Aches and pains
Backaches
Lower generalized
backaches are extremely common during pregnancy, particularly in the
third trimester; around two thirds of all pregnant women suffer from
backaches.
Causes
As pregnancy
progresses, the increased weight of your abdomen tends to pull on the
lower spine so that it curves inward and your center of gravity shifts
forward. As you try to correct this, you may strain the lower back
muscles. In addition, pregnancy hormones soften your ligaments, causing
them to stretch and provide less support for your back.
What to do
Maintaining good
posture and avoiding tilting your pelvis forward helps relieve pressure
on your back and helps both prevent and alleviate backaches. Regular,
moderate exercise to keep your muscles toned and supple is also
beneficial.
Try to avoid
standing in one position for too long and vary your daily tasks, if
possible breaking them down into shorter stints. If your work involves
standing or sitting for long periods, take regular short breaks, and
while sitting, make sure your lower back is supported. Avoid lifting
heavy objects.
Massage and warm water
can help relieve backaches. If back pain is particularly troublesome,
talk to your doctor about wearing a supportive maternity belt.
Pelvic girdle pain (PGP)
Also known as
symphysis pubis dysfunction, pelvic girdle pain (PGP) refers to
discomfort and pain felt in the pelvic area and groin. The pain may be
concentrated in the buttocks or travel down one leg, and for this reason
is sometimes mistaken for sciatica.
PGP is often worse when doing activities such as walking or going up
stairs; it may also be troublesome at night, but this is usually related
to activities done during the day. PGP is most common toward the end of
pregnancy and may range in severity from mild to serious enough to need
a walking aid.
Causes
Various factors may
contribute to PGP. The pelvis is made up of three bones: the sacrum and
the two iliac (hip) bones. The bones are connected at the front by the
symphysis pubis joint, and at the back by the sacroiliac joints. The
joints are stabilized by ligaments and usually move very little. During
pregnancy, however, ligaments soften and stretch more easily so that
there is more movement at these joints. This results in instability of
the pelvis. In addition, postural changes due to the enlarging abdomen
may mean that one joint is more mobile than the other, putting extra
strain on the joints. The result is inflammation of the joints and
discomfort or pain.
What to do
If there is
increased movement in one side of your pelvis, a pelvic support belt may
be recommended, which often gives instant relief. You may be referred
to a physical therapist who will show you how to modify everyday
activities, such as walking and getting up, in order to avoid pain, and
may also recommend abdominal and Kegel exercises .
Acupuncture can help relieve pain, and prenatal water aerobic classes
are helpful. Preventative measures include avoiding activities that
cause pain, and avoiding heavy lifting, lying on your back, and
sustained periods of activity. It’s also important to get plenty of
rest.
Round ligament pain
The two round ligaments
run from the top of the uterus on either side and attach to the side
walls of the abdomen. As the uterus enlarges, the round ligaments
gradually become stretched, which can cause an ache or brief, sharp pain
on one or both sides of the lower abdomen or in the groin. Round
ligament pain usually starts during the second trimester.
What to do
See your doctor, who
will rule out other causes for the abdominal pain. Once you have been
reassured, you should find it easier to deal with the pain. When you
have an episode, try to rest and relax. Lying on your side and bringing
your knees up toward your chest may be helpful, as can taking a warm
bath.
Sciatica
This is pain in one or
both buttocks that may radiate down one leg. There may also be tingling
or numbness in the legs, although this occurs only in a small percentage
of women. Sciatica is most likely to occur after the second trimester.
Causes
Sciatica is caused
by trapping or compression of the sciatic nerve as it runs through the
spinal column. The pain is termed referred pain, that is, pain felt in
an area away from the problem site. Sciatica is not caused by
compression of the nerve by the fetus’s head. The causes of sciatica in
pregnancy are the same as in women who are not pregnant and include poor
posture, wear and tear on vertebral joints, and poor lifting
techniques.
