Third trimester pregnancy aches and pains—and how to treat them

The third trimester brings its own, um, joys. Here's how to manage late pregnancy aches and pains.

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That nine-month stretch of pregnancy can be a long haul of wild (“Why can’t I feel my hand?”) and wonderful (“Her foot is pushing against my ribs!”) aches, pains and discomforts. But in the last 12 weeks, in particular, a number of odd and sometimes startling symptoms can surface just as you’re approaching the finish line. Here are some of the more common complaints — and ideas on how to handle them. 

1. Backache

“Backache is probably the most common complaint I hear from pregnant women,” says Tom Bailey, a Victoria family physician and past president of the College of Family Physicians of Canada . He explains that the cause isn’t only weight gain, but the higher demand on muscles and the changing centre of gravity as your baby bump grows, which puts more stress on the spine. Your body is also producing relaxin, a hormone that develops in pregnancy to loosen joints to help prepare for delivery, which can also put more strain on your lower back.


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Solution:
All the general rules of back health apply: Bend with your knees; don’t lean over at the waist when picking things up; avoid awkward twists and turns that put your lower back in vulnerable positions. Other back-friendly tips during pregnancy include not standing on your feet for extended periods and walking daily.

“We find 30 minutes of walking a day is really helpful at this stage because it strengthens both your back and core muscles,” says Karen Buhler, head of the Department of Family Practice at BC Women’s Hospital & Health Centre in Vancouver. “Walking stimulates your posture muscles and helps keep them strong.” Can’t bear the thought of hoofing it for half an hour? Slip into a pool instead, or ask your caregiver to recommend stretches to relieve pressure on your back.

You might feel similar pain in your pelvis because of your joints loosening up. Try heat to relieve the ache. When you’re getting out of bed or trying to find a comfortable sleeping position, avoid strain by rolling like a log, rather than twisting your body, suggests Helen McDonald, an associate professor in the Midwifery Education Program at McMaster University in Hamilton. Or you may find you need to get out of bed altogether to flip sides. “Sleeping with a body pillow, or a pillow between your legs, can also help keep everything supported,” says McDonald.

2. Restless leg syndrome

Just as you’re finally drifting off, you feel a jittery, jarring movement in your legs. Or maybe there’s a creepy-crawly feeling that might be painful. While at first you think it may be leg cramps — which tend to suddenly cripple your leg with pain — restless leg syndrome (RLS) feels as if there’s an energy moving about your legs.

Solution:
“Having a bath right before bed may help — RLS tends to happen late at night,” says Buhler. “And taking your calcium at night also seems to help, either a supplement or a glass of milk.” You may also want to try stretching your legs out, or having your partner give them a quick rubdown before bed.

3. Rib pain

“Some women’s ribs are very sore because the rib cage sort of flares out to accommodate the baby, and the baby pushing on the ribs can cause pressure and pain,” says McDonald. Junior may even have jammed a foot up against your rib cage.

Solution:
Trying to nudge that hand or foot slightly away from your ribs doesn’t hurt your baby, so don’t be afraid to try. “Some women also find it helpful to lean back in a chair rather than sitting forward, or they use cold and hot packs to relieve the pain and pressure on their ribs,” says McDonald.

4. Varicose or spider veins

Varicose veins (which look like veins “bulging” out of your leg) or spider veins (thin, red veins, sometimes in a lacy pattern) also fall victim to the pressure the baby is putting on your body. “It’s like stretch marks — some women are really susceptible to these kinds of veins, and others not so much,” says Bailey.

Solution:
Elevating your feet above your heart by propping them up on pillows as much as possible will help, as will support stockings that improve the circulation in your legs. Walking is good, but avoid long periods of standing.

5. Heartburn

Some women who have never experienced heartburn before pregnancy suddenly find themselves intimately familiar with that uncomfortable burning sensation rising into the upper chest and into the throat. What causes it? Bailey explains that as the uterus grows, it puts pressure on the stomach. In turn, that pressure pushes the contents of your stomach — including the stomach acids that help digest your food — back up into the esophagus, which triggers the burning sensation.

Solution:
Try eating smaller meals every two to three hours, rather than three large ones, because the fuller your stomach, the more likely the acid will splash up and irk that esophagus. Avoid typical heartburn triggers, such as spicy foods, caffeine and fizzy drinks. “Many people find milk or water helpful because it coats the esophagus,” recommends McDonald. “Drugstore remedies are helpful too — just be sure not to take more than the prescribed dose.” (Ask your doctor which over-the-counter items are safe during pregnancy.) And at night, when heartburn is likeliest to hit, stuff some thick blankets under the head of your mattress or blocks of wood under the legs so you’re sleeping on an angle. That helps any stomach acids in your chest flow south.

