Managing Symptoms and Discomforts of Pregnancy

More than half of all pregnant people experience nausea and vomiting during pregnancy. While it is often referred to as morning sickness, these symptoms can occur at any time of the day.

Nausea and vomiting during pregnancy is believed to be caused by changes in hormone levels. For many patients, symptoms improve after the first trimester.  

Suggestions for managing nausea:  

• Eat small meals every two or three hours instead of two or three large meals over the course of the day.
• Avoid having an empty stomach; feeling hungry may make your nausea worse.
• Eat whatever food appeals to you in frequent small amounts until you are feeling better.
• Try eating plain, bland foods like crackers, pretzels, mashed potatoes, rice, dry cereal or plain noodles. Also try fruity or tart foods like fruit popsicles, lemonade, pickles, and watermelon.
• Drink fluids between meals to avoid feeling too full, rather than with meals. Try broth, ginger ale, or gelatin dessert.  
• Limit your intake of high-fat, fried, garlicky, caffeinated and spicy foods.
• Keep crackers by your bedside in an airtight container and eat a few before getting out of bed in the morning.  
• Avoid strong food and cooking smells to minimize triggers. Try eating cold foods, opening windows to freshen the air or having others cook for you.
• Wait a while after eating before brushing your teeth. Be careful when brushing your tongue, as it can cause a gag reflex.  

When to seek medical attention:

In some cases, nausea and vomiting in pregnancy cannot be managed by diet alone. Lack of food, fluids and nutrients can lead to dehydration, which may be harmful to your well-being and that of the baby. If nausea and vomiting persist, leading to signs of dehydration (infrequent urination or dark yellow urine, dry mouth, fatigue or light headedness), seek medical attention.  

If nausea and vomiting is affecting your well-being and your daily activities, there is an effective prescription medication available to treat nausea and vomiting in pregnancy called doxylamine succinate/pyridoxine HCL (Diclectin).

This medication is a combination of vitamin B6 and an antihistamine called doxylamine. It is the only medication approved in Canada for the treatment of nausea and vomiting in pregnancy. Its safety and effectiveness throughout pregnancy has been long established and studies have shown no evidence that it has any harmful effects on the baby.  

Constipation is common during pregnancy.  Hormonal changes that relax the digestive tract and slow the movement of wastes through the colon may cause constipation. The longer the wastes stay in the colon, the more water is absorbed from it back into the body, leading to harder, dry stools that are difficult to pass.

The expanding uterus also puts additional pressure on the colon, making bowel movements more difficult. Less physical activity, bed rest and taking iron supplements can further contribute to constipation during pregnancy.

If needed, you can take psyllium husk (Metamucil) as directed.  

Tips for managing constipation:  

• Increase your fibre intake gradually. Fibre helps to increase the bulk of your stool, which means it makes your stool heavier, so it moves through your digestive tract more easily. Try to consume at least 28 grams of fibre per day. If you are not eating a lot of fibre, increase your intake slowly to minimize any cramping or excessive gas. Good sources of fibre include whole grain breads and cereals, vegetables and fruit, and legumes (for example, beans, lentils, or chickpeas).
• Eat at least five servings of whole grain products every day.  
• Eat at least seven servings of fruit and vegetables a day. Choose whole fruits instead of drinking juices.
• Drink between eight and 12 cups of fluids every day, including water, milk, broth or juice. This helps to keep the stools soft and easier to pass. Some patients find drinking warm or hot liquids stimulates the bowels.
• Stay active. Even moderate amounts of exercise, such as walking, may help. Learn more about the Canadian Guideline for Physical Activity throughout Pregnancy.
  
  If constipation persists despite these measures, consult your physician before using over-the-counter medications or laxatives.  

Heartburn is characterized by a burning sensation in the lower part of the esophagus. It is caused by gastric reflux where stomach acid moves up from the stomach into your lower esophagus.

During pregnancy, hormonal changes relax the valve between the stomach and the esophagus. As the fetus grows, the expanding uterus puts pressure on the stomach, forcing stomach contents up into the esophagus leading to heartburn.

Tips to reduce heartburn:  

• Eat smaller, more frequent meals.
• Eat slowly and chew your food thoroughly.  
• Drink fluids between meals, instead of during meals, when possible.
• Avoid spicy, high fat fried or greasy foods.
• Limit coffee, chocolate, and mint.
• Limit acidic foods like oranges, lemons, tomatoes and their juice.
• Avoid lying down for at least one to two hours after eating.
• Elevate the head of your bed.
• Wear loose-fitting clothing to relieve pressure on your stomach.

Talk to your doctor if heartburn becomes severe or if it makes it difficult to eat properly. If the above solutions do not help, discuss other prescription options with your physician. 

Bleeding during pregnancy does not necessarily mean something is wrong, but it may be a sign of miscarriage or other medical issues.  

Common reasons for bleeding during pregnancy include:

Implantation bleeding: A small amount of bleeding may occur around 10 to 14 days after conception, usually at the time you would expect your period. This is common and generally not a cause for concern.

Post-coital bleeding: Bleeding that happens after sexual intercourse.  

Miscarriage: About half of pregnant people who experience bleeding in the first trimester will go on to have a healthy pregnancy, while another half will miscarry. If you are bleeding, your physician may recommend an ultrasound, a physical examination of your cervix or a blood test to assess your pregnancy status. In the first trimester, there are no medical interventions available to save a threatened pregnancy.

