Why do I have so much gas during pregnancy?

99.9% of pregnant women get gassy. The hormonal changes during pregnancy slow down your gastrointestinal tract. Many women also get constipated from these hormonal changes and taking your prenatal vitamin. Even though you may not be able to keep this symptom to yourself, there are things you can do to help ease the gas. Exercising regularly, avoiding the gas causing foods and drinks-carbonated drinks, dairy products, beans, broccoli, cabbage, cauliflower, Bussel sprouts and dried fruits-helps!

Why do I lose urine every with sneezing and coughing during pregnancy?

It is very common for pregnant women to suffer from loss of urine, medically known as urinary incontinence while exercising, walking, laughing, sneezing, coughing, and during sexual activity. Urinary incontinence happens as a result of the increased pressure on the bladder and pelvic floor muscles caused by the growing uterus during pregnancy. Urinary incontinence can occur as early as the first trimester and continue throughout the entire pregnancy and during the first few months of the postpartum period.

Kegel exercises help make the muscles in your pelvic and vaginal area strong.  These pelvic floor muscles support the uterus, bladder, and bowels which control bladder and bowel function. Kegel exercises are meant to strengthen the pelvic floor muscles.  There are many reasons why you can weaken your pelvic floor muscles, from pregnancy and childbirth to aging and being overweight.  Kegel exercises can help delay and prevent symptoms of urinary incontinence if done regularly. Kegel exercises should be a permanent part of your daily routine before you get pregnant.

If done correctly and repeatedly over time, you can avoid symptoms such as stress and urge incontinence caused by childbirth, aging, and obesity.    Kegel exercises can also make sexual intercourse more enjoyable for you and your partner. You will notice a benefit to your pelvic floor strength in 8 to 12 weeks when done faithfully.

Someone experiencing urinary incontinence needs to work with a healthcare provider to identify the cause. Keeping track of urinary incontinence in the form of a bladder log to determine the frequency and circumstances with the symptoms of urinary incontinence will help the healthcare provider develop a treatment plan. Emptying your bladder regularly is also helpful in avoiding urinary incontinence.

Other lifestyle habits that are helpful include maintaining a healthy weight, avoiding lifting heavy objects, and staying well hydrated.

Emptying your bladder frequently (every 2 hours whether you have to go or not!) helps but when it happens regardless of how frequently you are going to the bathroom, you should wear protective undergarment linings or Thinx-like underwear.

Pregnancy and childbirth are a common cause of urinary incontinence. If urinary incontinence persists months during the postpartum trimester, it’s time to discuss your symptoms with your healthcare provider for further evaluation and treatment options.

Why am I experiencing nosebleeds? 

During pregnancy your heart pumps 40% more blood volume to support the growing fetus that you are carrying. As a result of this increase in blood volume and changes in blood cells/vessels in your body, nosebleeds can occur.  Tiny blood vessels in your nose can become engorged, dry out and rupture causing your nose to bleed.  It is the combination of increased blood flow in the nose and sinus area and dryness that make nosebleeds more common.  One of the ways to prevent dryness is to use a humidifier in your bedroom while you sleep.  Additionally, you can use a saline nose rinse to keep the nasal passages moist and petroleum jelly around your nostrils before going to bed.  When you blow your nose be extra gentle and use a soft tissue around the nasal area.  If you experience a nosebleed treat them in the usual way by applying pressure and something cold over the nose.  You can insert a tampon into your nose and apply pressure for an alternative strategy to stop the bleeding. It is very unusual for nosebleeds to occur as a result of a serious medical condition such as high blood pressure or a bleeding disorder.  Pregnancy related nosebleeds usually subside quickly, but if you cannot stop the bleeding, call your Obstetrician or health care provider.

How common are varicose veins seen during pregnancy? 

During pregnancy, varicose veins are stretched out and enlarged veins in your body, especially in the legs and genital area. When blood pools in veins enlarge by the hormones of pregnancy, varicose veins are seen. Standing, sitting and walking for long periods of time puts a lot of pressure on the veins in the lower extremities making them susceptible to becoming overextended and engorged

While varicose veins often disappear after pregnancy, you can lessen them by:

• Avoiding standing or sitting for long periods of time
• Wearing loose-fitting clothing
• Elevating your feet when you sit
• Wearing support hose

 

Why do pregnant women get hemorrhoids during pregnancy?

Varicose veins that can occur in the rectum cause hemorrhoids and are  —common during pregnancy. Hemorrhoids can be extremely disruptive and painful. They may bleed, itch or sting, especially during or after a bowel movement.

Eating a fiber-rich diet, drinking plenty of fluids daily, taking a daily stool softener and exercising regularly can help keep bowel movements regular. There are also helpful and safe creams and suppositories that help relieve some of the disruptive symptoms associated with hemorrhoids during pregnancy. 

