What could be causing the painful pulling sensation and fullness pressure in my groin area at 22 weeks pregnant, especially when standing?

Groin Pain at 22 Weeks Pregnancy: Round Ligament Pain

Your symptoms of fullness, pressure, and painful pulling sensations in the groin when standing at 22 weeks gestation are most consistent with round ligament pain, a normal physiological response to uterine growth during pregnancy that does not require imaging or intervention beyond reassurance and conservative management.

Understanding Your Symptoms

What Is Happening

• Round ligament pain occurs as the ligaments supporting your growing uterus stretch and spasm, causing sharp or pulling sensations in the groin, lower abdomen, or hip area that worsen with sudden movements or position changes 1
• At 22 weeks, your uterus has grown significantly and continues expanding, placing mechanical stress on the round ligaments that extend from the uterus through the inguinal canal to the labia majora 1
• The sensation of fullness and pressure you describe is consistent with the normal physiological changes of pregnancy, including increased pelvic blood flow and venous congestion 2

Why Standing Makes It Worse

• Position changes from sitting or lying to standing cause sudden stretching of the already-taut round ligaments, triggering the sharp pulling pain you experience 1
• Standing also increases gravitational pressure on pelvic structures and venous return, which can intensify the sensation of fullness 2

What You Should Do Now

Immediate Management (No Medical Intervention Needed)

• Change positions slowly: Move gradually from lying to sitting to standing to minimize sudden ligament stretching 1
• Apply warmth: Use a warm (not hot) compress or heating pad on low setting to the affected area for comfort 1
• Support garments: Wear a maternity support belt or band to help support the uterus and reduce ligament strain 1
• Rest when needed: Avoid prolonged standing and take frequent breaks to sit or lie down 1

Pain Relief Options

• Acetaminophen is safe during pregnancy for pain control if needed 1
• Avoid NSAIDs (ibuprofen, naproxen) as these are not recommended during pregnancy, particularly after 20 weeks 1

When to Seek Medical Attention

Warning Signs That Require Evaluation

You should contact your healthcare provider immediately if you develop any of these symptoms:

• Fever (temperature >38°C/100.4°F), which could indicate pelvic inflammatory disease or other infection 1
• Severe, constant pain that does not improve with rest or position changes 1
• Vaginal bleeding or fluid leakage 1
• Decreased fetal movement or absence of movement for several hours 1
• Pain specifically in the left leg with swelling, as left-sided deep vein thrombosis is more common in pregnancy due to compression of the left iliac vein by the gravid uterus 1
• Unilateral leg swelling with >2 cm calf circumference difference between legs 1

Why Imaging Is Not Indicated

• Ultrasound is the initial imaging modality for pregnant patients with pelvic pain only when there is concern for specific pathology beyond normal pregnancy changes 1
• Your symptoms with normal fetal movement and absence of fever, bleeding, or severe pain do not warrant imaging at this time 1
• If symptoms persist or worsen despite conservative measures, transvaginal and transabdominal ultrasound would be the appropriate first imaging study, not CT or MRI 1

What This Is NOT

Conditions Ruled Out by Your Presentation

• Appendicitis: Would present with fever, right lower quadrant pain, and typically requires imaging for diagnosis in pregnancy 1
• Deep vein thrombosis: Would show unilateral leg swelling (particularly left-sided), not bilateral groin pressure 1
• Pelvic inflammatory disease: Requires fever and would show bilateral adnexal masses on ultrasound in 82% of cases 3
• Ovarian torsion: Presents with acute, severe, unilateral pain, not bilateral pulling sensations 1
• Inguinal hernia: Would present with a palpable bulge and would not typically cause bilateral symptoms 4

Expected Course

• Round ligament pain typically improves after 24 weeks as the uterus rises out of the pelvis and the ligaments accommodate to the stretched position 1
• Symptoms may recur intermittently throughout pregnancy but should not progressively worsen 1
• The fact that you feel your baby moving is reassuring and indicates fetal well-being 1