Round Ligament Pain During Pregnancy: What It Is, Why It Happens and How to Manage It

You roll over in bed and a sharp, pulling pain shoots through your lower belly. Or you sneeze and it catches you off guard, a sudden stab in your groin that takes your breath away for a second. It is gone almost as quickly as it came, but it was enough to make you wonder what on earth just happened.

If this sounds familiar, you are almost certainly dealing with round ligament pain. It is one of the most common complaints I see in pregnant women, particularly from the second trimester onwards. It can be sharp and startling, but it is harmless and very manageable once you understand what is going on.

What is the round ligament?

The round ligaments are two cord-like structures that run from either side of your uterus, through the inguinal canal (the passage in your groin) and into the tissue of the labia. They contain small arteries, veins and nerve fibres, which is why they can produce such a sharp pain when they are irritated (Chaudhry and Chaudhry, 2023).

When you are not pregnant, these ligaments are short, firm and do not do much. But as your uterus grows, they stretch significantly to accommodate it. That stretching, combined with the hormonal ligamentous laxity of pregnancy (thanks, relaxin), means these ligaments are under increasing tension. When you make a sudden movement, the ligament contracts or spasms, and the nerve fibres within it fire. That is the sharp, grabbing pain you feel.

When does it happen?

Round ligament pain is most common in the second trimester, typically between weeks 14 and 27, when the uterus is growing rapidly but has not yet reached the size where other structures take over more of the support. That said, some women experience it earlier or later in pregnancy.

Common triggers include:

Sudden movements. Rolling over in bed, standing up quickly, getting out of a car.
Coughing, sneezing or laughing. Anything that causes a sudden increase in abdominal pressure.
Prolonged standing or walking. Especially towards the end of the day when you are tired and your posture changes.
Exercise. Particularly movements with quick direction changes or impact.

The pain is usually one-sided (more often the right, because the uterus tends to rotate slightly to the right as it grows) but it can be felt on both sides.

What does it feel like?

Round ligament pain is typically a sharp, sudden, stabbing or pulling sensation in the lower abdomen or groin. It can also present as a dull ache that lingers after a period of activity. It usually lasts a few seconds to a few minutes and then settles. It does not get progressively worse over time, and it is not associated with any other symptoms.

That last point is important, because lower abdominal and groin pain during pregnancy can have other causes. If your pain is persistent, worsening, accompanied by fever, bleeding, pain with urination or you simply feel that something is not right, get it checked. A thorough assessment can rule out other causes and give you peace of mind (Dhamecha et al., 2023). Round ligament pain is a diagnosis of reassurance, but it is one that should be made properly rather than assumed.

How to manage it at home

The good news is that round ligament pain responds really well to simple strategies. Most of the women I see find that once they know what it is and make a few small adjustments, it becomes much less disruptive.

Move slowly and deliberately

This is the single most effective change. The pain is triggered by sudden movements, so slowing down your transitions makes a big difference. When getting out of bed, roll onto your side first, then push yourself up with your arms rather than sitting straight up. When standing from a chair, take a moment rather than springing up.

Flex your hips when you feel a sneeze or cough coming

This one sounds odd, but it works. If you feel a sneeze coming on, bend your knees slightly or lean forward. This takes the tension off the round ligaments before the sudden contraction hits. The same goes for laughing or coughing.

Use warmth

A warm (not hot) pack or wheat bag over the area of pain can help relax the ligament and surrounding muscles. A warm bath can also provide relief, particularly at the end of the day.

Support your belly

A maternity support belt can take some of the load off the round ligaments, particularly if you are on your feet a lot. Even a simple belly band can make a noticeable difference during the second and third trimesters.

Stretch gently

Gentle hip flexor and adductor stretches can reduce tension in the structures around the round ligament. A simple stretch is to kneel on all fours, then gently rock your hips back toward your heels and hold for 20 to 30 seconds. Repeat a few times, a couple of times a day.

Rest when you need to

If the pain has been particularly active, give yourself permission to rest. Lying on your side with a pillow between your knees takes the rotational load off your pelvis and lets the ligaments settle.

How chiropractic care helps

Round ligament pain does not exist in isolation. It sits within a broader picture of pregnancy-related musculoskeletal change: your pelvis is widening, your centre of gravity is shifting forward, your ligaments are more lax and your muscles are working harder to stabilise everything. A systematic review by Weis and colleagues (2020) found that chiropractic care is associated with improved outcomes for pregnancy-related low back and pelvic girdle pain, with no serious adverse events reported.

Soft tissue work on the round ligament and surrounding structures. Gentle release of the muscles and fascial tissues around the inguinal area, hip flexors and lower abdominals can reduce the tension that contributes to round ligament irritation. This often provides immediate relief.

Pelvic and sacroiliac joint mobilisation. Round ligament pain often coexists with pelvic girdle pain and sacroiliac joint dysfunction. When the pelvis is not moving symmetrically, the ligaments on one side can be under more tension than the other. Restoring balanced pelvic movement helps distribute the load more evenly. Approximately 20% of pregnant women experience pelvic girdle pain (Wu et al., 2004), and addressing it alongside round ligament pain gives a much better result than treating either in isolation.

Exercise and stretching guidance. I prescribe specific stretches and strengthening exercises tailored to your stage of pregnancy. Exercises that support the hip flexors, glutes and deep core help stabilise the pelvis and reduce the strain on the ligaments. A review by Fiat and colleagues (2022) supports non-pharmacological approaches including exercise and manual therapy as first-line management for pregnancy-related musculoskeletal pain.

Treatment is gentle and pregnancy-specific. All techniques are adapted for your stage of pregnancy. We use comfortable positioning with pregnancy pillows and bolsters so you can lie safely and comfortably. A systematic review by Hall and colleagues (2016) found a moderate treatment effect for complementary manual therapies on pregnancy-related back and pelvic pain, supporting the role of hands-on care during pregnancy.

It is not something you just have to put up with

Round ligament pain is common, but that does not mean you have to grit your teeth and wait it out. With the right management, most women find it settles significantly and stops getting in the way of their day, their sleep and their ability to stay active during pregnancy.

If round ligament pain or any other pregnancy-related discomfort is bothering you, I am happy to help. We see pregnant women at every stage and I understand how your body is changing and what it needs.

Get in touch or book an appointment.

References

ROUND LIGAMENT PAIN DURING PREGNANCY: WHAT IT IS, WHY IT HAPPENS AND HOW TO MANAGE IT