 

Is feeling the heart racing a common occurrence during pregnancy?

During pregnancy your heart works much harder, especially during delivery!  Since your blood volume increases by 30-50% throughout pregnancy, your heart has to increase how much it pumps, or its cardiac output.  In addition to having an increase in cardiac output, the heart rates increase by 10-20 beats per minute.  The changes involving your cardiovascular system peak during 20-24 weeks and usually resolve completely within 6 weeks of delivery.  As a result of these changes with your heart you may experience flutters or a racing feeling better known as palpitations, shortness of breath and a reduced tolerance for prolong periods of exercise.  If you notice these symptoms, it is important to tell your health care provider to ensure these are the normal symptoms related to all the cardiovascular changes.

 

Is there anything a new mom can do to prevent stretch marks? 

No one likes stretch marks on their body! Stretch marks are pink, reddish or purplish indented streaks that often appear on the belly, breasts, upper arms, buttocks and thighs.  Unfortunately, stretch marks cannot be prevented since they are genetically determined, which means if your mom got them, especially during pregnancy, you probably will too.  Stretch marks usually occur when you gain or lose weight quickly.  Using creams and gels rarely make much of a difference in their appearance.  I am a true believer that coconut oil has a lot of health benefits for hydrating the skin…anywhere on your body!  Coconut oil has not been proven to help prevent or treat stretch marks, before, during or after meals. What can help to manage your stretch marks is using the new laser treatments.  Fortunately, stretch marks fade with time and become silvery white or red but rarely disappear completely.

What can be done about constipation during pregnancy?

Definitely one of the more uncomfortable problems that can be exacerbated during pregnancy, constipation is a common complaint.  Between the hormonal effects of progesterone slowing down the motility of your intestines, the iron and calcium in prenatal vitamins, the displacement of the intestines by a growing uterus and the changes in our diets during pregnancy all lead to a disruption in bowel function.  Some have bowel changes consistent with a softer and more frequent stool, others have hard “rabbit” pellets and many others have bowel movements every 2-5 days.

Constipation during pregnancy can be prevented with the following lifestyle changes:

• • Drink plenty of fluids. Water is the best choice and I would recommend drinking at least 8-10, 8 ounce glasses a day. Fruit juice, especially prune juice, will help regulate your constipation.  Drinking warm liquids in the morning is also effective.
  • Physical activity and exercise should be a part of your daily routine.  Daily walks, lasting 30-45 minutes, and other aerobic activities can help prevent pregnancy constipation.  Exercising regularly aids in our digestion and makes you feel physically and emotional stronger and more energetic. 
  • Include more dietary fiber in your diet. Choose high-fiber foods, such as fruits, vegetables, beans and whole grains.  Fiber helps bring water into the intestines, softening the stool and allowing it easier to pass.  With your health care provider’s OK, consider a fiber supplement, such as Metamucil, Citrucel and Miralax.

• Stool softeners, such as Colace, moistens the stool allowing easier passage. I encourage most of my patients to take 50mg to 100mg of Colace two times a day throughout the duration of the pregnancy.  

Bulk forming laxatives such as fiber supplements are the gentlest on your body and safe to use during pregnancy.  Metamucil, Citrucel and Miralax are examples of this and are recommended throughout pregnancy.  Stimulant laxatives, such as Ex-Lax and Senokot are the hardest on your intestines and should not be used during pregnancy.

There are remedies and solutions for this serious and uncomfortable side effect of pregnancy.  As always consult with your health care provider for recommendations on the safest route to follow.  

 

How does pregnancy affect IBS? Do symptoms get better or worse?

 

Pregnancy can be challenging enough on a woman’s bowel habits. The hormonal effects of progesterone slowing down the motility of your intestines, the iron and calcium in prenatal vitamins and the shifting of the intestines by a pregnant uterus creates a disruption in bowel function causing constipation during pregnancy.  Some have bowel changes consistent with a softer and more frequent stool, others have hard “rabbit” pellets, while others have bowel movements every 2-7 days.

During the first trimester, symptoms of heartburn and nausea tend to be worsened. One third of women with IBS have an increased incidence of constipation, while another 1/3 have an increased incidence of diarrhea, especially during the 3rd trimester.  

If you already have a known diagnosis of irritable bowel syndrome (IBS), you have a history of altered bowel habits including constipation, diarrhea or both.

Other symptoms include sharp, painful stomach cramps, abdominal bloating, distension and spasms which can be debilitating.  It could be 3 days of constipation or 5 days of diarrhea.  It’s one of the most common gastrointestinal medical problems occurring in 10-20% of women.

