Minor Discomforts of Pregnancy

Minor discomforts of pregnancy

All women will experience some form of discomfort during their pregnancy due to the normal changes pregnancy brings, and the type and degree of severity of these can vary greatly among women. Most of these can be self-managed but if at any time you feel you need advice or assistance please consult your obstetrician who may be able to provide you more information or refer you to another health professional for further advice and support. The topics are presented in alphabetical order for ease of perusing only rather than importance or how common they are.

Bleeding gums and nose bleeds

During pregnancy, the hormones widen the blood vessels in your body tissues, including the moist linings (mucous membranes) of your mouth and nose. You also have a greater volume of blood flowing round your system. These changes together, cause congestion and make bleeding from the tiny blood vessels (capillaries) in your mouth and nose more likely.

Some women stop brushing and flossing their teeth due to the bleeding but it is important to continue to brush and floss thoroughly and more regularly. Getting rid of the plaque is the best way to treat the gums until the hormone balance is restored after your pregnancy. Neglecting your gums can lead to more serious problems and an increased risk of premature birth.

Nose stuffiness and bleeds are also normal and common especially from the second trimester of pregnancy onwards. Most nose bleeds during pregnancy are usually minor annoyances. By taking care of your nose, avoiding harsh nose blowing or picking, and minimising nasal irritation, you may find you avoid this altogether. Some things you can do to prevent nose bleeds include:

If you do have a nose bleed, these steps can help to control it:

If you find that your nose bleeds occur frequently or that you are not able to stop a nose bleed after trying the above-mentioned steps, please contact your doctor or hospital.

Carpal Tunnel Syndrome

Hormonal changes and swelling of the hands during the latter stages of pregnancy can cause pressure on the nerves of the wrist resulting in symptoms like pain and numbness of the hand and fingers. This condition is called carpal tunnel syndrome. The symptoms are often worse at night but can affect daily activities too and they normally resolve within 2 weeks of birth. Symptoms include:

Women who have high blood pressure, preeclampsia or excessive weight gain, and have swelling in pregnancy, are at more risk of developing carpal tunnel syndrome. Things you can do to try to avoid this condition include:

Your doctor may need to arrange a referral to a physiotherapist if symptoms require further management. Treatment options include:

Surgical options are generally not recommended during pregnancy.

Constipation

Constipation refers to bowel movements that are hard in consistency, are difficult to pass, or are infrequent (less than 3 per week). During pregnancy the combined effect of your hormones slowing your bowel movement, and the shifting of your internal organs due to the growing uterus, may cause constipation. You may also become constipated from irregular eating habits, changes in your environment, stress, and added calcium and iron in your diet and vitamin supplements. Some medicines, too little exercise and not enough fibre and liquids may also contribute to the problem. Some things you can do to avoid constipation during pregnancy include:

Laxatives should be avoided until discussed with your doctor. Sometimes constipation can be caused by taking iron tablets so you may ask your doctor if you can change to a different type.

Cravings and altered taste

Many women experience food cravings during pregnancy. We don't really understand the reason for this and some theories say cravings indicate a deficiency in some nutrients but there is no evidence to support this. Some women may also crave non-food items such as chalk or clay. Conversely, some women find that foods taste different or they 'go off' certain foods they used to eat. Cravings usually settle down as the pregnancy progresses so if you have found it difficult to eat particular foods that are important for your diet, you may like to try them again later in the pregnancy. It is important to continue to maintain a healthy, balanced diet by eating a wide range of nutrient rich foods as described in the Nutrition section.

Headaches

Increased blood volume and hormonal changes of pregnancy may cause headaches. Nasal congestion, fatigue, eyestrain, anxiety or tension may also increase the frequency of headaches. These are some things you can do to relieve simple headaches:

Regular checks during your pregnancy can assist in identifying and reducing risks or complications to either you or your baby. Antenatal visits also give you a chance to ask any questions and to talk about any issues that you are unsure about, such as aches and pains, the birth, feeding your baby or any other concerns.

If you are having headaches that are severe, frequent, long lasting, or accompanied by blurred vision, spots or flashes of light, swelling, abdominal pain, vomiting or any associated weakness, it is important to contact your obstetrician or hospital immediately. High blood pressure in pregnancy is a serious condition that must be recognised and managed promptly and appropriately to avoid further complications to you or your baby.

Panadol, if used occasionally, may generally be used safely in pregnancy. Painkilling medications such as aspirin and ibuprofen may be harmful if taken during pregnancy and have been linked to an increased risk of miscarriage.

Heartburn/reflux

Most women will experience heartburn or reflux by the third trimester (at around 28 weeks). Heartburn is partly caused by hormonal changes and then later by the growing baby pressing on your stomach. Heartburn is a burning feeling in your chest, accompanied by a bitter taste of fluid in the mouth when stomach acids flow backwards into the oesophagus (food pipe). Some things you can do to relieve heartburn include:

If these measures don't help your obstetrician or GP may prescribe an antacid. Products such as baking soda are high in salt and should not be taken.

