Pregnancy discomforts

A variety of uncomfortable symptoms are common during pregnancy, including backaches, constipation, heartburn, hemorrhoids, leg cramps, nausea and swelling. Fortunately, these symptoms are often only temporary. To make your pregnancy as comfortable as possible, learn to prevent or treat these bothersome symptoms.


Backaches
Causes/associated factors
Backaches are common during pregnancy, especially after the first trimester (12 weeks). Backaches are usually related to normal pregnancy changes, such as the loosening of pelvic joints to provide a larger passageway for the baby during delivery and the imbalance caused by your abdomen's increased weight. This increased weight may lead to a curved lower back and muscle strain.

Signs/symptoms
Lower back pain may extend into the buttocks and leg. Although lower back pain can be expected as part of the normal changes of pregnancy, it can also be a sign of a urinary tract infection or preterm labor.

Backaches related to a urinary tract infection may be accompanied by a burning sensation during urination and a fever. Backaches related to preterm labor may be accompanied by other symptoms, such as:

a rhythmic cramping pain in your back
menstrual-like or generalized abdominal cramping
a feeling of pelvic pressure (as if the baby were pushing into your pelvis)
an increase or change in the type of vaginal discharge (watery, mucusy or bloody)
diarrhea
To pinpoint the cause of any backache, consult your doctor.

Diagnosis
Diagnosis is based on your symptoms and a physical exam.

Treatment/prevention
Consider the following suggestions to ease or prevent lower back pain:

Apply heat or cold to your lower back. Try a water bottle filled with warm water or ice water, a heating pad wrapped in a towel, or a warm (not hot) bath.

Massage your lower back.

Sit in chairs with good support. Opt for chairs that are not too low and have straight backs and armrests. It may also help to place a small pillow behind your lower back for support and rest your feet on a footstool. If you must sit for an extended period of time, get up and walk around for a while at least once an hour.

Avoid standing for long periods of time. If standing can't be avoided, rest one foot on a stool or elevated surface.

When lifting, bend at the knees instead of the waist and keep your back straight. Ask for help if the object is heavy.

Wear shoes that provide adequate support. Avoid high heels and shoes without heels at all. A 2-inch heel is sometimes recommended to help correct body alignment.

Sleep on your side. Place a pillow between your legs to help keep your top leg at the level of your hip. Sleeping on a firm mattress or placing a board under a soft mattress will provide good support. Take care when you get in and out of bed -- lift your legs in and out of bed instead of twisting your back.

Maintain your weight within the range your doctor recommends.
Your doctor may also recommend a maternity girdle to provide additional support for your abdomen and special exercises to strengthen your back muscles, abdomen, hips and upper body.

Complications
Hospitalization is sometimes needed to relieve severe backaches.


Constipation
Definition
Constipation is the strained passage of hard, dry stools -- NOT simply the absence of a bowel movement every day.

Causes/associated factors
During pregnancy, several factors may contribute to constipation, including hormonal changes that make the muscles of your intestines more relaxed and sluggish, thereby allowing greater time for the water to be reabsorbed from the stool while passing through the colon. Also, increased pressure on your intestines from the enlarging uterus slows down the intestines' normal activity. Iron supplements can also have a constipating effect.

Signs/symptoms
Your bowel movements may be infrequent, hard, uncomfortable and difficult or even painful to pass.

Diagnosis
Diagnosis is based on your symptoms. No special tests are necessary.

Treatment/prevention
Constipation can usually be treated or prevented with simple measures.

Drink plenty of fluids. Aim for at least six to eight glasses of fluid a day. Try water, fruit juice or vegetable juice. Sometimes prune juice is especially effective. Avoid drinks containing caffeine, such as certain sodas, teas and coffees. Caffeine actually causes increased water loss from your body.

It's also important to eat plenty of fiber. Try foods such as dried beans, dried peas, fresh and dried fruits, raw or slightly cooked vegetables, whole-grain breads and cereals, and wheat bran. You may notice an increase in gas as you begin to eat more fiber. To help your body adjust, it may be a good idea to gradually increase the amount of fiber you eat.

Adequate exercise is also important. Daily exercise (such as walking) can make your intestines work more effectively. Discuss an appropriate pregnancy exercise program with your doctor.
If these self-help measures aren't effective, consult your doctor. You may need to use a bulk-forming laxative made of vegetable fiber, psyllium seed or a stool softener. Enemas and strong laxatives are typically not suggested during pregnancy. Mineral oil should also be avoided because it interferes with your body's absorption of important vitamins (including vitamin K, which helps the blood to clot, an essential element during delivery). Remember to only take medications your doctor recommends, even those available without a prescription.