Pregnancy can definitely make symptoms of IBS worse unless you are making thoughtful lifestyle choices to avoid disruptive symptoms.

What other bowel problems can occur during pregnancy?

Prior to pregnancy, women are aware of their normal baseline bowel habits.  Early bowel changes can be seen as soon as you start taking a prenatal vitamin which is loaded with vitamins, calcium and iron. Constipation, diarrhea and a change in stool color, shape and consistency can occur while taking a prenatal vitamin in the first trimester.  

Throughout pregnancy, it can be a constant battle dealing with constipation and diarrhea. Additional iron is often necessary during pregnancy which further exacerbates constipation especially in the third trimester. 

It’s best to understand and learn about the normal effects of pregnancy on bowel function so you are not surprised by the sudden changes in bathroom habits.

How normal/common is diarrhea in pregnancy?

Diarrhea can occur in pregnancy, but it’s not universally common. Many women experience some gastrointestinal issues, such as constipation or nausea, but diarrhea can happen due to various factors including diet, stress, or infections.

Does diastasis recti affect the way your belly looks? 

Diastasis recti is where the middle of the abdomen separates the muscles on the right and left side of the midline.  Every pregnant woman is familiar with the protruding ridge that is easily seen going down your belly when you are going from a lying to sitting position.  This ridge normally separates the abdominal muscles and can become overly stretched causing a more pronounced separation called “diastasis recti.”  If you develop one during pregnancy, the growing bump will lean more forward off your abdomen and get worse with each pregnancy. 

If a pregnant woman has diastasis recti, the growing uterus will appear more forward.   The muscles of the abdomen are overly separated in the middle of the abdomen and there is very little separating the skin of the abdomen from the protruding uterus.

What is diastasis recti?   

Diastasis recti is where the middle of the abdomen separates the muscles on the right and left side of the midline.  Every pregnant woman is familiar with the protruding ridge that is easily seen going down your belly when you are going from a lying to sitting position.  This ridge normally separates the abdominal muscles and can become overly stretched causing a more pronounced separation called “diastasis recti.”  If you develop one during pregnancy, the growing bump will lean more forward off your abdomen and get worse with each pregnancy.

 If a pregnant woman has diastasis recti, the growing uterus will appear more forward.   The muscles of the abdomen are overly separated in the middle of the abdomen and there is very little separating the skin of the abdomen from the protruding uterus.

 

Why does my belly button stick out during pregnancy?

An umbilical hernia happens when there is weakness in the abdominal wall around the belly button often caused by pregnancy causing a bulge around the area of the belly button (also known as the navel or umbilicus).  Depending on the size of the hernia, a growing bump will lean more forward from the abdomen.

Umbilical hernias are the second most common type of abdominal hernia occurring in 3-8% of women.  When an umbilical hernia is seen immediately after pregnancy, especially if you have had 2 or more, it’s best to wait at least one year before considering surgery.  Doing abdominal strength training along with losing the extra weight gain during pregnancy is important before having a surgical consultation.  

Why are women so itchy during pregnancy? 

Due to all the normal physiologic and hormonal changes during pregnancy, skin can become dry and itchy. Mild itching is considered a normal symptom of pregnancy. 

There is a medical condition called Cholestasis of pregnancy that can cause itching which is much more serious.  Cholestasis occurs in the third trimester of pregnancy, itching becomes progressively more severe, especially at night, and can lead to complications of pregnancy.

Ways to relieve or minimize itching include taking a daily warm bath with extra virgin coconut oil, using a non-fragrant body moisturizer and wearing loose clothing made of cotton.

What is a Perineal massage?

Perineal massage is the practice of massaging a pregnant woman’s perineum around the vagina in preparation for childbirth. Perineal massage can be done by the pregnant woman or her partner.  You should be in a comfortable place, sitting or reclining that allows you to access the skin around the vagina. It can be done for 10-20 minutes a day during the last 4 to 6 weeks of pregnancy.  Typically, perineal massage is done using massage oil or a water-based lubricant, which lubricates the tissue making it softer, more supple and improving is flexibility. The idea is to attempt to prevent tearing of the perineum during birth, the need for an episiotomy or an instrument delivery such as a vacuum or forcep fetal extraction.  Clinical trials show that perineal massage is effective in reducing vaginal episiotomy’s in about 6 percent of the cases.

 

Should women restrict work during pregnancy?

Nowadays, women do not have the option of not working during pregnancy.  The good news is that it is completely safe to work during pregnancy.  Working during pregnancy is usually not a problem unless a woman has risk factors, such as hypertension, or a complicated pregnancy, such as preterm labor. Women should check with their healthcare providers for specific restrictions. With an uncomplicated pregnancy, working close to or near the due date should not be a problem. