Pain in Stomach 28 Weeks Pregnant | Understanding Discomfort

Reaching 28 weeks means you are well into your third trimester, a time when your body is undergoing significant transformations to accommodate your growing baby. New sensations and discomforts often arise as your uterus expands and your organs shift. Understanding the common reasons for stomach pain at this stage helps you discern what is typical and when to reach out to your healthcare provider.

The Shifting Landscape of Your Third Trimester Body

At 28 weeks, your uterus has grown considerably, now extending well above your navel. This expansion places pressure on surrounding organs, ligaments, and muscles. Your center of gravity also shifts, influencing posture and muscle strain. These physical changes contribute to a range of sensations, including various types of abdominal discomfort.

• Your growing baby occupies more space, pushing against your stomach, intestines, and diaphragm.
• Hormonal changes continue to affect muscle relaxation throughout your body, including your digestive tract.
• Increased blood volume and fluid retention can also play a role in how your body feels.

Common & Expected Causes of Stomach Pain

Many types of stomach pain during the third trimester are typical and do not indicate a serious problem. These often relate to your body’s adjustments to pregnancy.

Round Ligament Pain

This pain often presents as a sharp, stabbing sensation or a dull ache in the lower abdomen or groin area. It typically occurs on one or both sides. The round ligaments are two cord-like structures that help hold the uterus in place. As the uterus grows, these ligaments stretch and thin, becoming more sensitive.

• Pain might intensify with sudden movements like coughing, sneezing, laughing, or changing positions quickly.
• Rest often brings relief from round ligament pain.
• Gentle stretching or applying a warm compress can also help ease discomfort.

Braxton Hicks Contractions

Often called “practice contractions,” Braxton Hicks are irregular uterine tightenings that occur as your body prepares for labor. At 28 weeks, they might become more noticeable. They are usually not painful, feeling more like a tightening or hardening of the abdomen.

• Braxton Hicks contractions are typically infrequent and do not follow a regular pattern.
• They do not increase in intensity or duration over time.
• Changing positions, walking, or drinking water can often make them subside.

Gas, Bloating, and Constipation

Digestive issues are common culprits for stomach pain during pregnancy. Progesterone, a hormone abundant in pregnancy, relaxes smooth muscles throughout the body, including those in the digestive tract. This slows digestion, leading to increased gas production and constipation.

• Gas pain can feel sharp, cramping, or generalized across the abdomen.
• Constipation can cause lower abdominal discomfort and a feeling of fullness.
• Iron supplements, often prescribed during pregnancy, can also contribute to constipation.

Digestive System Adjustments and Discomforts

The continued growth of your uterus directly impacts your digestive organs, leading to specific types of discomfort beyond general gas or constipation.

Heartburn and acid reflux become more common as the uterus pushes against the stomach, forcing stomach acid upwards into the esophagus. This can cause a burning sensation in the chest or upper abdomen. Eating smaller, more frequent meals and avoiding trigger foods can help manage these symptoms.

In some cases, upper abdominal pain, particularly on the right side, might relate to gallbladder issues. Pregnancy hormones can affect bile flow, sometimes leading to gallstones. This pain is often sharp and can radiate to the back or shoulder, sometimes worsening after fatty meals.

When Pain Signals More: Conditions Requiring Attention

While many causes of stomach pain are benign, some situations warrant immediate medical evaluation. Recognizing these signs is important for your health and your baby’s well-being. The American College of Obstetricians and Gynecologists provides comprehensive guidance on pregnancy health, including warning signs to monitor. For more detailed information, you can refer to resources from ACOG.

Preterm Labor

At 28 weeks, preterm labor is a serious concern. It involves regular, painful contractions that cause changes to your cervix. Unlike Braxton Hicks, preterm labor contractions become stronger, more frequent, and do not subside with rest or hydration.