Complications
Constipation during pregnancy can lead to painful hemorrhoids and rectal bleeding.


Heartburn
Definition
Heartburn is a burning pain in the upper abdomen and chest.

Causes/associated factors
Heartburn is common during pregnancy. It's caused by:

an increase in stomach acid related to pregnancy
hormonal changes that cause the muscle separating the esophagus (the tube that connects the throat and stomach) and stomach to loosen, which allows acidic contents to flow back into the esophagus
slowing of stomach activity, which allows stomach contents to remain in the stomach longer
pressure on the stomach from the enlarging uterus
Heartburn is often aggravated by stooping or lying down, eating large meals, eating acidic or spicy foods, drinking caffeine or alcohol, smoking and stress.

Signs/symptoms
You'll feel a burning pain in the upper abdomen and center of your chest, sometimes extending into your throat, and pressure in your upper stomach. You may also belch or become nauseated. If you have heartburn, consult your doctor.

Diagnosis
Diagnosis is based on your symptoms and a physical exam.

Treatment/prevention
To treat or prevent heartburn, consider the following suggestions:

Modify your diet. Avoid acidic, highly seasoned, greasy or fried foods, processed meats, alcohol and drinks containing caffeine. It may also be helpful to eat smaller, more frequent meals. Eat slowly, do not eat during the two to three hours before bedtime, and do not lie down after eating.

Avoid bending down and lying flat. Elevate your head while sleeping. It may be more helpful to elevate the head of the bed with blocks of wood than to use pillows, because pillows tend to shift during the night.

Don't smoke.

Wear clothing that fits loosely around your waist.
If these measures aren't effective, discuss additional options with your doctor. He or she may also suggest an antacid or acid-reducing medication. But remember to only take medications your doctor recommends, even home remedies or other medications available without a prescription.

Complications
Rarely, heartburn may lead to an inflammation or ulcer in the lower part of the esophagus due to irritation by the stomach acid.


Hemorrhoids
Definition
Hemorrhoids, often called piles, are stretched and swollen veins in the anus (the end of the large intestine) or lower rectum. Hemorrhoids may be on the inside or the outside of the anus.

Causes/associated factors
An estimated 20 to 50 percent of pregnant women experience hemorrhoids. Factors that may lead to hemorrhoids include:

compression of the veins in the anus by the enlarging uterus, preventing normal blood flow
constipation or straining to have a bowel movement
prolonged sitting or standing
Signs/symptoms
Hemorrhoids may cause rectal pain, itching and sometimes bleeding, especially when you have a bowel movement. You may also notice a lump at the rectal opening. Consult your doctor if you suspect you have hemorrhoids.

Diagnosis
Diagnosis is based on your symptoms and a physical exam. If you have internal hemorrhoids or rectal bleeding, you may need a digital rectal exam, a procedure in which the doctor lubricates a gloved finger and feels for abnormalities in the anus. An anoscopy or proctoscopy exam (a procedure in which the doctor uses a small tube to directly see the internal part of the rectum) may also be necessary.

Treatment/prevention
To treat or prevent hemorrhoids, consider the following suggestions.

Avoid putting added pressure on the rectal veins by not standing or sitting for long periods of time or sleeping on your back. Take frequent breaks throughout the day for a walk or change of position, and try to sleep on your side.

Avoid straining when you have a bowel movement. You may find it helpful to rest your feet on a low stool while you sit on the toilet. Also, follow the suggestions for constipation as described above.

Sit in warm bath water for 10 to 20 minutes several times a day. Ice packs or cool compresses using a witch hazel compound may also help relieve symptoms.

Try Kegel exercises, which are the rhythmic tightening and relaxing of the muscles around the rectum and vagina.
Do not use topical hemorrhoid medications unless your doctor specifically recommends them.

Complications
A blood clot called a thrombosis may develop in the vein affected by hemorrhoids. This condition, which is not very common during pregnancy, can be quite painful. If the treatments described above aren't effective, a minor surgical procedure may be needed to remove the blood clot.


Leg cramps
Causes/associated factors
About half of all pregnant women experience leg cramps at some point, usually during the third trimester. Factors that may contribute to leg cramps include a lack of calcium in the diet, fatigue, cold, stress, and pressure from the enlarging uterus on the blood vessels and nerves in your legs.

Signs/symptoms
You may notice a recurring, painful spasm in your leg muscles, often in the calf. These spasms occur more often during the third trimester after you've gone to bed, but they can appear any time during pregnancy and at any time of day.

