Pregnancy can be a disconcerting time for women. With all the changes your body is going through, it can be hard to tell what’s normal and what you should be concerned enough about to discuss with your care team.
Many pregnant women experience rib pain during pregnancy as their bodies expand in myriad ways to accommodate the fetus. But rib pain may also point to an underlying condition or complication that needs medical evaluation and treatment. Here’s what to know about rib pain during pregnancy.
Is It Normal for Ribs to Hurt During Pregnancy?
Pain in and around the ribs, whether it’s a dull ache, sharp pain, or just a feeling of tenderness, is common in pregnancy. Right rib pain is more of a concern than left rib pain, but any severe pain should be evaluated by your doctor.
What Causes Rib Pain During Pregnancy?
The ribs take up a sizable space in the thoracic body. Rib pain during pregnancy can be caused by a number of issues; Not all rib pain actually comes from stress on the ribs. Further, left side rib pain and right-side rib pain may point to different issues, some of them serious. Here are some of the most common causes of rib pain during pregnancy:
As your uterus grows to accommodate the fetus it pushes upwards, adding pressure on organs under the ribs that can result in rib pain and inflammation. As your breasts get bigger, this can also put pressure on the ribcage from the opposite direction. Most women experience rib pain due to musculoskeletal changes such as these in the second and third trimesters [*].
Near the end of the second trimester, your baby should move into a head-down position, with its feet pointing toward your ribs. This pressure on the ribs can make you feel sore, and baby’s kicks and movements may further exacerbate that soreness. If baby remains in a breech position, you may experience some pain from its head there [*][*].
Pregnant women produce relaxin, a hormone that helps the muscles relax and expand to accommodate the fetus [*]. Relaxin can also cause heartburn because it relaxes part of the esophagus. This may encourage acid reflux, which can sometimes feel like rib pain. This can start in early pregnancy and continue throughout.
Right rib pain during pregnancy, especially upper right, near your liver, can be a sign of a kidney or urinary tract Infection (UTI), gallstones, pancreatitis, preeclampsia, or an undiagnosed tumor.
Urinary Tract Infections (UTI)
The bacteria in your urinary tract can change with pregnancy and it may be harder to empty your bladder if the fetus is putting pressure on it, resulting in a urinary tract infection. The pain in your bladder or kidneys can present as rib pain [*].
Gallstones can present as pain in the upper right quadrant. Rising estrogen levels during pregnancy can change the composition of bile, leading to malfunction of bile ducts and the formation of bile deposits [*]. Progesterone can also have a deleterious effect. Gallstones may form at the end of the first trimester with increased risk of forming in the second and third trimesters. An ultrasound of the abdominal cavity at the end of the first trimester can assess this issue. Gallstones may need to be removed surgically after pregnancy.
In rare cases, gallstones can lead to acute pancreatitis, a life-threatening disease for mother and baby which carries an increased risk of preterm labor and fetal mortality [*]. It may present with abdominal pain.
Preeclampsia is a dangerous complication of pregnancy caused by high blood pressure that arises from a developmental problem with the blood vessels supplying the placenta [*]. Women who have it may have no noticeable symptoms, but it can also present with right rib pain or upper right quadrant pain, sometimes radiating up to the shoulder and making it painful to lie on your right side. Other symptoms of preeclampsia include swelling, headaches, nausea, lower back pain, sudden weight gain, and vision changes like flashing, spots, blurriness, or auras. Contact your care team and get to a hospital immediately if you’re experiencing these symptoms.
If you’re less than 12 weeks pregnant, rib pain or shoulder pain can be a sign of an ectopic pregnancy, but this is rare [*].
Cancer during pregnancy is rare, seen in roughly 1 in 1,000 pregnancies [*]. However, it’s hard to detect because cancer can have many of the same symptoms as early pregnancy (bloating, fatigue, breast changes, nausea, constipation…). Right rib pain that persists can be a sign of a liver problem. For any rib pain, abdominal pain, or upper right quadrant pain that persists, talk to your doctor.
How Does Rib Pain Change During Pregnancy?
Rib pain can change during pregnancy based on the underlying cause. For instance:
You may experience indigestion from the hormonal changes during the first trimester, but with your baby only weighing about an ounce, you’re not likely to feel rib pain from musculoskeletal issues.
Rib pain caused by musculoskeletal changes can become more intense later in pregnancy, especially in the second and third trimesters, as the baby continues to grow. You may also experience some shortness of breath.
Rib pain from the baby’s arm and leg movements is common in the third trimester, as well as from the pressure of the expanding uterus and breasts. Once your baby has dropped into the pelvis in the last few weeks of pregnancy, you may find relief as the pressure on the ribs subsides.
Talk to your doctor about any rib pain you’re experiencing, and any symptoms you may be having in addition to rib pain to eliminate the possibility of pregnancy complications.
How Do You Relieve Rib Pain During Pregnancy?
There are a number of ways to ease rib pain at any time during your pregnancy, and to avoid it in the first place.
Gentle exercise, stretching, and deep breathing every day can go a long way to preventing rib pain in the first place. Swimming, water aerobics, and yoga are all good choices to help muscles stay strong and supple and also calm your nervous system [*]. You can also try pregnancy exercises on an exercise ball, like rolling over the ball on your back, or other exercises recommended by a pregnancy physiotherapist. If your job requires you to sit for long periods, try setting a timer and getting up and stretching every 20 minutes.
A warm compress on the ribs may help the tense muscles relax and offer you some relief. Just keep it on the ribs, away from the baby. A warm bath with some epsom salt can also help calm inflammation while providing a nice dose of magnesium [*]. For more sharp pain, a cool compress may feel better. You can alternate between warm and cool to relieve pain.
Get a Massage
A gentle massage can help diminish trigger points and lengthen tight muscles.
Be Mindful of Your Posture
Slouching or overarching your back can cause more pressure on the ribs and also lead to abdominal coning. It can also make symptoms of shortness of breath worse. Talk to a physiotherapist, Alexander Technique teacher, or chiropractor to help you be more mindful of your use and assist with any adjustments that would make you more comfortable.
Watch Your Weight Gain
Change Your Eating Habits
If indigestion or heartburn is causing you rib pain, try eating smaller meals more often, not eating within three hours of going to bed, and cutting down on caffeine along with foods that are sugar-filled, rich, spicy, or fatty.
Consider Your Clothing
Pregnant women are often advised to wear loose clothing but it’s also important to invest in good undergarments. A well-fitted bra without an underwire or a belly band that supports your abdomen might help.
Take an Analgesic
If your doctor approves, acetaminophen may take the edge off rib pain.
How Should I Sleep to Prevent Rib Pain During Pregnancy?
If you’re experiencing rib pain and shortness of breath, it may help to sleep on a slight incline, made with pillows or a sleeping wedge. If you sleep on your side, put a pillow between your knees. In the second and third trimesters, try to sleep on your left side. This will reduce pressure on your liver and improve your circulation [*].
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The Bottom Line
If your little one is practicing karate in the womb, a certain amount of rib pain may be unavoidable in the course of your pregnancy. For most musculoskeletal issues, exercise, diet, and the occasional heating pad can help you keep it at bay. But if your pain is severe or is attended by other symptoms, be sure to reach out to your care team.