• Regular or frequent contractions (e.g., every 10 minutes or more often).
• A constant low, dull backache.
• Pelvic pressure, feeling like your baby is pushing down.
• Abdominal cramping, with or without diarrhea.
• A change in vaginal discharge (watery, bloody, or mucus-like).
• Vaginal bleeding or spotting.

Urinary Tract Infections (UTIs)

Pregnancy increases the risk of UTIs. If left untreated, a UTI can lead to kidney infection or preterm labor. Symptoms can include lower abdominal pain or pressure.

• Pain or burning during urination.
• Frequent urge to urinate, even if little urine comes out.
• Cloudy, strong-smelling, or bloody urine.
• Fever or chills.

Other serious conditions that can cause stomach pain include:

• Preeclampsia: This condition involves high blood pressure and signs of organ damage, often after 20 weeks of pregnancy. Upper abdominal pain, particularly under the ribs on the right side, can be a symptom. Other signs include severe headache, vision changes, and sudden swelling.
• Placental Abruption: This occurs when the placenta separates from the inner wall of the uterus before birth. It causes sudden, severe, constant abdominal pain, often with vaginal bleeding and uterine tenderness. This is a medical emergency.
• Appendicitis: Though less common in pregnancy, appendicitis remains a possibility. It typically causes sharp pain that starts around the navel and moves to the lower right abdomen, worsening over time.

Distinguishing Between Different Types of Pain

Understanding the characteristics of your pain can help you and your provider determine its cause. Consider these factors:

• Quality of Pain: Is it sharp, dull, cramping, burning, or a generalized ache?
• Location: Is the pain in your upper abdomen, lower abdomen, on one side, or spread across your entire belly?
• Duration and Frequency: Is it constant, intermittent, or does it come and go in waves? How often does it occur?
• Accompanying Symptoms: Are you experiencing fever, chills, vaginal bleeding, changes in discharge, nausea, vomiting, diarrhea, or difficulty urinating?
• Relieving or Aggravating Factors: Does the pain improve with rest, position changes, eating, or drinking? Does it worsen with activity or specific foods?

Keeping a mental note of these details helps paint a clearer picture for your healthcare provider.

Practical Approaches for Managing Discomfort

For common, non-serious causes of stomach pain, several strategies can offer relief. These methods focus on supporting your changing body and digestive system.

• Hydration: Drink plenty of water throughout the day. Dehydration can trigger Braxton Hicks contractions and worsen constipation.
• Dietary Fiber: Increase your intake of fiber-rich foods like fruits, vegetables, and whole grains to prevent constipation.
• Movement and Light Exercise: Regular, gentle activity, such as walking, can aid digestion and alleviate gas.
• Rest and Position Changes: Lying down, especially on your left side, can improve blood flow and reduce pressure. A warm bath (if approved by your provider) can also soothe muscle aches.
• Smaller, Frequent Meals: Eating smaller portions more often can ease digestive strain and reduce heartburn.
• Pelvic Tilts: These exercises can help strengthen abdominal muscles and relieve pressure on your back and pelvis.

The Centers for Disease Control and Prevention (CDC) offers valuable resources on healthy pregnancy practices, including nutrition and physical activity guidelines. You can find more information at CDC.

Knowing When to Contact Your Healthcare Provider

It is always wise to err on the side of caution when you are pregnant. If you experience any concerning symptoms, reaching out to your healthcare provider is the best course of action. They can assess your situation and provide appropriate guidance.

Contact your provider immediately if you experience:

• Severe or persistent abdominal pain that does not improve with rest or position changes.
• Vaginal bleeding or spotting.
• Regular, painful contractions that become closer together or stronger.
• A sudden gush or trickle of fluid from your vagina.
• Fever or chills.
• Persistent nausea, vomiting, or diarrhea.
• Pain or burning during urination.
• Sudden, significant swelling in your face, hands, or feet.
• Severe headache or vision changes.
• Any pain that feels different or more intense than what you have experienced before.

Your provider is there to help you navigate your pregnancy. Do not hesitate to call them with any worries or questions about your symptoms.