is a suspicion of appendicitis in the blood test, there will be significant leukocytosis with a shift of the formula to the left and acceleration of the ESR. The same changes are also 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 limits of the norm, then an instrumental study is needed to exclude or confirm a specific diagnosis. The main method of instrumental diagnosis during pregnancy can be considered ultrasound. This method is not so harmful to the child and can have greater diagnostic significance for establishing the majority of diagnoses. By results of US it is possible to tell or say about an inflammation of a cholic bubble - then its wall thickens and in a cavity there will be indistinct koross. You can determine the stone in the gallbladder or ureter and confirm colic. Acute right-sided pyelonephritis can also be defined as an expansion of the pelvic system.

If a suspected acute appendicitis is rectal examination. The advantage of this diagnosis is the sharp soreness of the rectum wall in the projection of the appendix during palpation. This is a very serious symptom that confirms acute pathology.

In addition to the state of the mother, ultrasound can assess the condition of the fetus. It is possible to exclude pathology of the placenta and other complications of pregnancy, which is important for differential diagnosis. If the disease occurs in the third trimester, then in addition to the ultrasound of the fetus, cardiocoograms must be carried out to determine the condition of the child and the risk of complications. Then it is possible to determine the violation of the heartbeat, increased uterine tone and premature birth, which can cause pain in the right side with the same probability as other pathologies.

[8], [9], [10]

Differential diagnosis

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

No less important is the pathology of internal organs to differentiate directly with the causes of pregnancy itself. Premature detachment of the placenta has a clinic with a similar pain syndrome, especially if the placenta is exfoliated to the right. But in this case, bloody discharge is often observed, and it can be confirmed with the help of ultrasound examination - a retrocopental accumulation of blood is detected. This is an urgent situation that requires immediate action, so a pregnant woman first of all needs to differentiate this state with other pathologies.

Correct diagnosis and the cause of the disease is necessary in order to start treatment on time, until complications arise.

[11], [12], [13]

Treatment of the pain in the right side during pregnancy

Treatment of a pregnant woman sets the main task of eliminating the cause of pain, but first of all you need to reduce the severity of the pain syndrome so that there are no premature births and other complications. If it is a question of acute surgical pathology, then medication is only part of the preparation for surgery.

If the cause of acute pain is renal or hepatic colic, then anesthesia should be performed immediately, since the severity of the pain syndrome is very strong.

1. Baralgin is a universal combination that is used to treat colic. The composition of the drug includes metamizole, which has an analgesic effect, as well as fenpiperin 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. The route of administration is intravenous or intramuscular. Dosage of the drug at one dose from two to five milliliters. Side effects that can be skin hyperemia, fever, chills, body t0, weakness, palpitations, arterial hypotension headache, dizziness, insomnia, nausea, constipation, vomiting, local reactions at the injection site. Precautions - use in pregnancy is decided on an individual basis and only under the control of the condition of the woman and the fetus.
2. Diclofenac sodium is a non-steroidal anti-inflammatory drug that relieves pain in colic and can be used as an alternative in case of contraindications to others. Dosage - 50 mg at a time after meals. Side effects - dyspeptic disorders, dizziness, hepatitis, erosive-ulcerative lesions of the stomach, 12 duodenal ulcer, allergic rash (rarely), "aspirin asthma." Given the strong effect on the gastrointestinal tract, it is desirable 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 is due to right-sided pyelonephritis, then complex treatment should be used, the main element of which is the restoration of the outflow of urine. In pregnant women, pyelonephritis has a secondary nature because the uterus contracts the ureters, so an obligatory element of treatment is stenting with restoration of the outflow of urine. Then you need to prescribe an antibiotic that can be given to pregnant women. Such authorized antibacterial agents include unprotected aminopenicillins and cephalosporins. If it is an exacerbation of chronic cholecystitis, then it is necessary to use antibiotic in treatment. To the complex treatment can add antipyretic and antispasmodic drugs.