Ectopic pregnancy: An ectopic pregnancy occurs when the fertilized egg implants outside the uterus, most commonly in the fallopian tube. As it continues to grow, it may rupture the fallopian tube, causing severe bleeding, lightheadedness, and pain. Most ectopic pregnancies will cause pain before the 10th week of pregnancy. If you have symptoms of an ectopic pregnancy, seek immediate medical attention. 

Backache is common during pregnancy. When you are pregnant, hormones cause the ligaments in your pelvis to relax. This combined with weight gain and a shifting centre of gravity, contributes to back pain.

To reduce backache, try to maintain good posture throughout the day and avoid sitting or standing for long periods. Try using a footstool while sitting, avoid lifting heavy objects and wear shoes with low heels.  

​Massage, physiotherapy, pelvic tilt exercises, and yoga may also provide relief. It is safe to use acetaminophen (Tylenol) if needed to treat the pain. When working with a therapist please try to work with someone who is trained to work with pregnant people. Remember to notify any therapist ahead of time that you are pregnant, so they can take the necessary precautions and ensure your safety and comfort. 

The broad ligament is connective tissue that covers the uterus, ovaries and fallopian tubes which also connects the uterus to the pelvis. The round ligaments are bands of tissue that support the uterus.

Symptoms of broad and round ligament pain feel like sharp twinges or a muscle pull, usually experienced on the lower left or right side of abdomen.

To reduce pain and discomfort, move slowly, especially when you are getting up or turning in bed. It also helps to use pillows to support your abdomen and participate in gentle stretching. It is safe to use acetaminophen (Tylenol) if needed to treat the pain.   

Bleeding gums are more common during pregnancy because your blood flow is increased. To prevent bleeding gums, make sure to get regular dental check-ups, practice gentle and regular flossing and use a soft-bristled toothbrush. Eating food high in vitamin C can also help prevent and reduce bleeding gums.  

Dizziness often happens during pregnancy due to low blood pressure or low blood sugar. Getting up too quickly from a sitting position to a standing position can cause dizziness.  

To keep from falling try to rise slowly when getting up. Avoid standing for long periods and stay well-hydrated and well-nourished, especially in hot weather. 

To help with fatigue during pregnancy, make sure to rest and take naps when possible. Maintaining a healthy diet with limited sugar and processed foods is important. In some cases, fatigue can be caused or made worse by nutritional deficiencies, so it is important to take your prenatal vitamins and discuss your symptoms with your health care team. 

Frequent urination is a common pregnancy symptom. To reduce how often you urinate, limit your fluid intake before bedtime and avoid caffeinated beverages.

Strengthening your bladder muscle by practicing pelvic floor exercises (Kegels) can help.  If you feel any discomfort or pain when urinating, please notify your doctor. 

Hemorrhoids are swollen veins that occur in and around your anus and lower rectum are very common during pregnancy.  

To reduce your risk of hemorrhoids, try to prevent constipation and avoid straining during bowel movements. Pelvic floor exercises can also help, as they can help you avoid straining.

To decrease discomfort if hemorrhoids develop, consider using witch hazel wipes, warm soaks, or an ointment like Preparation-H, which can provide relief for hemorrhoids. 

For mild headaches during pregnancy, stay hydrated and try to rest. Massaging your forehead can also provide relief. You can also take acetaminophen (Tylenol) unless your physician tells you otherwise.  

Consult your physician if you have a severe headache. If you are over 20 weeks pregnant and your headache is accompanied by changes to your vision, swelling in your hands or face or pain in upper right side of abdomen, please go to the labour and delivery triage unit on the 15th floor of Mount Sinai Hospital for assessment. These symptoms can be a sign of pre-eclampsia. 

Leg cramps during pregnancy usually happen in the calf muscle. There are several reasons that contribute to these cramps, including low calcium and magnesium levels, muscle strain due to increased weight, and changes to your blood circulation.

To minimize the occurrence of leg cramps, stay well-hydrated, stay active and eat a diet that is high in calcium and magnesium. You may also discuss with your physician if taking a supplement may be helpful. Additionally, avoid standing for long periods and include regular stretching, especially before bedtime.  

Swollen ankles and feet are common during pregnancy. Activities such as walking may help in reducing swelling. Make sure to drink enough water and, whenever possible, elevate your legs above the level of heart when sitting.  

Pregnancy can make it difficult to sleep. You may improve your sleep routine by avoiding eating right before bedtime, taking a warm bath before bed, and using extra pillows as necessary to get comfortable.  

It is important to avoid mental stimulation before bedtime and during wake-ups in the middle of the night like (using a phone or tablet. Including calming practices to your bedtime routine such as relaxation techniques, meditation and deep breathing may also help you get a restful sleep

During pregnancy, inflamed and swollen mucus membranes in the nose can lead to sinus congestion. This is a common symptom in the second and third trimester.  

To reduce sinus congestion, it is important to stay hydrated. Additionally, you may try using saline drops and a nasal irrigation device or nasal strips. Also try to sleep with your head slightly elevated.  

Varicose veins are more common during pregnancy. In most cases they are swollen and twisted blood vessels in the legs that can feel itchy or painful.

To help prevent varicose veins, avoid sitting for long periods or crossing your legs. Elevate your feet whenever possible. You may also discuss with your physician whether using support stockings is right for you. 

Increased vaginal discharge is normal during pregnancy. Wear cotton underwear and change as necessary. Sleeping without underwear at night can also help.

Avoid using panty liners and avoid douching or using perfumed soaps/body washes. If you notice a foul odour or experience irritation, please discuss with your physician.