What to do
Specific exercises
can help to stretch muscles gently and release pressure on the sciatic
nerve. Your doctor may be able to advise you on exercises or may refer
you to a physical therapist for help.
Coccygeal pain
The coccyx, or
tailbone, is the small bone found at the base of the spine. This bone is
usually fairly immobile; however in pregnancy it becomes more mobile,
which facilitates the passage of the baby through the birth canal during
labor. Pain in this area can make sitting for long periods extremely
uncomfortable, particularly at work or during travel. Coccygeal pain can
occur throughout pregnancy.
Causes
Coccygeal pain
may predate pregnancy due to a previous injury to the area; the
discomfort may then be exacerbated by the hormonal and mechanical
changes of pregnancy. Alternatively, coccygeal pain may arise in
pregnancy, since increased movement in the coccyx during this time makes
injury more likely. Sometimes the coccyx is injured during labor by the
baby’s head, and coccygeal pain therefore develops after the birth.
What to do
Moving around
frequently and gently massaging the area can help relieve discomfort.
Ask your doctor which analgesics are safe for you to take. The condition
usually gets better within 6 weeks of delivery.
Leg cramps
Cramps in the
legs, particularly in the calf muscles, are a common problem during
pregnancy. These occur most commonly at night, but may sometimes come on
when walking, and their frequency can increase as your pregnancy
advances.
Causes
There is debate as to the
cause of leg cramps in pregnancy. They are likely to be caused by a
combination of factors including maternal posture, increasing body
weight, restriction in the blood flow to the legs, and the pressure of
the uterus on the pelvic nerves. Some suggest that leg cramps in
pregnancy may be due to a lack of salt in the diet. However, research
demonstrates that low levels of salt are healthy in pregnancy, and that
it is very unlikely that anyone who is eating a balanced diet will
suffer from salt depletion.
What to do
Leg cramps may be
relieved by changing position, flexing the toes of the affected leg
upward, and massaging the cramped muscle. To avoid leg cramps, massage
your legs before bed and avoid sitting or standing in one position for
long periods. A warm bath before bed may also help. Stay well hydrated
and alternate regular periods of moderate exercise with periods of rest.
If you have persistent pain, redness, or swelling in your calf, this may be a sign of deep vein thrombosis (DVT) , which requires prompt medical attention.
Restless leg syndrome
Restless leg syndrome is an
uncomfortable feeling or unpleasant tingling that creates an
overwhelming desire to move your legs, or causes legs to jerk
uncontrollably, especially during sleep. Sufferers describe the
sensation as being like an electric current passing through the legs or
like having itchy bones. During pregnancy, the problem is most likely to
occur during the third trimester.
Causes
Restless
legs syndrome is frequently triggered or aggravated by pregnancy. The
cause is unknown, but some studies indicate that it might be related to
low iron levels. Many sufferers have a family history of the condition.
What to do
If you’re suffering
from restless leg syndrome, talk to your doctor about having a blood
test to check your iron levels. If levels are low, a simple iron
supplement may be prescribed. Some women find it helpful to exercise or
stretch their legs, to use hot or cold compresses, or to have a leg
massage. If the condition occurs for the first time in pregnancy, there
is a very good chance that it will disappear after the baby is born.
Carpal tunnel syndrome
The carpal tunnel is a
small tunnel in the wrist through which nerves run from your forearm
into your hands and fingers. Carpal tunnel syndrome occurs when the
nerves are compressed, resulting in tingling and pain in the fingers,
which is often worse at night. In severe cases, there may be
considerable discomfort and a reduced grip. In pregnancy, this is most
likely to occur in the second and third trimesters.
Causes
Carpal tunnel
syndrome is caused by pressure on nerves running through the tunnel due
to swelling of surrounding tissues. During pregnancy, swelling in the
hands and feet is common as a result of the extra fluid and blood
volume.
