Pregnancy can be a wonderful time, and a time when you can feel simply fantastic – hello pregnancy glow!
There can be some downsides though; struggling to get comfy in bed, constantly needing to wee, back pain… Here’s a bit more info on some common pregnancy struggles, what you can do to help it and when to get a doctor’s opinion.
Quick links:
Obstetric Cholestasis (OC) – ‘Itchy Liver Syndrome’
Placenta Previa
Sacroiliac Pain
Carpal Tunnel Syndrome
Pre-Eclampsia & Eclampsia
Gestational Diabetes (GD)
What’s with Constipation in Pregnancy?
Haemorrhoids (Piles)
Varicose Veins
Symphysis Pubis Dysfunction & Diastasis Symphysis Pubis
Obstetric Cholestasis (OC) – ‘Itchy Liver Syndrome’
Obstetric Cholestasis (OC) is a condition of the liver which occurs in some pregnant women. OC means there is a reduced flow of bile down the bile ducts in the liver. Some bile then ‘leaks’ out into the bloodstream, in particular the bile salts. These circulate in the bloodstream and can cause symptoms.
OC occurs in about 1 in 100 pregnancies in the UK. It is more common in women carrying twins, triplets, or more. Mothers, daughters and sisters of affected women have a higher than average risk of also being affected when pregnant. It is more common in certain parts of the world.
Typically, symptoms occur in the last third of pregnancy when the hormone levels are at their highest. However, it sometimes develops earlier in pregnancy.
Itching is the most common and typical symptom. The itching can be ‘all over’, but it is often worst on the hands and feet. Commonly, itching is the only symptom. It tends to get worse until you have the baby. The itching can become severe and affect sleep, concentration, mood, and can become distressing. Note: mild itching from time to time is normal in pregnancy especially on the expanding abdomen. However, if a woman develops a constant and global itch or itching particularly located at the hands and/or feet, it’s best to seek advice from your health care provider. A simple blood test will confirm whether it is OC.
The diagnosis is confirmed if you have:
Itching that is not due to any other known cause (such as a skin disorder), and high levels of liver enzymes and/or bile salts in your blood that cannot be explained by any other liver disease such as viral hepatitis. Both the itch and high level of liver enzymes and bile salts go away after the birth of the baby. A blood test done sometime after the baby is born can confirm this. This sometimes helps to confirm that the diagnosis was, in fact OC if there had been any doubt.
Placenta Previa
Placenta Previa occurs when the placenta lies low in the uterus below the presenting part – head or buttocks. This means that the birth canal is obstructed to a varying degree by the placenta. If the placenta starts to peel off the uterus, there will be painless bleeding. There are various degrees of Placenta Praevia and the use of ultrasound scanning helps to make this diagnosis. Major placenta Praevia is the most serious problem in that it is associated with recurring, painless bleeding and, ultimately, the foetus will have to be delivered by C-Section. This is usually preceeded by an extended hospital stay in the first instance as the mother is immobilized and kept under observation. One of the earliest signs of Placenta Previa is spotting or any kind of bleeding during Pregnancy. Please seek advice from your Health Care Provider should you experience ANY BLEEDING DURING YOUR PREGNANCY.
Sacroiliac Pain
The Sacroiliac Joint (SIJ) is one of the largest joints in the body. It is the point of connection of the Sacrum (base of the spine) and the Ilia (wings of the pelvic girdle). The SIJ is crossed by very strong ligaments which hold the joint together. The joint is further stabilized by Symphysis Pubis at the front of the pelvis.
Causes & Symptoms of Sacroiliac Pain
One of the theories associated with these joints as a generator of pain is that the Sacrum and pelvic bones can slide out of optimal position. This generates a non-optimal fit and non-optimal ability to transfer load efficiently through the entire muscular skeletal system.
Joint laxity and pelvic instability can be caused or exacerbated by pregnancy hormones causing movement at one or both of the joints.
Or conversely, pain can be caused by a lack of movement at the joints resulting in the two joint surfaces becoming stuck and producing a “locked” joint reducing the degree of mobility.
Symptoms can vary, but generally consist of mild to severe pain in the sacrum and lower (lumbar) back region. This pain can radiate out from that central point and can travel through the buttocks and down either or both of the back of the thighs. Referred pain may also be felt in the at the Symphysis Pubis area. Sacroiliac pain can sometimes be misdiagnosed as Sciatica. A key difference to note is that Sciatic pain usually travels down the leg as opposed to remaining in the pelvic region.
