Heartburn, reflux and indigestion
Heartburn, reflux and indigestion are common during pregnancy. These discomforts are due to the action of the hormone progesterone. Progesterone relaxes smooth muscle, including the muscle at the top of your stomach that keeps your food and gastric acid contained. We usually feel this as a burning sensation around the breastbone. However, it can also present as burning at the base of the throat.
These symptoms can get worse in later pregnancy, mostly due to the baby pressing up against your stomach as they grow bigger. Try and avoid strong tea or coffee, acidic fruit juices, spicy and fatty foods. Eat slowly, drink plenty of water, and if it still bothers you, antacids often help. Your discomforts will usually resolve once your baby is born.
Morning sickness happens due to the new mix of hormones involved in keeping your pregnancy going. While it is one of the more unpleasant and distressing discomforts, it does pass for most women as the end of your first trimester approaches. However, for some women, nausea and vomiting are severe and last beyond the first trimester. This situation is not as common and may require hospital treatment for the dehydration that goes with the inability to keep fluids and food down.
These tips may help you get through this phase of your pregnancy:
- Take your time getting up
- Try and eat something light as soon as you wake up and before you get out of bed
- Take little sips of water or an electrolyte replacement fluid throughout the day. Aim to get through 10 cups of liquid.
- Eat little and often
- Avoid food containing a lot of fat or spices
- Avoid smoking, alcohol and caffeine (a good idea in pregnancy anyway)
- Eat dry crackers or toast if you can’t cope with anything else
- Ginger tea or ginger tablets may help reduce nausea
- Rest several times a day
- Avoid smells that make you feel sick
- Get some fresh air and exercise by going for a little walk when you are up to it
Nausea and vomiting are discomforts that do not appear to negatively impact pregnancy. Research suggests that morning sickness is associated with a reduced risk of miscarriage (37).
Constipation is one of the common discomforts in pregnancy and is due to the relaxing action of progesterone on your bowels. A healthy balanced diet containing plenty of fibre-rich foods such as fresh fruit, vegetables and whole-grain cereals is the best way to keep your bowels moving. These foods will also provide you and your baby with quality nutrition. Drink plenty of water and keep in mind that when your body moves well, so do your bowels. Regular exercise will help keep you in shape inside and out.
Swollen hands and feet
Swelling of the feet, ankles, fingers and hands is common in pregnancy. The swelling is due to the extra fluid your body needs to ensure sufficient a blood volume that meets the demands of pregnancy. The swelling is called oedema. Gravity is usually the main culprit here – it’s the parts of your body that hang down (the bottom parts of your arms and legs) that are most commonly affected. As your pregnancy advances, your system is working hard to return all the blood and fluid to your heart, and sometimes it just doesn’t manage to get it back up there. While uncomfortable, it is common and usually harmless (except maybe for your shoes).
You can manage oedema using compression stockings (for your lower half), but it will only go away entirely after your baby is born. If you don’t mind swimming, hanging onto the edge at the deep end and letting your legs dangle can move some of the fluid back up and out of your legs. The deeper your legs dangle, the better the effect. Please don’t do this if you can’t swim.
Sometimes oedema that is severe and comes on fast is a sign of more severe problems. This is not common. If this is happening to you, your face is swollen, or you leave indents in your swollen parts when you press on them, please speak to your health care provider about it sooner rather than later.
Varicose veins are common during pregnancy and are usually found in the legs, but can also develop in your vulva. These happen when the walls of the veins are not strong enough to maintain their proper shape and function and are unable to return the blood to the heart effectively. The veins then get pushed out of shape, and blood starts to collect in distended pockets in affected lengths of the vein. This distension and blood collection gives them a lumpy shape, which can be seen or felt through the skin.
Varicose veins may itch, and ache, and they don’t look pretty. Some research investigating varicose veins has found that they are associated with a higher risk for blood clots (deep vein thrombosis – DVT) in some groups. However, pregnancy does not appear to be one of them (38). Compression stockings can help reduce the severity of these discomforts and give your veins the support they need to return the blood to your heart more effectively. Try and avoid standing for long periods and rest with your feet up when you can. Always tell your midwife or GP if you notice any hot, red or painful areas in your legs or vulva. These may be signs of DVT developing.