Haemorrhoids

Haemorrhoids or piles are swollen veins around the rectum and anus (back passage) that may itch, ache or feel sore and they can sometimes bleed. Piles may make going to the toilet uncomfortable. They can be triggered by constipation and or pressure from the baby's head. Things you can do to relieve these include:

Talk to your obstetrician or GP about a suitable ointment or suppository if bleeding and pain persist.

Leg cramps

Muscle cramps in the foot, calf or thigh are very common during pregnancy, especially at night. The cause of cramps is unclear. Results of research studies have shown that calcium and magnesium supplements fail to provide improvement or relief of cramps. The following simple measures may help relieve muscle spasm/cramp:

You may get more information on stretching exercises from a physiotherapist or your midwives in antenatal classes. It is important to know the difference between cramps and blood clots in the legs so you can act promptly and seek medical advice. If you experience redness, swelling, pain in your calf or varicose veins, that may or may not be associated with a fever, please seek advice from your obstetrician, GP or hospital immediately.

Morning sickness/nausea and vomiting

For many pregnant women who experience morning sickness, nausea is more common in the morning and early stages of pregnancy. For others it can happen at any time of the day, or at any stage of their pregnancy. Most women experience morning sickness at around six weeks gestation and find it settles by about 14-16 weeks. The exact cause is unknown, but it is thought to be due to changes in hormone levels during pregnancy. Some things you can do to minimise the effects of morning sickness include: eating small meals and snacks frequently, drinking plenty of fluids, getting plenty of rest and avoiding triggers like rich foods and strong smells. If none of these measures help please contact your obstetrician or GP.

Avoid taking any anti-nausea medicines that you can buy without a prescription. There are medications available for controlling morning sickness that are safe during pregnancy so see your doctor if you feel you need this. There is a serious condition called hyperemesis gravidarum where pregnant women may experience severe nausea, vomiting, weight loss, and dehydration or electrolyte imbalances. If you have nausea and vomiting that does not respond to simple treatments, please contact your doctor immediately. You may need hospital treatment and support with intravenous (IV) fluids and medications.

Pelvic and lower back pain

Most women experience backache at some stage during their pregnancy. The causes include altered posture as the baby grows, hormonal changes leading to loosening of ligaments and greater water retention in the tissues. Backache is often worse at night contributing to sleeping difficulties, especially during the later stages of pregnancy.

To prevent and relieve back pain you can:

About 1 in 5 women develop a more painful condition of the pelvis called symphysis pubis dysfunction. Please see the link in the For more information box for more about this condition and its management

Consider the possibility of backache being due to preterm labour if your backache is unrelieved and accompanied by regular uterine tightenings and/or bleeding or leakage of water from your vagina. If you suspect this may be the case, please contact your obstetrician and hospital immediately for further advice.

If your back or pelvic pain is unrelieved by the simple measures discussed above please talk to your doctor. A referral to a physiotherapist may be useful.

Shortness of breath

During pregnancy your growing uterus puts pressure on your internal organs and diaphragm and this in turn can lead to shortness of breath. Your body adapts by becoming more sensitive to carbon dioxide in your blood stream and your ribs move upwards and outwards, giving extra room for your lungs to expand. As a result you might find you take deeper breaths than when you weren’t pregnant. Activities such as climbing stairs and just finding a comfortable position at night can be associated with difficulty in breathing. Things start to improve once the baby has ‘dropped’ into your pelvis or engaged, and moved further below your diaphragm, giving your lungs more space to expand. In the meantime, some things you can do to relieve your breathlessness include:

Please contact your obstetrician or hospital early for advice and possible treatment if:

These may be signs and symptoms of more serious conditions.

Skin changes, irritations, rashes

The hormones of pregnancy can change the tone and colour of your skin. The extra blood circulating around your body can cause your skin to 'glow' but for some women it may cause uncomfortable symptoms such as: red patches, worse acne, dry and scaly patches, and deeper pigmentation across the face.

Changes in pigmentation affect nearly every pregnant woman, especially the areas of the body that are already pigmented such as moles, freckles and the areola (area around your nipples). Your genitals, the inner sides of thighs, underneath your eyes and in your armpits may also become darker in tone. Some women develop a dark line running down the centre of their stomach, called the linea nigra. Chloasma is a special form of pigmentation called the ‘mask of pregnancy,’ which looks like brown patches on the bridge of the nose, cheeks and neck. Some dark skinned women develop patches of paler skin on their face and necks. These patches will begin to fade after the baby is born. You may use make-up to cover up these patches. Exposure to sunlight may intensify areas of skin that are already pigmented and many women find that they tan more easily during pregnancy. Even after birth, the deeper pigmented skin will remain darker for some time but will gradually fade and disappear.

As your baby grows, the skin of your abdomen gets tighter and may cause mild itching. This is common in pregnancy. However, contact your doctor for any persistent or severe itching, especially if it’s on your palms and soles of your feet, or if you notice a yellowing of your skin, as this can be a sign of a more serious problem. Medication and further tests may be ordered.

