Pregnancy Discomforts

From Head to Toe

Managing the Small Discomforts of Pregnancy

If you’ve ever run a marathon, received a promotion at work, aced a test in school, or renovated a home, you have probably figured out that the very satisfying rewards of these accomplishments require hard work, dedication, and sometimes even physical pain. Well, pregnancy is no different! In order to reach the moment when you are able to hold your perfect baby in your arms, you undoubtedly will have to put up with your share of aches, pains, and frustrations. Fortunately, many of these discomforts can be managed with minor interventions. Stay tuned to learn – from head to toe – what you may experience, ways you can cope, and when you need to call your doctor.

Headaches
Many women will experience headaches in pregnancy. They may be related to tension, dehydration, or they could be migraine headaches. About a third of women with migraines will experience worse headaches during pregnancy, a third will have similar headaches as before the pregnancy, and a lucky third of women with migraines will actually have less severe headaches.
What to Try: Make sure you stay hydrated (you’ll notice this is important for many problems!). Tylenol is the safest medication to take (500-1000mg or 1-2 extra strength tablets), but you cannot take more than 4000mg in one day. You can also try relaxation therapies like deep breathing, light exercise, yoga, massage, and acupuncture if you are concerned about tension playing a role, but be sure that your instructors or providers are aware you are pregnant. Caffeine can be helpful in small doses (i.e.: one 8oz cup of coffee). If you have a history of migraine headaches, it may be worthwhile to talk to your doctor about this early and develop a treatment plan for if your headaches do not respond to conservative measures like Tylenol.
When to Call: If your headache persists despite the interventions above or you have any associated visual changes, weakness in your arms/legs/face, or any other concerns.

Nasal Congestion
Because of pregnancy hormones, the lining of your nasal passages can swell and make more mucus. This can leave you constantly sniffling and blowing your nose, even when you don’t have a cold. Sometimes, minor nosebleeds may also occur.
What to Try: Saline nasal spray can work wonders for congestion. Room humidifiers can also be helpful, especially in the winter.
When to Call: If you have difficulty breathing or a nosebleed that doesn’t stop with gentle pressure.

Bleeding Gums
Pregnancy causes the gums to swell and makes them more susceptible to trauma, especially during teeth brushing.
What to Try: It is important to continue to maintain good oral hygiene, with teeth brushing and flossing as a part of your routine, to decrease the risk of developing a dental infection. As long as the bleeding from your gums is minimal and stops shortly after brushing, it is not threatening to your health.
When to Call: If you have significant bleeding from your gums or bleeding from other injuries that doesn’t stop with pressure.

Lightheadedness/Dizziness
When you’re pregnant, much of your blood flow is redirected to the placenta to help your baby grow. Your blood volume will increase to meet this demand, but sometimes you can experience lightheadedness or dizziness simply from dehydration or increased physical activity. In addition, when you lie flat, the uterus can compress blood vessels and prevent blood from returning to your heart as quickly, which can also cause you to feel dizzy.
What to Try: Make sure you are drinking plenty of water or other fluids. If you exercise or do heavy physical chores, you should be able to carry on a conversation during activity. If you notice lightheadedness while lying down, try turning to your left side or putting a pillow underneath your left hip.
When to Call: If you feel lightheaded or dizzy throughout the majority of the day despite trying the tricks above or if you ever lose consciousness.

Insomnia
Especially as your belly gets larger and you become more uncomfortable, but even as early as the first trimester, you may notice more difficulty falling and staying asleep.
What to Try: Go to bed and wake up at the same time each day. Find a pillow that makes you comfortable. Avoid caffeine and fluids after dinner. Used occasionally, Benadryl (25-50mg) can be a helpful medication to induce sleep.
When to Call: If you are unable to sleep even with the tips above, your doctor may prescribe a stronger medication.

Nausea/vomiting
This is one of the most common early pregnancy complaints. Unfortunately for many women, it’s not just “morning sickness”— it could be “any time of the day” sickness! The pregnancy hormones can cause an upset stomach and make eating and drinking difficult. The good news: for most women, these symptoms begin to improve by the end of the first trimester. Also, although many women worry that their babies will not get enough nutrients to grow properly; this is almost never the case. Babies will take what they need and even if you feel miserable, they usually are quite content!
What to Try: Eat small, frequent, bland meals. Try eating easily digestible foods—many times these are white in color—white rice, white bread, potatoes, bananas, oatmeal. It’s important to drink a lot of fluids. Sports drinks like Gatorade often have electrolytes which can be helpful.
When to Call: If you are unable to keep down any food or drink for more than 36-48 hours. Your doctor may prescribe prescription anti-nausea medications and/or give you intravenous fluids.

Heartburn
Pregnancy hormones can relax involuntary muscles in your gastrointestinal tract and make it more likely that you could have some stomach acid travel upwards into your esophagus. Add to this an enlarging uterus and baby that press on your intestines and stomach, and you’ve got a recipe for heartburn!
What to Do: Avoid spicy or very heavy foods. If it’s worse when lying flat, put 2-3 pillows under your head while sleeping. You can also try an over-the-counter medication like Tums or Zantac; these are safe in pregnancy, but you should always let your doctor know what medications you are taking.
When to Call: If your heartburn causes you to have frequent vomiting or you get no relief from the suggestions above.