Exercise Considerations
Restorative exercises for the TVA (transverse abdominal muscle); a thin muscle that runs under the front and side of the abdominal wall, it runs perpendicular to the linea alba, the multifidus; short triangular muscles that run down the spine, and anterior pelvic floor muscles along with strengthening the glutes especially glute medius, a small glute muscle that helps with hip motion – can be beneficial to aid the stabilization of the pelvis.
Activities where weight is distributed unevenly can often aggravate the condition.
Single leg work whether carried out standing or supine can cause aggravation.
Lower body exercises requiring abduction (opening of the legs from the midline) or adduction (closing the legs towards the midline) may cause discomfort as may breast stroke swimming (because of the “frogleg” movement of the legs). The “bend-to-extend” movement pattern, such as deadlifts may also cause discomfort.
What to do?
The best course of action if you are feeling pain is to contact your health professional; GP, midwife or women’s health physio and discuss with them the best way to move forward.
Carpal Tunnel Syndrome
Causes
The main nerve that serves your hand and fingers is called the median nerve. It passes through the Carpal Tunnel; a narrow space at the front of the wrist. The tendons that bend the fingers and wrist pass through the carpal tunnel, so space is limited. Any swelling (in the case of pregnancy and postnatal; usually caused by water retention) in the region will compress or irritate the median nerve and interfere with nerve impulses.
Symptoms
Symptoms of carpal tunnel syndrome include a loss of sensation or pins and needles in the hands, wrists and/or fingers (especially the thumb and first and second fingers) with sometimes accompanying numbness and weakness. Occasionally the whole hand and forearm are affected and it can occur from conception, throughout pregnancy and sometimes well into the post birth period.
Exercise Considerations
In an exercise scenario, people with carpal tunnel syndrome can often complain of pain when bearing their weight on their hands in a flexed position i.e., when in all-fours/table-top position.
Painful positions should be avoided and good wrist alignment maintained and monitored throughout the exercise session. If your ability to take part fully in the exercise is reduced or your ability to carry out everyday activities is hindered, you should get in touch with your health care professional.
Treatments
Diuretics, pain relieving injections and sometimes even surgery are all used as solutions to this unfortunate ailment although a qualified sports massage therapist or physiotherapist should be able to work with you to help relieve the symptoms and provide you with some exercises to treat it.
Pre-Eclampsia & Eclampsia
Pre-eclampsia is a condition that only occurs during Pregnancy. Its major symptoms are high blood pressure and when tested women are found to have high levels of protein in their urine.
It usually develops sometime after the 20th week of pregnancy. The severity of pre-eclampsia can vary. Serious complications may affect the mother, the baby, or both. The more severe the condition becomes, the greater the risk that complications will develop. If left unmonitored/untreated pre-eclampsia can eventually progress to Eclampsia.
Eclampsia is a type of seizure (convulsion) which is a life-threatening complication of pregnancy. About 1 in 100 women with pre-eclampsia develop Eclampsia. So, most women with pre-eclampsia do not progress to have Eclampsia. However, a main aim of treatment and care of women with pre-eclampsia is to prevent Eclampsia and other possible complications (listed below).
What Causes Pre-Eclampsia?
It is thought that the blood vessels in the placenta do not develop adequately and this then has a negative effect on the transfer of oxygen and nutrients to the baby. Pre-Eclampsia can also affect various other parts of the mothers’ body. It is thought that substances released from the placenta are transported around the body and damage the blood vessels, making them become ‘leaky’ and dysfunctional. Pre-eclampsia can run in some families so there may be some genetic factor. Pre-eclampsia can develop anytime after 20 weeks of pregnancy and is indicated by: Blood pressure becoming high and an abnormal amount of protein in the urine. Pre-eclampsia is not the same as ‘high blood pressure of pregnancy’. Many pregnant women develop mild high blood pressure whereas most do not have pre-eclampsia. With Pre-Eclampsia you have high blood pressure, plus excessive protein in your urine, and sometimes other symptoms and complications listed below. If the pregnant woman develops mild high blood pressure, it is vital that she has regular ante-natal checks which can detect Pre-Eclampsia as early as possible.
What are the symptoms of pre-eclampsia and how does it progress?
- Headaches
- Blurring of vision, or other visual problems
- Abdominal (tummy) pain. The pain that occurs with pre-eclampsia tends to be mainly in the upper part of the abdomen, just under the ribs
- Vomiting
Swelling or puffiness of your feet, face, or hands (oedema) is also a feature of Pre-eclampsia. This is common in a normal pregnancy. Most women with this symptom do not have Pre-Eclampsia, but it can become worse in Pre-Eclampsia. Therefore, any SUDDEN worsening of swelling of the hands, face or feet need to be promptly to your doctor or midwife.