Haemorrhoids are varicose veins found in the rectum or anus. They may be found in 85% of women during the second and third trimesters of pregnancy (39). These happen for the same reason as varicose veins. However, the pressure of the baby on your bowels and the pelvic floor doesn’t help the situation. Like varicose veins in the legs and vulva, they may be painful and itchy and may be made worse by constipation.
Like most common discomforts of pregnancy, they will usually go away after your baby is born. However, in some cases they just shrink and go back inside, just waiting for your next bout of constipation or your next pregnancy to bring them out again. Supporting your bowels with appropriate diet, fluids, and exercise can help the situation. Still, like any varicose vein, they have many causes. Ask your midwife or doctor about what treatment is best for your circumstances. There three different types of haemorrhoids:
- Internal haemorrhoids exist inside the rectum. These are not usually painful but can bleed when under strain,
- Prolapsed haemorrhoids are more severe and painful. These push through the anus and hang out of the body, particularly after going to the toilet.
- External haemorrhoids feel like hard lumps and are like small haemorrhages (bleeds) under the skin.
Haemorrhoids do not appear overnight and can take years to develop. While not dangerous, they can be painful, uncomfortable and cause bleeding from the rectum. They can be managed (and sometimes avoided) by have a diet that includes fibre-rich foods and maintaining adequate hydration. Vegetables, fruits, cereals, and water will help produce soft bowel motions that you pass them easily and regularly. Doing your pelvic floor exercises and trying not to strain when you use your bowels can help too.
Urinary tract infection
Women are more susceptible to urinary tract infections (UTI’s) than men, being most common in sexually active women. The reason is that sexual activity can push bacteria into the urethra and infect the system that carries urine out of the body – the kidneys, bladder, and the tubes that connect them. Many different bacteria live in the intestines and genital area, and for the most part, this is normal. However, urine and the urinary system are sterile.
A UTI happens when bacteria are introduced into this system accidentally. In most cases, the bacteria travel up the urethra to the bladder, where infection takes hold. Some women get a UTI almost every time they have sex. Women who use a diaphragm for birth control are especially vulnerable. Bladder infections are common and usually not serious if treated promptly. However, if the infection spreads to the kidneys, it can cause more serious illness.
Symptoms of a UTI include:
- Pain or burning during urination
- The urge to urinate often
- Pain in the lower abdomen
- Urine that is cloudy or strong-smelling
- Pain on either side of the lower back
- Fever and chills
- Nausea and vomiting
Please see your doctor if you have signs of a urinary tract infection. A bladder infection is generally not a medical emergency but also does not without antibiotics. People with a higher risk of complications include pregnant women, people with diabetes, kidney problems, or a weakened immune system. Sometimes a UTI can occur without any or all the usual symptoms. However, a urine test shows the presence of bacteria. In many cases, no treatment is necessary. Still, pregnant women are routinely tested and usually treated to avoid kidney infection.
Diagnosing a UTI
The first step in diagnosing a UTI is usually a quick dipstick called a urinalysis. It looks for bacteria, as well as red and white blood cells. Your doctor may also send urine to a lab for culture to confirm the type of bacteria. Prescription antibiotics will almost always cure a UTI. However, it is crucial to identify which bacteria are responsible for the infection. This identification is important because different types of bacteria respond to different antibiotics. Taking the wrong medicines will not cure your infection, but will kill the good bacteria you need in your body and contribute to the growing problems of antibiotic resistance.
During pregnancy, several factors increase your risk of getting a UTI. Hormones cause changes in the urinary tract, and the uterus may put pressure on the ureters or bladder or both — making it more difficult for urine to pass from the kidneys to the bladder and out. Untreated UTIs can irritate your uterus and contribute to preterm labour, so be sure to visit your doctor if you suspect you have an infection (40).
Here are some ways to reduce the risk of you getting a UTI:
- Drink plenty of water.
- Visit the toilet before and after sex.
- Wipe from front to back.
- Avoid feminine hygiene sprays.
- Take showers instead of baths
Managing your UTI
Your health care provider may recommend drinking lots of water and emptying your bladder frequently to help flush out the bacteria. Some women are prone to getting recurrent UTIs. If you experience three or more infections a year, please talk to your doctor about how to prevent or minimize these infections. Some studies suggest that cranberry juice can prevent, but not treat an infection. This method appears to be more effective in young and middle-aged women. Cranberries contain a substance that prevents E. coli bacteria from sticking to the walls of your bladder. Cranberry is also available in capsules or tablets, however people with a history of kidney stones should check with a doctor first.
Other strategies can include taking:
- low-dose of antibiotics long-term
- single antibiotic dose after sex
- antibiotics promptly when symptoms appear.
The vagina is a self-cleaning system, with vaginal discharge serving a function in the health of the female reproductive system. Glands inside the vagina and cervix make a fluid which carries away dead cells and bacteria. This mechanism keeps the vagina clean and helps prevent infection.
Most of the time, vaginal discharge is normal. The amount, odour and colour change throughout your cycle, so ‘normal’ can encompass a wide variation in the discharge you notice. For example, around ovulation, your discharge becomes thinner to assist sperm in making its way to the egg. However, an increase in discharge os common during pregnancy. Breastfeeding and sexual arousal also result in a change in your vaginal discharge. The smell may be different if you are pregnant or you don’t regularly attend your hygiene.
However, if the colour, smell, or consistency of your discharge changes, you may have an infection or other condition. Please see your doctor and discuss your concerns. Any change in the vagina’s bacterial balance can affect the smell, colour, or texture of your discharge. These include:
- Antibiotic or steroid use
- Bacterial vaginosis
- Birth control pill
- Cervical cancer
- Sexually transmitted infections
- Douches, scented soaps or lotions, bubble bath
- Pelvic infection after surgery
- Pelvic inflammatory disease (PID)
- Vaginal atrophy, the thinning and drying out of the vaginal walls during menopause
- Vaginitis, irritation in or around the vagina
- Yeast infections (Thrush)
The doctor will start by asking about your history and symptoms. The doctor may take a sample or do a swab to collect some of the discharge for further examination. Some questions they may ask are:
- When did the abnormal discharge begin?
- What colour is the discharge?
- Is there any smell?
- Is there any itching, pain, or burning in or around the vagina?
Bacterial Vaginosis (BV)
Bacterial vaginosis (BV) is a mild infection of the vagina caused by a bacterial imbalance. Usually, “good” bacteria keep “bad” bacteria in check as part of the vaginas self- maintenance. In women with bacterial vaginosis, the balance has been upset for some reason, and harmful bacteria multiply out of control. Bacterial vaginosis is usually mild, however, it’s a good idea to see your doctor and get antibiotic treatment. You are at increased risk of BV if you have multiple sex partners, a new sex partner or douche (rinse out your vagina).
Many women with bacterial vaginosis do not have any symptoms. This infection does not usually cause itching, but excessive greyish white (or even yellow/green) vaginal discharge with a fishy odour is common. It often clears up on its own, but for some women, this is not the case. Antibiotics work for some women but not others. There are times women are more susceptible to BV, including during pregnancy.
Women with BV during pregnancy have a higher risk of premature labour or uterine infection after their baby is born than women without BV. Your doctor will recommend treatment if you are considering any surgery of this nature. For some women, the bacteria balance themselves again, and BV goes away without treatment. However, when it does not go away even with treatment, bacterial vaginosis is frustrating and irritating. Please see your doctor if you are pregnant or having persistent symptoms.
Candida is a fungus that generally lives throughout the body in small numbers. How much of it lives in us is usually controlled by our good bacteria and the balance they maintain. When this balance is upset, and organisms grow out of control, symptoms occur. Taking antibiotics, high estrogen levels (such as in pregnancy or hormone therapy) can cause this imbalance. So can specific health problems, such as high stress, low immunity, diabetes or HIV. A vaginal yeast infection (thrush) means that too much candida is growing in the vagina. Although thrush can be very uncomfortable, it is common and treatment is simple.
Thrush causes itching, soreness and irritation in and around the vagina and vulva and can be associated with pain or burning when you urinate or have sex. Some women also have a thick, clumpy, white (‘cottage cheese’) discharge that has no odour. If you have any of the symptoms of thrush, please see your doctor.
If you aren’t sure what you have or if this is the first time you have had these symptoms, it is a good idea to get a medical review and run some tests. These tests are especially important if you are pregnant. About 40% of women will develop thrush at some time during their pregnancy (41). Your doctor may want to take some swabs to be sure with what you are dealing.
