Coping with common discomforts of pregnancy

By Physiotherapist- Lauren Clarke
During pregnancy many physical changes occur which may cause concern for some women and have little or no impact on others. Below is a list of a few tips to help you to manage them. Please contact your healthcare provider if any of these symptoms are severe.

What can you do to keep your bladder ‘healthy’?

• Drink well:
o For adults two litres of fluid everyday is encouraged, mostly water.
o Be aware that the recommended fluid intake may vary with weather, exercise and other health conditions.
o Aim to drink gradually and consistently over the course of the day rather than drinking too much later in the day to prevent needing to empty frequently overnight.
• Avoid bladder irritants:
o These are drinks that irritate the bladder and may make you go to the toilet more often or more urgently. Examples of drinks to minimise include coffee, tea, chocolate or cola drinks, and soft or artificially sweetened drinks.
o Aim for no more than two of these drinks per day and avoid them in the late afternoon and evening
• Avoid going ‘just in case’:
o Go to the toilet only when your bladder is full and you need to go.
• Practise good toileting habits:
o Do not hover over the toilet seat.
o Take your time to empty your bladder – ensure that you do not rush if you have not completely emptied.
o If you feel your bladder is not empty after voiding, stand up, sit back down again, lean forwards and have a second attempt.
o Do not strain to empty. Instead try rocking the pelvis backwards and forwards or do a small sit to stand then try to empty again if this is a problem for you.

Practise good bowel habits:

• Eat a high fibre diet (fruit, vegetables, wholemeal grains and cereals). Try to include fibre with each meal.
• Discuss the use of aperients (medications used to minimise constipation) with your treating pelvic floor physiotherapist if your stools become harder and more difficult to pass.
• Avoid straining during your bowel motion. Adopt a good position on the toilet (see diagram):
 Lean forward with a straight back
 Rest your arms on your thighs
 Raise your heels coming up onto your toes, so that your knees are higher than your hips.
 To empty, relax your abdominals and bulge your tummy out. It can help to support your perineum with your hand.

What are haemorrhoids?

• Haemorrhoids are swollen veins that usually occur around the rectum and the anus (back passage) that may cause itching, pain or aching. They may bleed when you open your bowels and can make going to the toilet uncomfortable. They very commonly occur in pregnancy due to pressure from the baby’s head and can be triggered by constipation.
• Follow the guidelines above for good bowel habits and ensure you speak to your treating obstetric team or pelvic floor physiotherapist if they are causing bother.

Varicose veins and swollen ankles:

Varicose veins and swollen ankles commonly occur in late pregnancy. They occur because of extra fluid in the tissues during pregnancy and increased blood volume placing greater strain on your veins. The hormone progesterone also causes the walls of your veins to relax or dilate.
• Avoid crossing your legs and standing for long periods.
• When sitting, elevate your legs and circle your feet to improve circulation.
• Calf raise exercises may help (standing, repeatedly rise up and down onto your toes 10 to 20 times). Repeat regularly throughout the day.
• If your varicose veins become painful or prominent you may need to wear support stockings. Speak to your doctor or physiotherapist as to where to purchase these products.

How do I reduce muscular cramping?

Cramps in the foot, leg and thigh are common during pregnancy, especially if resting in bed. It is not known what causes cramping but to help relieve this muscle spasm:
• Massage the affected area.
• Do some calf stretches during the day (standing in a lunge, front knee bent, back knee straight, drop your heel towards the ground, hold for 30 seconds, repeat this 5 times, 3 times per day).
• Make sure you drink plenty of water.
• Take a pregnancy multivitamin daily.

I’m having difficulty sleeping. What tips can I try to make myself more comfortable?

• Lie on your side with a pillow under your tummy and/or one between your knees.
• Avoid stimulants such as tea, coffee and alcohol prior to bed.
• Shower prior to bed to help you to relax.
• Listen to some relaxing music or meditate prior to sleeping.