What to do
If you think you may
have carpal tunnel syndrome, talk to your doctor. You may be referred to
a physical therapist for treatment, who will recommend specific
exercises to help relieve the discomfort. You may also be advised to
wear a lightweight splint to support your wrists, which can be
especially beneficial if the pain is disturbing your sleep. Carpal
tunnel syndrome usually disappears after the birth. However, if it
persists, a simple surgery can be performed to relieve the pressure on
the nerves.
Urinary and vaginal problems
Yeast infections (candidiasis)
During pregnancy, an
increased vaginal discharge is normal. However, if the discharge is
creamy and thick, and you have some soreness and itching in your vaginal
area, you may have yeast, a fungal infection. If you have a vaginal
discharge with an odor, you could have trichomoniasis or bacterial
vaginosis, which are sexually transmitted infections that can lead to
premature delivery if not treated with antibiotics. You are more prone
to yeast during pregnancy, particularly during the third trimester.
Causes
A yeast infection is caused by a fungus called Candida albicans.
The organism exists normally in small numbers in the intestines and
vagina, and doesn’t cause problems. However, during pregnancy, the
environment in the vagina changes, causing overgrowth of the fungus. If
you are under stress, feeling generally unwell, taking antibiotics, or
have diabetes, you may be more likely to develop a yeast infection.
What to do
If you think you have a
yeast infection, contact doctor, who can take a vaginal swab to confirm
the diagnosis. He or she may recommend an over-the-counter vaginal
cream. Yeast infections can be harder to control during pregnancy, and
may take up to two weeks to go away. To prevent additional infections,
wear cotton underwear and always wipe from front to back after a bowel
movement.
Stress incontinence
If you have stress
incontinence, you pass small amounts of urine unintentionally,
particularly when coughing, sneezing, or laughing, and when exercising
or lifting heavy objects. Stress incontinence can happen at any time
during pregnancy, but is most common in the last trimester.
Causes
The pelvic floor
muscles are under additional strain during pregnancy and are also
affected by hormonal changes. Therefore any increase in abdominal
pressure caused by coughing, sneezing, laughing, or other activities
that puts these muscles under pressure may result in leakage of a small
amount of urine.
What to do
Stress incontinence
can be embarrassing and distressing; however, you should mention the
problem to your doctor who will be able to advise you on Kegel exercises ,
which should help reduce the problem if you practice them regularly.
It’s important too to empty your bladder whenever you need to. You may
want to wear a sanitary pad for additional reassurance.
Urinary tract infections
During pregnancy,
you’re more susceptible to urinary tract infections. Most commonly, such
infections are confined to the bladder, when they are known as
cystitis. Symptoms of cystitis include a frequent, urgent need to
urinate and a painful burning sensation when passing urine; there may be
some blood in your urine. Occasionally, an infection can travel up from
the bladder to the kidneys. In this case you may also have pain in your
lower back on one side (over the kidney area), have a high temperature,
and may feel nauseous or vomit. Sometimes a urinary tract infection is
present but causes no symptoms. Prompt treatment of urinary tract
infections is especially important in pregnancy because if an infection
reaches the kidneys, it can trigger early labor.
Causes
Urinary tract
infections are caused by bacteria entering the body through the urethra
(the outlet from the bladder) and multiplying. Such infections are
probably more common during pregnancy because the effect of hormones on
the urinary tract slows the passage of urine.
What to do
If you have any
symptoms of a urinary tract infection, see your doctor right away. The
doctor will take a mid-stream urine sample and the sample will be sent
to a laboratory to identify the type of bacteria that is causing the
infection. Your doctor may prescribe a seven to ten day course of
antibiotics that are safe for both you and your baby. Symptoms usually
improve in a few days after the start of treatment. Because some urinary
tract infections are asymptomatic, all pregnant women have urine tests
at prenatal doctor’s visits, and if bacteria are found, appropriate
antibiotics are prescribed.
