Rib pain during pregnancy: why it happens, how to ease it and when to see a physio in Singapore

Rib pain during pregnancy is common in the third trimester, and most of the time it comes from your growing womb pushing up against your rib cage. HealthHub's guide to weeks 29 to 34 says to "expect shortness of breath as the enlarging womb presses against your rib cage", and adds that your baby's sudden movements "may be painful". Your joints are looser too, so the muscles and joints between your ribs take more strain. What helps: sit up straight, make room under your ribs when you sit and sleep, stretch your side gently, wear looser clothes, and ask a hospital physiotherapist for help if it stops you sleeping. One kind of rib pain is not normal: strong pain under the right ribs, especially with a headache, blurred vision or sudden swelling, can be pre-eclampsia and needs to be seen at once.

Why your ribs hurt in pregnancy

KKH's pregnancy planner explains that from the third trimester your enlarging womb "will weigh on your diaphragm and make it more difficult to breathe", and SingHealth's trimester guide says hormonal changes "result in loose joints". Put together, the lower ribs get pushed outwards and the muscles between them stretch, which is why slumping in a chair tends to make it worse.

Heartburn is easy to confuse with rib pain. SingHealth says it affects 60 to 80% of pregnancies and feels like burning in the throat, chest or stomach. If that sounds like you, see our guide to heartburn during pregnancy.

How to ease rib pain at home

Most of these come from Singapore hospital advice for breathlessness and back pain in pregnancy, which share the same cause.

• Sit tall. Slumping on a sofa or office chair folds your bump into your ribs. SingHealth suggests sitting upright to give your chest more room. A cushion behind your lower back helps.
• Sleep propped up or on your side. SingHealth's guide suggests "sleeping on propped up pillows or lying on your side to allow more space for your chest to expand". A pillow under the bump and one between the knees takes the twist out of your middle. KKH's Dr Jessie Phoon also advises side-sleeping with knees bent for back pain.
• Stretch the sore side. Stand or sit tall, lift the arm on the painful side over your head and lean gently the other way for a few slow breaths. Stop if it hurts more.
• Breathe slowly. Slow, relaxed and deep breaths "can also sometimes help", says SingHealth.
• Change position often. Get up from your desk every half hour or so. KKH advises against standing or sitting for long periods.
• Wear loose tops and a soft bra. A tight band sits right on the sore lower ribs.
• Give your baby room. If a foot seems lodged under one rib, change position or kneel on all fours for a minute.
• Try heat or cold. KKH's Dr Phoon says either can ease pregnancy back pain, whichever you prefer. Keep it to a warm pack, not a sauna, in the last trimester.
• Keep moving. HealthHub says you can carry on walking for as long as you feel comfortable, and our guide to safe exercise in pregnancy lists what's fine in each trimester.

For heartburn-type pain, SingHealth's advice is small, frequent meals, no eating just before bed, and sitting up straight during and after meals. HealthXchange's guide says paracetamol is safe in pregnancy; check with your doctor before taking anything else, and our pregnancy sleeping positions guide has more on getting comfortable at night.

When rib pain is a warning sign

Pre-eclampsia affects about 4% of pregnancies in Singapore, according to SGH, and usually starts after week 20. KKH lists right-sided upper abdominal pain as one of the signs to act on straight away, along with severe headaches, visual disturbances, severe nausea and vomiting, and sudden swelling of the ankles, feet or face. Our pre-eclampsia guide explains the checks your gynae does at each visit.

When to see a physio at a Singapore hospital

See a physiotherapist if the pain stops you sleeping, makes it hard to sit through a work day, or hasn't eased after a week or two of the steps above. Ask your gynae first, so they can rule out the warning signs and refer you.

KKH says its physiotherapists assess women with musculoskeletal complaints, teach pain-relieving strategies and exercises, and supply "assistive devices such as maternity belts where indicated". KKH's Dr Phoon says some women find maternity support belts useful in the second and third trimesters, and that strengthening exercises are best started with a physiotherapist's advice. Private hospitals and clinics also run women's health physio; check the price before you book, and our guide to back pain during pregnancy covers the lower back, which often hurts at the same time.

Does rib pain go away before the birth?

Often it eases near the end. HealthHub says that from about week 35 your baby's head begins to descend into your pelvis, which moves the pressure lower: pelvic aches and the need to pass urine often increase at that stage instead. For the breathless side of the same problem, see our guide to feeling breathless during pregnancy.

Frequently asked questions

Is rib pain normal during pregnancy?

Yes, in the third trimester. HealthHub says the enlarging womb presses against your rib cage from weeks 29 to 34, and that your baby's sudden movements may be painful. Strong pain under the right ribs is different and needs to be checked straight away.

Why does my right rib hurt during pregnancy?

Often it's your baby's kicks or the womb pressing on that side. But right-sided upper abdominal pain is also a sign of pre-eclampsia, KKH says, so see a doctor at once if it is strong or comes with a headache, vision changes or sudden swelling.

How do I stop rib pain at night?

Sleep propped up on pillows or on your side, with a pillow under the bump and between your knees. SingHealth suggests these positions to give your chest more room. Loose sleepwear and a short side stretch before bed also help.

Can a physio help with rib pain in pregnancy?

Yes. KKH's physiotherapists assess pregnancy-related musculoskeletal pain, teach exercises and pain-relief strategies, and can supply a maternity belt. Ask your gynae for a referral.

When does rib pain start in pregnancy?

Most women notice it in the third trimester. KKH explains that in the third trimester the womb weighs on your diaphragm, and HealthHub describes it pressing against the rib cage from weeks 29 to 34.