Diagnosis
Diagnosis is based on your symptoms and a physical exam.

Treatment
During the cramp, try to straighten your leg and slowly point your toes up toward your head. It may also help to stand with your foot flat on the floor. After the cramp subsides, try a warm compress on your leg to relieve discomfort.

Prevention
To help prevent leg cramps, periodically elevate your legs, keep your legs warm, and exercise regularly as recommended by your doctor. Don't point your toes away from your body -- this can stimulate a cramp.

Complications
You may feel pain in your leg after the cramp. However, leg pain may also be caused by a blood clot in a blood vessel. Call your doctor if you can't relieve the pain from a leg cramp with the measures described above.


Nausea
Causes/associated factors
About half of all pregnant women experience nausea and vomiting early in pregnancy. Although often referred to as morning sickness, it's not limited to a specific time of day. The exact cause of morning sickness is unknown, but it may be partly due to the hormonal changes you experience during pregnancy. Morning sickness doesn't typically interfere with the baby's nutrition and usually subsides by the end of the first trimester (12 weeks).

Signs/symptoms
Many pregnant women feel nauseated when they get up in the morning. You may vomit after you eat, and by noon the nausea may disappear. Remember, however, morning sickness may strike any time of the day or night. For some women, it lasts all day.

Diagnosis
Diagnosis is based on your symptoms. No special tests are necessary.

Treatment/prevention
Consider the following suggestions to ease or prevent morning sickness:

Don't let your stomach get too empty or too full. Eat a small snack high in carbohydrates, such as crackers or rice cakes, about 20 minutes before you get out of bed in the morning. Eat small, frequent meals or snacks throughout the day, and have another small snack at bedtime and if you wake up in the middle of the night.

Get plenty of protein and carbohydrates. Eat foods such as turkey, chicken, peanut butter, nuts, cheese, milk, yogurt, crackers, rice and fruit. Avoid foods that are fatty, fried, salty, spicy or acidic (such as citrus fruits).

Drink plenty of fluids, especially if you're vomiting. For variety, opt for fruit or vegetable juices, milk shakes, soups or broth. You may find it helpful to take frequent, small sips between meals and snacks rather than drinking with food.

Avoid tobacco smoke and any other smells, sights or tastes that tend to nauseate you. If necessary, hand the cooking duties over to someone else.

Prenatal vitamin supplements can aggravate morning sickness, so take them at a time when you don't usually feel sick.

Get plenty of rest. Emotional and physical fatigue can increase morning sickness.

Try a motion sickness band, such as Sea Band or ReliefBand. These bands are based on the principle of acupressure applied to the inner wrist.
If these self-help measures aren't effective, consult your doctor. A supplement of vitamin B6 is sometimes recommended to combat morning sickness. Some prescription medications may also be taken for severe nausea and vomiting. As always, only take medications your doctor recommends, even those available without a prescription.

Complications
Severe nausea and vomiting during pregnancy is called hyperemesis gravidarum. This condition may cause weight loss, dehydration and significant changes in your body's delicate chemical balance. Hyperemesis gravidarum is rare, occurring in only 1 to 2 percent of all pregnancies. Treatment may require hospitalization, intravenous fluids and antinausea medication.


Swelling
Causes/associated factors
As many as 75 percent of pregnant women experience mild edema (swelling) of the feet and ankles, especially during the latter part of pregnancy. This swelling is related to the normal hormonal changes and increases in body fluids that accompany pregnancy, as well as pressure from the enlarging uterus on the veins that return blood from your feet and legs.

Signs/symptoms
The swelling late in pregnancy is usually mild and limited to the ankles and legs. The swelling may be aggravated by warm weather and prolonged standing or sitting. It's often worse toward evening and usually improves or disappears after a good night's sleep. Swelling in your hands, face and buttocks, swelling that's worse in the morning, gaining more than 2 pounds a week, or suddenly gaining weight over a period of one to two days may indicate the more serious problem of preeclampsia (a serious condition that causes elevated blood pressure, as well as protein in the urine). To be on the safe side, report any swelling to your doctor.

Diagnosis
Diagnosis is based on your symptoms and a physical exam.

Treatment/prevention
To ease or prevent normal swelling, elevate your legs and lie down as often as possible. It may also be also helpful to avoid highly salted foods and wear pregnancy support hose.

Complications
There are no complications related to normal swelling. Swelling can be a warning sign of preeclampsia, however, so it's important to report any swelling to your doctor.