Round Ligament Pain or Pelvic Floor Pain? How to Tell the Difference During Pregnancy
"My doctor told me it was round ligament pain."
This is one of the most common things I hear from pregnant clients.
Sometimes they are absolutely right.
Round ligament pain is a common part of pregnancy and affects many people as the uterus grows.
But sometimes, the diagnosis does not fully explain what someone is experiencing.
If your pain is also associated with painful sex, pain with urination, pelvic floor tension, or symptoms that existed even before pregnancy, there may be more pieces to the puzzle.
Understanding the difference matters, not because one diagnosis is "better" than another, but because different tissues require different treatment approaches. Pelvic floor physical therapy can help differentiate your treatment plan.
What is round ligament pain?
The round ligaments are two bands of connective tissue that help support the uterus. As pregnancy progresses, these ligaments lengthen and adapt to the growing uterus.
People often describe round ligament pain as:
sudden
sharp
brief
located low in the abdomen or groin
triggered by rolling in bed, coughing, sneezing, standing up quickly, or changing positions
The pain often lasts seconds to minutes before settling down.
Although it can be uncomfortable, it is generally considered a common adaptation during pregnancy.
However, if you are experiencing true round ligament pain during, it is generally because the round ligament is over working to stabilize when something like your core is underworking.
It is understandable that during pregnancy the core has a harder time firing because it is being stretched out. Even still, many functional movements you used to be able to get away with without a core brace now require more mindful movement patterns. If you are pregnant and experiencing round ligament pain during movement, my first recommendation as a pelvic floor PT is to see if you can notice your breath and brace your core before the painful movement. If bracing your core and breathing out helps the pain go down, it is likely you have a biomechanical driver to your pain that can be changed with good coordination patterns. If you are unsure of how to brace your core appropriately during pregnancy, book a call or session with me or a pelvic floor expert to learn more. This will give you better outcomes during your pregnancy, birth and postpartum experience.
One other important fact to note is that nervous system sensitivity contributes to pelvic girdle pain during pregnancy. If biomechanical approaches alone do not change your symptoms, you may need to consider cortisol levels in your body due to stress and even diet. Lowering inflammation through somatic approaches to nervous system regulation, good sleep, and quality diet changes can go a long way in decreasing round ligament pain during pregnancy. These factors simply cannot be ignored when considering inflammation as a key component to the physiology of pain.
Round Ligament Pain vs Pelvic Floor Pain
Now imagine a different scenario.
Someone is pregnant and experiences:
pain with intercourse
burning around the urethra
pain with urination
symptoms primarily on one side
longstanding knee pain on the same side
pelvic muscles that feel constantly tight
Adductor (inner thigh) tightness/pain
They have been told it's "round ligament pain."
Could the round ligament be contributing?
Possibly.
But does the diagnosis explain the entire picture?
Probably not.
This is where a more comprehensive evaluation becomes important.
A Pelvic Floor Case Study Example
Recently, I worked with a pregnant client who had been told her symptoms were due to round ligament pain.
During our evaluation, however, we found several clues suggesting a more complex picture.
Her symptoms included:
pain with penetration
urethral pain
pain during urination
pain that consistently favored her left side
a history of chronic left knee pain before pregnancy
Rather than viewing these as isolated problems, we became curious about whether they might reflect a connected pattern involving the pelvic floor, surrounding muscles, connective tissues, and movement habits.
Pregnancy may have increased the demands on this existing system, making symptoms more noticeable.
Upon an internal assessment, I was able to recreate her pain by palpating a specific muscle at the urogenital triangle on the left side. Being able to recreate her symptoms in real time at the pelvic floor was further evidence that her symptoms were being driven by pelvic floor dysfunction, not purely round ligament pain.
Why A Pelvic Floor Assessment Matters
Different tissues behave differently.
Round ligament pain is often mechanical.
It tends to appear with sudden stretch or rapid movement.
Pelvic floor pain, on the other hand, often behaves differently.
Symptoms may be provoked by:
penetration
prolonged sitting
urination
bowel movements
sustained muscle activity
stress
breathing patterns
movement strategies
The pain may linger rather than disappear immediately after movement.
Recognizing these differences helps guide treatment.
Pain During Pregnancy Can Be Pre-Exisiting
One of the biggest misconceptions is that every new pain during pregnancy must be caused by pregnancy.
Pregnancy certainly changes the body.
Hormones shift.
The uterus grows.
Pressure changes.
Movement strategies adapt.
But pregnancy can also amplify patterns that have existed for years.
For example, if you already had chronic hip pain, recurrent knee pain, pelvic floor tension, or painful intercourse before pregnancy those patterns do not suddenly disappear because you are pregnant.
Instead, pregnancy may reveal them more clearly.
Pelvic Floor PT Is Holistic
As a pelvic physical therapist, I rarely think of one tissue in isolation.
Instead, I ask questions like:
How is the diaphragm moving?
How are pressure changes managed?
How are the hips contributing?
How does the pelvic floor coordinate with breathing?
Are symptoms occurring only with stretch, or also with muscle contraction?
Are neighboring tissues becoming protective?
Rather than chasing one painful structure, I try to understand how multiple systems are interacting.
This systems-based perspective is increasingly supported by research on regional interdependence, pain neuroscience, and motor control. Pain often reflects the interaction of local tissue changes, movement patterns, nervous system sensitivity, and a person's broader history, rather than just a single “injured” structure.
Pelvic Diagnoses Matter
Diagnostic labels are incredibly useful.
They help us communicate.
They help guide medical decision-making.
But they can also shape how we imagine our bodies.
If someone believes every symptom is caused by a ligament "stretching," they may overlook other contributors that are highly treatable.
Conversely, if someone assumes every pain means something is seriously wrong, they may become fearful of movement when gentle activity would actually be beneficial.
The goal is not to replace one label with another.
It is to remain curious.
A diagnosis should be the beginning of understanding, not the end of the conversation.
Book Now With A Pelvic Specialist In Oakland, CA
The encouraging news is that many pregnancy-related pelvic pain conditions respond well to pelvic floor physical therapy.
At Bodyful, treatment may include:
improving movement coordination
addressing pelvic floor muscle overactivity or weakness, depending on the individual
optimizing breathing and pressure management
reducing unnecessary muscular guarding
modifying activities temporarily
educating patients about their symptoms
quality exercise coaching, including true gluteal engagement and coordination
pelvic floor relaxation techniques
birth prep techniques
If you want to address your round ligament pain during pregnancy or want to be evaluated for possible pelvic floor dysfunction during pregnancy, Dr. Karah Charette at Bodyful is a pelvic floor expert. Book with her today to learn more about your pelvic pain during pregnancy and what can be done to treat it if you are located in Oakland, CA or the Bay Area. If you are in California, you can book a telehealth session.