1. Ceppodoxime is a beta-lactam antibiotic of the third generation, it is especially effective when it acts on the gram-positive and gram-negative flora bactericidal. The drug has a bactericidal effect on possible anaerobic pathogens of urinary tract infections, so it can also be used for cholecystitis. Dosage of the drug - 200 mg twice a day, at least ten days. Side effects are possible with the influence on the stomach - develops colitis or dysbiosis, which manifests itself by bloating, a violation of the stool. Precautions - do not use the drug for allergies to antibiotics-penicillins, as well as for congenital fermentopathies.
2. If the phenomenon of abdominal pain is associated with compression of the intestine, then often there are disorders of the stool, disperse phenomena, which leads to a non-radiological eating of the woman. Therefore, the use of probiotics in the treatment of such conditions can solve all the problems.

Lactobacterin is a drug that has in its composition lactobacilli, which form lactic acid and do not allow reproducing pathogenic bacteria. Due to this, the preparation forms favorable conditions for the development of useful intestinal microflora. These properties of the drug contribute to the fact that spasmodic phenomena in the intestine pass and the pain decreases, if the cause is physiological changes. Dosage, sufficient to restore microflora and intestinal peristalsis is one dose of the drug once a day. Side effects are diarrhea or a feeling of heaviness and overflow in the abdomen that goes away after a while. Precaution measures - if there are symptoms of food poisoning, the drug should be taken with a doctor.

Vitamins can be used by a woman to treat pain and discomfort that are caused by functional intestinal spasms. In this case, you need to give preference to complex vitamin products with an increased amount of magnesium.

Physiotherapy treatment is possible only if it is not contraindicated for a pregnant woman and does not harm the child. For example, when exacerbation of chronic cholecystitis can not be used thermal procedures.

Surgical treatment of pain in the right side during pregnancy is the main method, if a woman has acute appendicitis. In this case, a general anesthesia is performed, taking into account the minimal harm to the child and begin the operation. Operative access depends on the period of pregnancy and the degree of uterine enlargement. In most cases, classical access is performed in the right iliac region and the inflammation of the uterus is removed bypassing the uterus.

If the cause of the pain is premature detachment of the placenta, then the woman should immediately be hospitalized in the maternity hospital with the determination of the need for delivery.

Alternative treatment of pain in the right side in pregnancy

Alternative treatments for such pain are widely used if there is no organic pathology. If a woman has chronic cholecystitis or urolithiasis, they use drugs that reduce the formation of stones. If the bowel function is disrupted, the means for improving peristalsis and normalizing the digestive function are also used.

1. Tincture of root aira with walnuts has excellent detoxification and antioxidant properties, which reduces the amount of harmful substances and speeds up digestion. This helps not only reduce the soreness of the intestines, but also neutralizes nausea and heartburn. To prepare a medicinal tincture, you need ten grams of calamus root and as much nutshells, pour water in a volume of half liter, and then after it tinges for twenty minutes, strain and drink. Dosage - a teaspoon should be drunk three times a day, preferably in a freshly prepared form.
2. Kalina with sugar very well affects the general condition of a woman, improves blood circulation of the placenta and has antioxidant and immunomodulatory properties. To do this, it is enough to take the fennel with sugar over the course of the pregnancy. This is also an additional source of vitamin C.
3. Grape leaves have many useful tannins and because of this they display their antispasmodic properties well. Therefore, with severe spasmodic pain caused by the pathology of the gallbladder, use tincture. To do this, you need to pour three large grape leaves with liquid fresh honey and leave for a month to insist. Tincture should be stirred occasionally and at the end of the period add a few drops of olive oil. Take this infusion is necessary for pain on a teaspoon, it neutralizes the pain syndrome and does not harm the child.
4. To accelerate the excretion of stones from the kidneys, it is recommended to take green tea with milk. To do this, boil a liter of milk and add a tablespoon of leaves of any green tea. You can drink both hot and cold several times a day.

The use of herbs also has a good effect on spasmodic gallbladder and intestines, improves outflow of bile, normalizes digestion. For this purpose, use different infusions and herbal teas.

