Round Ligament Pain (RLP)

The round ligaments surround your uterus in your pelvis – they are also known as ligamentum teres uteri. Gotta love the Latin.

roundlig - pic

Below is another picture showing the location of the round ligament, and its relationship to surrounding structures. WARNING, it is an actual photo of a pathology sample, so if you’re grossed out by bodily tissues/ organs etc, don’t click on it… you’ve had your warning. Apart from the location of the round ligament, also of interest is the relationship between the uterus and the bladder (explains those loo stops every 5 minutes):

roundlig - path

Round ligament pain can be felt as a sharp pain (eg. During running, when suddenly changing position) or as a dull ache. Its location is ‘deep’ inside the groin, if you were making reference to your skin’s surface, it would run from your groin to your anterior hip (the black line on the following picture):

roundlig - location1

It usually starts in the 2nd trimester, and can last until delivery (or even beyond). Some non-pregnant women also experience RLP.

Causes of RLP

  • Uterine growth during pregnancy: the round ligaments thicken and lengthen to support it;
  • Varicosities (enlargement of blood vessels found elsewhere on your body during pregnancy – eg. Leg varicose veins, haemorrhoids, vulva): enlargement of the blood vessels of the round ligament during pregnancy;
  • Involuntary spasming or cramping of the round ligament;
  • Rarer causes: eg. IVF drug stimulation causing cyst development on the round ligament.

Investigations

  • None needed to diagnose RLP;
  • Sometimes needed to exclude other causes of groin/ lower abdominal pain.

Current literature on the management of RLP in pregnancy is limited (a PubMed search only came up with nine papers):

  • A case of round ligament lipoma (a benign fat tumour) mimicking acute appendicitis;
  • Bilateral round ligament varicosities (engorged veins) mimicking inguinal hernia;
  • Postpartum pain due to thrombosed varicose veins of the round ligament of the uterus;
  • Use of the pelvic tilt exercise for RLP relief – appears to be effective, facilitates self-care of RLP during pregnancy.  Essentially tilting your pelvis forward and slouching your back a bit, like the following picture:

pelvictiltpic

‘General advice” includes:

  • Avoiding precipitating factors/ activities (applicable to all painful conditions really…), resting;
  • Lying down and flexing (bending) your hips, preferably with a pillow between your legs;
  • Heat (eg. hot water bottle, warm bath or shower);
  • Stretching: eg. On all fours, lower your head to the floor, keep your bottom in the air;
  • Placing your hands under your belly and lifting upwards to relieve the pressure of the uterus;
  • Simple analgesia (eg. Paracetamol);
  • Pregnancy support bands: people swear by them, mentioned extensively on running websites/ blogs, but so far I can’t find any evidence to support their use, only anecdotal reports.

Remember to contact your health care provider if your pain is persistent, especially if accompanied by red flag symptoms in pregnancy (contractions, fever, painful urination, trouble walking) or symptoms of non-pregnancy related condition (eg. Hernia, appendicitis, stomach/ liver/ kidney problems).

As for me, my pain went away as soon as I stopped running, but I may try a pregnancy support belt next time I go running…  looks like I’ll have to get a trendy leotard to go with it…

pregsupportbelt

REFERENCES
Andrews CM, O’Neill LM. Use of pelvic tilt exercise for ligament pain relief. J Nurse Midwifery. 1994 Nov-Dec;39(6):370-4.
Miller TJ, Paulk DG. Round ligament lipoma mimicking acute appendicitis in a 24-week pregnant female: a case report. Hernia. 2013 Apr;17(2):259-61. doi: 10.1007/s10029-011-0862-5. Epub 2011 Jul 24.
IJpma FF, Boddeus KM, de Haan HH, van Geldere D. Bilateral round ligament varicosities mimicking inguinal hernia during pregnancy. Hernia. 2009 Feb;13(1):85-8. doi: 10.1007/s10029-008-0395-8. Epub 2008 Jul 2. Erratum in: Hernia. 2009 Feb;13(1):111. Ijpma, F F A [corrected to IJpma, F F A].
Al-Qudah MS. Postpartum pain due to thrombosed varicose veins of the round ligament of the uterus. Postgrad Med J. 1993 Oct;69(816):820-1.

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