Backache in pregnancy, while uncomfortable and sometimes painful is very common with over 70% of pregnant women experiencing back issues. We believe the discomfort is due to the joints being stretched with the hormone relaxin. Having a pre-existing back problem will definitely increase the likelihood of developing backache during pregnancy.
I advise avoiding bending over, bending at your knees and seeing a physiotherapist who will help you with stretching and massage. Hot packs are great, as are massage and Pilates. Avoiding high heels for long periods of time and trying not to spend too long on your feet should help as well. If you require painkillers, Panadol or Panadeine are suitable.
Most women experience breast tenderness early in pregnancy, but sometimes it can become very uncomfortable. This is due an elevation in both the Progesterone and Oestrogen hormones which produce an increase in glandular and ductal tissue in the breast. Sometimes extra breast tissue can appear in your armpits; this is a normal finding and is called accessory breast tissue.
Carpal tunnel syndrome is a condition that can occur in pregnancy when the median nerve becomes compressed in the bony and ligamentous carpal tunnel in your hand. We believe it is related to increased fluid retention when you are pregnant. Sensations such as numbness and burning or tingling, in the inner half of one or both hands associated with wrist pain are quite common. Occasionally numbness can extend into the forearm or shoulder. It occurs in up to 1 in 7 pregnant women and pain can often be worse at night.
The best treatment for carpal tunnel is to try to apply a splint on a slightly flexed wrist, worn at night. I also recommend pain relief like Panadol or Panadeine. Sometimes a small surgical procedure to release the entrapped nerve, or a cortisone steroid injection may be necessary. This usually disappears after pregnancy.
Coccydynia is a condition that some women experience, most commonly after childbirth, due to the coccyx (or tailbone) being injured by the pressure. Sometimes, prolonged sitting on a particularly hard surface, bike riding or long travel can cause pain in the lowest part of the back, or coccygeal pain. This pain may also be worsened with sitting or prolonged standing. For some, intercourse or bowel movements may also be painful.
Treatment usually involves heat or ice and leaning forward when sitting rather than leaning back can help to ease the discomfort. Using a wedge cushion or a donut pillow to distribute your weight away from your coccyx may help. If the problem persists, anti-inflammatory medications, occasionally stronger analgesics and rarely anaesthetic or steroidal injections may be required.
There are a number of respiratory changes that occur during pregnancy. The hormone Progesterone stimulates respiration – which means that the amount of air that you shift which each breath increases by about 40%. The expanding uterus increases pressure in your abdomen and compresses your chest wall. Overall, you will experience increased ventilation and oxygen consumption due to deeper and more frequent breathing. This continues through to the second half of pregnancy. By the end of your pregnancy you may experience breathlessness, which can occur even in simple tasks such as walking up the stairs. I advise resting, relaxing and only exercising to a level you that can easily tolerate.
The pregnancy hormone that relaxes the uterus in pregnancy also acts on the smooth muscle in the bowel. This slows down bowel contractions and allows more water to be absorbed from the bowel material. This produces a hard and at times painful bowel motion, also known as constipation.
To overcome constipation, I recommend drinking 3 litres of water a day. If you include lots of natural fibre in your diet such as cereal, grains, peas and beans and fruit this should help to reduce the condition. Exercise can help to increase bowel tone and medications that bulk up or soften your bowel motion can be helpful too. Some of these medications include Coloxyl, Lactulose, Normacol or Bisacodyl.
Feeling faint is common in pregnancy and can be related to the normal drop in blood pressure after 14 weeks. It’s important to have plenty of fluids, to avoid standing for long periods of time.
Tiredness can be one of the early symptoms of pregnancy. This is partly due to hormonal changes and partly because of the increased work the body must do to provide nutrition for your baby. It is not usually due to anaemia but we can perform blood tests to ensure that it is not the case. You will find that your energy levels return after the first part of pregnancy but in the meantime, I recommend plenty of rest and involving your partner in helping with the tasks ahead.
Heartburn occurs when the irritant acid contents of the stomach wash back into the oesophagus – which is the tube through which food enters the stomach. This occurs because of the Progesterone hormone which relaxes the valve at the top of the stomach in pregnancy. As well as this, later on in pregnancy the physical size of the baby can be enough to push stomach contents into the lower oesophagus. This causes a burning sensation, known as heartburn.
I recommend multiple small meals and avoiding fatty, spicy and acidic foods if you’re experiencing heartburn. Other methods such as lying down with your head propped up on a few pillows to avoid the gravitational effect and bending at the knees instead of the waist can also reduce the severity of the condition. Antacids such as Mylanta or Gaviscon are very effective treatments as well as Zantac if necessary. These can all be bought over the counter.