1. Infusion of dog rose well cleanses the liver and normalizes appetite, therefore, for the treatment of pain caused by the pathology of the liver, this infusion can be used. To do this, you need to boil the hips in the water and insist. Before you can add sugar and citric acid.
2. Yarrow is a plant that reduces the inflammatory process in the gallbladder and reduces the tone of the sphincter muscles, so the bile is better off. The medicine is used in women with chronic cholecystitis in the form of infusion. For a better spasmolytic effect, you need 30 grams of yarrow and eucalyptus grass to cover with cold water and insist for three days. Then, before use, drain the broth and boil, only after that you can take twenty grams in the morning and in the evening.
3. You need to take 200 grams of herb dandelion and plantain, make tea from two liters of water and drink in small sips throughout the day. The course of treatment is four weeks after the manifestations of traumatic pain, then all processes should normalize and the symptoms will pass.

Homeopathy can be used in many processes in the intestine and gallbladder, with 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 medicines.

1. Sanguinaria is a homeopathic remedy that has a composition of organic substances and promotes normalization of the liver, gallbladder and pancreas with a slight analgesic effect, which eliminates the severity of functional pain in the left hypochondrium. The way of application of the drug is in drops and dosage of four drops twice a day for half an hour before meals at the same time. The course of treatment is three months. There were no side effects. Contraindications to admission - it is hypersensitivity to the components of the drug.
2. Bryony albumus is a homeopathic remedy that consists 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, which causes weakness and asthenia. The method of applying the drug - three drops three times a day, under the control of the heartbeat - with the appearance of tachycardia, the dose can be reduced. There were no side effects. Precautions - do not take with allergies to lilies.
3. Bromine is a preparation of homeopathic origin from a group of inorganic preparations. Used to treat pain in the right side, which are caused by a violation of the gallbladder and have a strong spasmodic character. The drug is most effective in patients who are much nervous and have a bad dream. Method of application - two homeopathic grains three times a day. Side effects are possible in the form of hyperemia of the skin of hands and feet, as well as sensation of heat. Precautions - do not use in combination with soothing means, as there may be a summation of the effect.
4. Carbonium compositum is a homeopathic remedy of natural origin. This remedy is used to treat pain in pregnant women, which is caused by chronic pyelonephritis or impaired renal function. It has a diuretic effect and removes toxins. The drug is dosed two grains three times a day. Side effects are not common, but there may be nausea and bloating. Precautions - use of the drug in the acute period of intestinal infection is not recommended.

[14], [15], [16], [17], [18], [19]

Complications and consequences

The consequences of pain in the right side can be very serious, especially when it comes to acute surgical pathology. Complications of acute appendicitis can be in the form of the spread of the process 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 can be very serious, especially when it comes to diseases such as cholecystitis. Then there can be an empyema of the gallbladder and the spread of infection with the formation of subhepatic abscesses. The consequence of untimely diagnosis of placental detachment may be a large retroplacental hematoma, which eventually leads to the need for removal of the uterus.

Given such complications, it is necessary to diagnose the disease in time.

[20], [21], [22], [23], [24]

Prevention

Prevention of the appearance of pain in the right side during pregnancy is nonspecific, since this condition is difficult to foresee. To avoid complications and exacerbations of chronic diseases before planning pregnancy, you need to carefully monitor and prevent these symptoms. For a normal gestation of pregnancy, it is necessary to follow the regime, the food should be fresh and useful. It is necessary to maximally protect the health of a pregnant woman in order to avoid different infections.

[25], [26], [27]

Forecast

The prognosis for normal pregnancy and the birth of a healthy child is favorable, even if the pain is caused by acute appendicitis, but timely treatment was performed. 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, intestine, or acute appendicitis. Therefore, when these symptoms appear, you must first exclude such serious diseases, especially if there are other symptoms. All states are well treated and should not be worried about the life of the unborn child, because the prognosis is favorable with timely treatment.

[28], [29]