Can we treat it?
If you are pregnant, please don’t use medicine for thrush without talking to your doctor first. If your symptoms are mild, you may want to adjust your diet and wait to see if it clears up on its own. Candida thrives in a high sugar environment, so reducing your sugar intake can help to limit the severity of the infection. While what you are experiencing is probably thrush, there are other conditions with symptoms like these.
These include bacterial vaginosis and sexually transmitted infections (STI’s). Products such as soap, bath oils, spermicidal jelly, or douches can also cause itching and redness of the vulva. If your symptoms are unfamiliar to you, please see your doctor for testing and an accurate diagnosis.
The following actions can help prevent a vaginal yeast infection:
- Eat a balanced diet rich in fruits, vegetables, whole grains, and non-fat dairy products. There is no evidence to suggest eating cultured dairy foods that contain lactobacillus prevent or treat episodes of thrush.
- Reduce your processed sugar intake.
- Antibiotics can kill off the good bacteria responsible for controlling the candida in your body. Avoid unnecessary use.
- Control diabetes.
- Maintain high levels of immunity
- Keep stress levels under control through life balance and lifestyle choices.
Bleeding gums in pregnancy are common because there is extra blood flow through the mouth. Pregnancy hormones also make the gums more susceptible to oral bacteria. Good oral hygiene is vital, as these issues can lead to gingivitis and periodontal disease. Brushing twice daily with fluoride toothpaste and regular flossing can help prevent these problems, as can regular visits to your dentist.
Backache happens in pregnancy for a few reasons;
- Your baby is growing out the front and puts extra strain on your back muscles,
- Your core muscles just don’t work correctly during pregnancy as the growth of the baby interferes with their function, preventing them from supporting your back,
- The hormone RELAXIN is softening your joints and ligaments, making them more flexible in preparation for birthing your baby. Your centre of gravity has changed, and your muscles must work harder to keep a healthy posture.
This discomfort will probably get worse as you get closer to your due date. All of these result in extra strain on the joints in your lower back and hips. Support your natural spinal curves by wearing flat shoes and keeping an eye on your posture. Stay active, rest when you can, take warm baths and showers and use heat packs and simple analgesia (such as paracetamol, as directed). These can help alleviate the discomfort.
Snoring and nasal congestion
Snoring in pregnancy is the result of extra fluid and the weight you carry while pregnant. Gravity plays a part in this too, as when you are laying down the fluid moves to your head, causing your nasal passages to swell up. This swelling may be alleviated by sleeping with an extra pillow, allowing your nasal passages to drain as you would when you have a cold.
Nasal congestion is also common in pregnancy for the same reason. You may get some relief from using a saline nasal spray. However, if it is a real problem, please speak to your midwife or doctor about other options that are suitable during pregnancy.
Symphysis pubis dysfunction (SPD)
This dysfunction happens when the small joint (the symphysis pubis) at the front of the pelvis loosens up. This loosening is due to the actions of relaxin and the pressure that the baby puts This dysfunction happens when the small joint (the symphysis pubis) at the front of the pelvis loosens up.
This loosening is due to the actions of relaxin and the pressure that the baby puts on it. It can be one of the worst pregnancy discomforts and can affect your mobility. However, it will usually heal and tighten up again after the baby is born. Wearing a pregnancy support belt can help alleviate the symptoms. Still, it may be necessary to enlist some help with getting around late in your pregnancy.
Stretch marks develop in 50% to 90% of pregnant women. When they first appear and throughout your pregnancy, they will be red or purple lines or streaks. These will fade slowly to leave pale marks on your skin. Why stretch marks develop is not currently known. At this stage, there is no evidence that special creams or oils applied to your skin make a significant difference in the prevention or treatment of stretch marks (42).
Light bladder leakage
Incontinence during pregnancy is common and usually brought about by increasing pressure on your bladder by your growing baby. When that happens, your bladder sphincter (which is also affected by progesterone) doesn’t function well enough to hold in urine. Pelvic floor exercises will assist with this and return to normal function after the baby is born. However, you can’t control the hormones or how your baby sits on your bladder!
Dr Janelle McAlpine (PhD), Clinical Midwife
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