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What is the Round Ligament?
The round ligaments are rope-like bands of connective tissue that support the uterus. There are two round ligaments, one on each side of the uterus. In a non-pregnant person, the round ligament is 3-4 inches long, but at the end of pregnancy, the round ligament can stretch up to twice that length, making it 6-9 inches long. These two ligaments help the uterus maintain its forward-tilted position within the pelvis.
The ligament attaches from the uterus into the abdominal wall and travels under the broad ligament to the inguinal canal. In half of people, it stops at the inguinal canal, and in others, it goes further towards the labia majora. This is often why you may feel round ligament pain in the groin or vulva.
During pregnancy, the uterus expands from about the size of an orange to the size of a watermelon. As the baby grows and the uterus expands, the ligaments stretch. Sometimes, this stretching, especially when combined with asymmetries in the pelvis, can lead to pain in the round ligaments. It usually starts around the second trimester of pregnancy (~13 weeks). Having a balance of the round ligaments also promotes balance in the womb, which is essential in baby positioning and an easier birth.
What does round ligament pain feel like?
It varies from person to person, but most describe it as:
Lower abdominal aching/cramping (usually worse on one side)
Pulling or pressure in the pubic bone
Sharp, stabby pain in the groin
Tugging in the vulva/vagina
The pain is usually worse with movement– particularly with sudden movements like getting up from a chair or turning abruptly, and should quickly subside.
What can be done?
See a pelvic PT!
The number one thing we see with round ligament pain is… it is NOT round ligament pain! Instead, it is far more common to have pubic symphysis pain or pelvic girdle pain. This type of pain feels incredibly similar to round ligament pain. A pelvic floor PT evaluates the whole body to find what is contributing to your pain. Once we get to the root of the cause, we can banish the pain for good! In addition, we are looking for balance in the round ligament for a smooth birth.
Gentle hip and pelvic stretches
Gentle hip and pelvic stretches can mobilize the round ligament and the tissues that it runs through. Cat/cow, hip flexor stretch, adductor stretches, and pelvic clocks are some favorites.
Seeing a pelvic PT to evaluate which muscles need work is the best way to know which stretches to start with (and which to stay away from!). Spinning Babies uses a forward-leaning inversion to help promote the balance of the round ligament.
Massage
Because the round ligament attaches near the labia, the tissue here often becomes tight and sensitive with round ligament pain. Gently (gently!!) massaging improves blood flow to the area, loosens the tissue, and mobilizes the ligament. Our specialty-trained physical therapists and massage therapists are able to massage the round ligament at the pelvic and belly attachments. We are also able to balance the rest of the muscles and ligaments that restore balance to the uterus and pelvis, which help out the round ligament.
Strengthen the abdominals
As the abdominals stretch during pregnancy, this can put additional strain on the round ligaments. Working on deep core strengthening can make a big difference! Not sure where to start? Working with a pelvic PT will help you learn how to activate the appropriate deep core muscles.
Try a belly band
Using a belly band (we really like Belly Bandit Upsie Belly, Baby Belly Band or Baobei Pro Bump), helps to offload the abdominal muscles, and thus the round ligaments.
Stay hydrated
Hydration is important for a lot of reasons, but especially as your body is growing. Staying hydrated helps with circulation, and stretching tissue needs the nutrients provided by adequate blood flow.
When to Call Your Doctor
Round ligament pain is usually nothing to worry about. But if it’s accompanied by other symptoms, you should check in with your OB/GYN or midwife:
Persistent, severe pain
Fever or chills
Pain on urination
Difficulty walking
Unusual vaginal discharge
These could be signs of a serious pregnancy-related complication, like preterm labor, preeclampsia, or placental abruption.
If you are struggling with round ligament pain, come see us in Richmond, Virginia... or virtually from anywhere in the state of Virginia
A. Bellier, G. Cavalié, G. Marnas, P. Chaffanjon,
The round ligament of the uterus: Questioning its distal insertion,
Morphologie,
Volume 102, Issue 337,
2018,
Pages 55-60,
ISSN 1286-0115,
https://doi.org/10.1016/j.morpho.2018.04.001.
(https://www.sciencedirect.com/science/article/pii/S1286011518300213)