Constipation
The same pregnancy hormones that contribute to heartburn can also slow down movement through your intestines, making constipation another joy of pregnancy.
What to Try: Make sure you are drinking plenty of water (a good test is to look at the color of your urine—if it’s dark or medium yellow, drink more; if it’s light yellow or clear, you’re doing well). You should also increase the fiber in your diet, which you can get from foods like bran, whole grains, fruits, and vegetables, or from supplements like Metamucil. Stool softeners like Colace can be very helpful.
When to Call: If you haven’t had a bowel movement and are very uncomfortable, your doctor may recommend trying a laxative, but you should not take laxatives regularly without your doctor’s knowledge as they can cause electrolyte imbalances.

Wrist Pain
For a number of reasons, pregnant women are more likely to have carpal tunnel syndrome, which is a group of symptoms related to pressure on a nerve running through the wrist. This may cause numbness, tingling, and/or pain in the wrists and hands during pregnancy.
What to Try: Avoid activities that require repetitive movements of the hand and wrist (like typing). If you can’t avoid the activity, try using an ergonomic device like a special pad that attaches to a keyboard and is designed to decrease pressure on the wrist. You can also try a splint or brace to keep the wrist in a neutral position, which should increase room in the carpal tunnel. Tylenol can be helpful for the discomfort.
When to Call: If you have severe pain or persistent numbness that does not improve.

Back Pain
As your baby grows, your center of gravity will shift. In order to not topple over, you will unconsciously change your posture, which may put strain on your back. Many women will have trouble sitting or standing in one position for a long time or have difficulty finding a comfortable position to sleep.
What to Try: When you lie down, use a pillow between your legs and lie on your side with a pillow supporting your back. This may help straighten your spine and put less pressure on the muscles that support it. You can also try wearing a “pregnancy belt” or a band across your belly that helps provide support so less is required from your back. These work for some women, but not all. Stretching exercises, like pregnancy yoga, can also be helpful in maintaining flexibility and proper posture.
When to Call: If you are unable to walk normally, have numbness or tingling in your legs, have severe pain that is not controlled with Tylenol, or have any other symptoms that concern you.

Pubic Symphysis Separation
A lot of pregnant women will experience pain low in the abdomen. Many times, this is simply pressure from the baby’s head, but sometimes the pain is more severe—worst with walking and changing positions, and it may be very painful to touch the pubic bone. In these cases, it is likely that the ligament between the pubic bones has relaxed and allowed the bones to separate more than is normal in preparation for delivery. This is called pubic symphysis separation or pubic symphysis diastasis and usually resolves after birth of the baby.
What to Try: Avoid positions that are uncomfortable, especially standing or walking for long periods of time. Try a pregnancy binder to help support the belly. Heat packs can provide some relief. Tylenol may be helpful in managing pain.
When to Call: If your pain is not localized only to the low pelvis, it could be a sign of a more serious problem. It is important to discuss this pain with your doctor. If you are unable to cope with significant pain, your doctor may prescribe a stronger medication.

Frequent Urination/Incontinence
It is very common to have to urinate small volumes of urine very frequently and to have some involuntary release of urine during pregnancy. Again, the pregnancy hormones may relax the muscles that hold urine in. Also, as the baby gets bigger, the growing uterus puts a lot of pressure on the uterus, which can make it feel like your bladder is always full.
What to Try: Avoid caffeine (coffee/tea) and alcohol, as these drinks are natural diuretics. You should also avoid drinking after dinner to try to decrease the amount of nighttime trips to the bathroom.
When to Call: If you have pain when you urinate or notice a funny color or smell to your urine, this could be a sign of an infection.

Hemorrhoids
Constipation during pregnancy may lead to straining to have a bowel movement, which can cause painful hemorrhoids to develop. Sometimes, hemorrhoids can bleed and you may notice spots of blood on toilet paper when wiping after a bowel movement.
What to Try: Stool softeners (see “constipation”) and fiber. Witch hazel pads and mild steroid creams may help with the discomfort.
When to Call: If you have concerns about bleeding or severe pain.

Leg Swelling
Towards the end of pregnancy, many women will notice that their legs and feet are swollen.
What to Try: Elevate your feet whenever you can. This will help blood flow out of the legs and back to the heart, which should help decrease the swelling. You can also try wearing compression stockings (these can be bought at many medical supply stores or your doctor may give you a prescription for specially fitted ones). Although they won’t help with the problem, shoes that are not tight may be more comfortable.
When to Call: If you have rapid, severe swelling of your legs that causes you to gain a significant amount of weight over a short period of time, your doctor may wish to examine you in the office.

Leg Cramps
The cause of leg cramps in pregnant women is unknown, but it’s a common complaint.
What to Try: Stay hydrated. Avoid sitting with your legs crossed. Stretch your calves a few times a day. Wiggle your feet and ankles if you need to sit for a long period of time. Take walks and/or exercise regularly. If you get a cramp, immediately stretch that muscle.
When to Call: If the pain persists, or you notice any redness or swelling in your leg. These could be signs of a blood clot and it is important to talk to your doctor.

As you work through some of the head-to-toe discomforts above, one of the most helpful strategies for coping is to enlist support. Whether it’s a mother or sister who can share what worked for her, or a friend who is also pregnant and can commiserate over some decaffeinated tea, sometimes knowing that you’re not alone can serve you better than another dose of Tylenol. Your doctor can always provide additional suggestions and is very accustomed to assisting women with these types of complaints. And, always “keep your eyes on the prize” — remember the little one for whom this will soon all be worthwhile!