As your baby gets bigger, your abdomen begins to run out of space. The baby tends to push your rib cage up and this can cause rib or back pain. One method that tends to help some women is to adopt a leaning forward posture. This can help to release some of the pressure from your ribs. The good news is that in the last month of pregnancy – as the head engages getting ready for birth, you should be able to breathe a little more easily.
Some women develop skin itch during pregnancy which may be associated with the stretching of the skin over the abdomen and breasts. If you have a pre-existing skin condition such as eczema or atopic dermatitis, this may worsen it. Using medications like antihistamines, moisturisers or calamine can be helpful to alleviate some of the irritation. Avoiding heat and keeping cool with a fan or air conditioning can provide relief too. In more uncommon instances a condition called intrahepatic cholestasis may be associated with the itchiness, in which case we would conduct blood tests and keep a very close eye on this throughout your pregnancy.
The hormone, Melanocyte Stimulating Hormone is increased in pregnancy and this is responsible for darkening of the skin due to stimulation of skin cells called melanocytes. This can be responsible for brown pigmentation on your face (which is known as chloasma or the mask of pregnancy). It’s common in the last trimester of pregnancy and can also develop in women taking the oral contraceptive. You may find similar pigmentation on the neck, nipples and in the midline on your abdomen (the linea nigra). These skin changes usually subside a few months after delivery.
Thrush is a condition that many women experience during pregnancy. It produces a white thick itchy discharge and a burning soreness on the external vulva. The high sugar levels in the body in pregnancy encourage thrush (also known as candidiasis). We usually treat this condition with a 6 day course of Canesten pessaries which you can insert with the finger, rather than with an applicator. The pessaries may take 24 hours to relieve the itch, but in the meantime, using some 1% hydrocortisone cream will help ease the itch and discomfort externally. This cream should be applied externally.
Swelling in the ankles towards the end of pregnancy is not uncommon and is usually worse in hot weather. Sometimes it can be associated with high blood pressure and it will certainly be worsened by standing for long periods of time. The origin of fluid retention probably lies from increased sodium retention by the kidneys. We advise you to keep a good fluid intake of up to 3 litres a day as the body needs this to supply the pregnancy. Reducing salt intake can help with this condition as well as light exercise such as walking and swimming. Although this can be a normal phenomenon in pregnancy, if you have other medical disorders such as high blood pressure, heart or kidney disease it is important you tell me about that immediately.
The optimum amount of weight gain in pregnancy depends on what your weight is at the beginning of pregnancy. The term B.M.I. (Body Mass Index) is the current medical standard used to calculate your weight classification. This is measured by having your weight in kilograms, divided by your height in metres and dividing this result by your height in metres again. For women with a normal B.M.I., weight gain throughout the whole of pregnancy is between 11.5 and 16 kg.
Women normally gain between 0.5 kg and 2 kg early on in pregnancy and subsequently gain about 400g per week after 12 weeks pregnancy. If you have a high or low B.M.I. the weight recommendations vary and I am happy to explain this in more detail in your consultation.
Being overweight does present a few problems including a high risk of pre-eclampsia (a high blood pressure condition) and a high risk of induction of labour and Caesarean section. For women with a high B.M.I., we generaly recommend early glucose tolerance tests, a high dose of folic acid and that you consider taking Aspirin and possibly calcium supplementation.
There are many benefits in continuing to exercise during pregnancy. Not only does exercise improve your muscle tone and promote a sense of wellbeing, it also helps to reduce some of the problems pregnant women experience, such as weight gain, leg cramps, fatigue, constipation and back ache. I advise a gentle exercise program during pregnancy. Women should have regular and nutritious meals and stop exercising if fatigue or breathlessness occurs. I suggest exercising in the coolest part of the day and exercising in an area that has good ventilation. Comfortable clothes that help skin evaporation and keep you cool are recommended, as well as a well-fitting bra. It is important to do a warm up stretch and cool down exercises before and after an exercise session and to maintain good hydration by drinking plenty of water. I generally suggest exercising 3 times a week and doing low impact exercise such as aqua aerobics, swimming, walking and using the exercise bike. Avoid exercise that involves a lot of jerking movement such as jumping and sudden changes of direction and bouncing. If you are going to use a Sauna, limit it to 10mins at a time ensuring your body temperature doesn’t go over 38 degrees. Particularly after 20 weeks avoid lying on your back as this may make you feel faint. It is better not to exercise if you have a fever or if you are feeling sick. Finally, it’s important to continue doing Pelvic Floor exercises throughout your pregnancy.
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