Gestational Diabetes (GD)
Symptoms & Causes
Gestational diabetes is type of diabetes that occurs during pregnancy. Diabetes is a condition in which the body is not able to utilize and process the sugar (glucose) in the bloodstream as efficiently as it should, so the level of sugar in the blood becomes higher than normal.
Gestational diabetes affects between 1% to 3% of all pregnant women. It usually develops in the second trimester (sometimes as early as the 20th week of pregnancy). In most cases, the symptoms of GD resolve after the baby is born but they can/may linger into the early postnatal period.
High blood sugar levels can have negative consequences for both the mother and the baby as follows: The baby may have a low blood sugar level, jaundice and weigh much more than normal. This increased size and weight of the baby may mean that vaginal delivery may be troublesome and need to be assisted or the mother may need a C-Section.
GD also increases the risk of developing PRE-ECLAMPSIA which is a condition that can be serious to both mother and baby and may even cause death if left untreated. Signs of GD are the same as for general Diabetes, and symptoms usually include an increase in thirst and desire to consume water and fluids and consequently, an increase in urination. Dizziness, faintness and changes in state after eating and also during long gaps between eating food may also be present.
Treatments
As well as offering medication to control the condition, your health care provider will suggest alterations in diet and exercise as a means of combating the condition. Exercise will help to normalise blood sugar levels and walking is usually the easiest type of exercise during pregnancy, but swimming or other exercises deemed low risk exercises can also be beneficial.
What’s with Constipation in Pregnancy?
The pregnancy hormones Progesterone & Relaxin cause muscle relaxation so that the muscular contractions of the bowel (PERISTALSIS) are less forceful and effective at transporting bowel and eventually faecal matter. The physical effects of the growing foetus compresses the large bowel in the pelvis. The infrequent passage of hard stools can result in abdominal pains as a result of the build-up of impacted faeces and so it is important to take measures to reduce constipation such as increasing optimal hydration and fibre in the diet alongside maintaining a regime of gentle exercise.
Haemorrhoids (Piles)
Symptoms & Causes
Piles are enlarged and swollen blood vessels in or around the lower rectum and anus. When the pressure of these blood vessels is increased, they swell and form small lumps and some may protrude. The birth delivery process may also cause piles to appear due to the increase of pressure when pushing to birth the baby. They may cause itching and pain and may bleed on passing of a bowel motion.
Resting with legs elevated and avoiding constipation will help. Many soothing creams and suppositories are also sold over the counter. Check with your doctor or pharmacist for their suitability for use during pregnancy.
Varicose Veins
Symptoms & Causes
Each leg has two large veins, one on the inner aspect and the other on the outside of the lower leg. When standing, the blood in these veins is under increased pressure as results of the forces of gravity acting on the blood in the circulation.
During late pregnancy, the pressure is greater because the increased weight acts to increase the pressure in the veins; also because of lower levels of exercise and general activity, the blood flow back to the heart from the legs is slowed. The leg veins then become distended and tortuous. Sometimes this can extend to involve the veins on the vulva – known as vulval varicosities. These changes are usually accompanied by a sensation of heaviness, throbbing, tingling or occasionally pain in the affected veins.
Compression tights may offer some relief as well as resting with feet elevated.
Exercise Considerations
Standing still for long periods should be avoided. Avoid crossed legs or kneeling back on the heels as this further compresses the veins. In terms of exercises, anything that improves/increases blood flow back to the heart is beneficial ie., most suitable exercise. In late pregnancy, walking is ideal.
Symphysis Pubis Dysfunction & Diastasis Symphysis Pubis
The Symphysis Pubis is the fibrocartilaginous tissue reinforced by several ligaments that forms the joint of the pelvic girdle at the pubis (front of the pelvic girdle).
During the pregnancy period, the pregnancy hormone Relaxin causes ligamental laxity, which eventually aids the delivery of the baby, allowing the pelvis to open sufficiently to allow the passage of the newborn.
Diastasis Symphysis Pubis is the name for the problem in its most severe form – where the Symphysis actually separates severely or tears. In some women, either because of excessive levels of ‘relaxing’ hormones, extra sensitivity to hormones, or a pelvis that is out of alignment, this area is extra lax or there is extra pressure on the joint.
When this increase becomes excessive there may be accompanying swelling and severe pain over the joint – especially when walking, getting in and out of bed, and climbing stairs. Pain may also be felt in and down the thighs and the back as the whole pelvis is put under strain. Some women may also be totally incapacitated by the pain and end up using wheelchairs or crutches during the later stages of their pregnancy.
Here is a great resource with more information and help with dealing with symphysis pubis dysfunction or Pelvic Girdle Pain –> https://pelvicpartnership.org.uk/