About 90 percent of women get stretch marks. These usually appear across the abdomen, although they can affect the thighs, hips, breasts and upper arms. Gradual weight gain allows the skin to stretch without tearing. While the red streaks look prominent during pregnancy, after the birth, they fade and become pale silvery streaks. Nothing you apply to the skin will prevent them.

Similarly, if you are concerned about any unusual breast changes such as pain, redness, itching, nipple discharge or lumps please seek advice from your doctor early.

Tiredness

Being tired is perhaps the most common complaint pregnant women experience. Most pregnant women experience difficulty sleeping in late pregnancy. At this stage, sleep is easily disturbed by visits to the toilet, heartburn, kicks from the baby or a feeling of discomfort when lying down. Some women may experience vivid dreams in the last couple of months, which can be due to anxiety or excitement about approaching childbirth and parenthood. These are some suggestions to help you sleep better:

Do not take any sleep medications without advice from your obstetrician or GP. Accept the fact that you need extra rest during pregnancy and pace your daily life accordingly:

If the suggestions offered above do not work for you, discuss your concerns with your obstetrician. In some cases, fatigue maybe related to anaemia so you might need a blood test and extra supplementation with iron tablets.

Urine frequency and incontinence

In early pregnancy, frequent urination is caused by hormonal changes, but in later pregnancy it can be related to the increasing size of the baby pressing on your bladder. You may find it more difficult to empty your bladder completely in late pregnancy. In the last few weeks of pregnancy you may 'leak' some urine when you cough, sneeze or lift something. It's very important not to limit the amount of water and other fluids you drink to manage frequent urination. This is because you and your baby still need plenty of water and limiting fluids could contribute to an increased risk of bladder or kidney infection.

Seek advice from your obstetrician or GP if you have any feelings of burning, stinging or back pain when you pass urine, or if your urine is cloudy, has a strong smell or has any blood in it. These could be signs of a urinary tract infection, which should be treated quickly to avoid any further complications. Additionally, you can discuss pelvic floor exercises with your doctor, midwife or physiotherapist.

It will also be important to understand the difference between a bladder leak and rupture of the membranes prior to labour. You can put on a pad and contact your obstetrician or hospital if you suspect it is your membranes.

Vaginal discharge

Almost all women have increased vaginal discharge during pregnancy and this is normal. The discharge is usually a mild-smelling milky fluid. It happens because more blood is flowing to the area around your vagina. It's probably not that different from the discharge that you had before you were pregnant. There's just a lot more of it now.

Simple things to do include:

Avoid using vaginal douches as they may increase the likelihood of vaginal infections occurring when you wash out the normal bacterial balance. If the discharge smells unpleasant or is discoloured, you may have a vaginal infection. The most common infection is thrush. It is important to see your obstetrician or GP so treatment can be commenced. Signs that something may be wrong and that you need to seek advice for include:

These signs are different to those you might experience when going into labour or if your membranes rupture. Please put on a pad and seek advice from your obstetrician or hospital if you experience a thick, mucous discharge that may be tinged with blood, a slow trickle or gush of brown, green or bloodstained fluid, or if you suspect your membranes have ruptured and the fluid is clear or pinkish in colour.

Varicose veins and swollen legs

About half of all pregnant women experience varicose veins and those with existing varicose veins will find they worsen with pregnancy. This is due to increased blood volume during pregnancy and the effect of hormones relaxing the walls of veins, causing them to swell and leak fluid into the surrounding tissues You can do a few things to relieve your varicose veins and swollen legs by:

Most women find that varicose veins improve in the few months after the birth of their baby, but some will go on to experience problems. You can talk with your obstetrician or GP about the various treatment options available.

If you experience any of the following signs or symptoms with your varicose veins, please seek advice and assistance from your obstetrician or hospital:

During pregnancy, it is also normal to experience some swelling of the feet, legs and hands that makes the skin feel tight and this is due to a number of pregnancy-related changes. The amount of blood in your body increases by about 40 percent during pregnancy and so your heart needs to work harder to circulate this extra fluid. The growing weight of your baby pressing on major blood vessels and veins also slows the movement of fluid causing it to pool around your lower limbs. About 1 in 3 women will experience swelling of the hands and feet during the last three months of pregnancy and find it worsens in hot weather. Some swelling or puffiness is not unusual or serious, but it can be uncomfortable. Some things you can do to reduce or prevent swelling include:

Seek advice from your obstetrician if swelling continues to be problematic for you. Restricting your intake of fluids or using diuretics (water tablets that make you pass more urine and salts) or alternative medicines is not recommended.

You should also seek immediate advice from your obstetrician or hospital if you experience sudden or severe swelling of your face, eyes, hands or feet, which may or may not be accompanied by headaches, or flashes of light, abdominal tenderness, pain or vomiting. These might be signs of a serious pregnancy complication called pre-eclampsia (High blood pressure and pre-eclampsia), which will need to be further investigated and treated appropriately.