6. Carpal tunnel syndrome

Can’t feel the fingers in your hand? Or maybe your fingers constantly feel like they’re on pins and needles? “Carpal tunnel is a result of swelling around the wrist joints. The nerves and tendons pass through a narrow little tunnel, called the carpal tunnel, and they go into the hand,” says Buhler. “When you’re pregnant, you retain fluid, which further narrows the space. The nerves become compressed and you get numbness in your hand.”

Solution:
While this symptom often disappears soon after giving birth, it can be painful to deal with. To ease the irritation, Buhler suggests keeping your hand in a neutral position as much as possible (not flexed) and when you’re sleeping, rest your hand and wrist on a pillow. If the problem worsens or you’re having trouble keeping the wrist neutral, talk to your care provider about wearing a brace on your wrist to maintain that neutral position. 

7. Shortness of breath

As you huff and puff up the stairs, you wonder: Am I really this out of shape? But it’s not you, it’s your growing baby putting pressure on your diaphragm — the muscle below your lungs that you use to breathe. “Because you can’t fully use the diaphragm, you’re just doing shallow chest breathing,” says Bailey. Multiply that feeling by 10 when you’re really exerting yourself.

Solution:
“Slow down and focus on chest breathing,” says Bailey. (Chest breathing is breathing with your ribs, as opposed to abdominal breathing, which is the big bottom-of-your-belly breathing.) When exertion is required, take it slow and stop regularly to catch your breath.

Warning: While a bit of breathlessness is to be expected in your third trimester, a sudden, severe shortness of breath means you should call your caregiver right away.

8. Constipation

When you’re having trouble emptying your bowels regularly, this can lead to hard, dry stools, which then become even more difficult to push out. According to Buhler, constipation is a symptom many women deal with throughout pregnancy — but it can get worse in the last trimester because of the pressure the baby is putting on your digestive system.

Solution:
Fibre-rich foods (fruits, vegetables, high-fibre cereals) paired with plenty of water will help keep things as regular as possible. Constipation can also be a side effect from taking high levels of iron, so if it’s a big problem, talk to your caregiver about switching prenatal vitamins.

Also be careful not to strain a great deal when pushing out a bowel movement because that can lead to another pregnancy-related issue: hemorrhoids (swollen, inflamed veins in and around the anus, causing a painful or itchy sensation). “If you’ve got hemorrhoids, you can use creams and ointments to treat the problem, or taking a stool softener may help,” says Bailey.

9. Swollen feet

Many women complain of sausage-like feet near the end of their pregnancy and opt for easy slip-on shoes to accommodate the swelling. You may even be forced to move up a shoe size. Blood normally travels through our bodies, but “the weight of the baby puts pressure on the veins that come up from the legs and back to the heart,” explains Buhler. Because it is more difficult for the blood to circulate back up to the heart, swelling ensues.

Solution:
Keep the swelling down by elevating your feet above your heart, perhaps on a couch with pillows propped beneath your tootsies. Cold water soaks and daily exercise, such as walking, may also help. Or you could ask your physician about purchasing compression stockings, which help boost circulation in your legs.

Warning: If you notice significant swelling in your hands and face as well as a persistent headache, call your caregiver right away. “Those are signs of high blood pressure and that type of swelling is a concern,” says Buhler.

10. You have to pee — a lot

Late in your last trimester, the baby’s head is moving deep into the pelvis and reducing the capacity in your bladder. “Frequent urination is common for pregnant women, but there’s not always a lot of volume when they do urinate,” says Bailey.

Solution:
“It’s a symptom that you can’t completely eliminate,” Bailey adds. And if you’re tempted to cut out that evening glass of milk before bed to avoid repeat bathroom breaks, don’t. Not only does it give you and the baby a much-needed calcium boost, but pregnant women need to stay hydrated as part of a healthy pregnancy. 

When to call the doctor
With so many changes going on inside your body, it’s sometimes hard to know what’s normal and what isn’t.

It’s better to err on the side of caution and consult your caregiver with any questions or concerns. Get in touch with your caregiver immediately if you have any of these symptoms:

  • vaginal bleeding or spotting
  • fever
  • sudden swelling of hands and face with headache
  • abdominal or vaginal pain
  • burning urination
  • visual blurring
  • vomiting and diarrhea

Originally posted in July 2011.

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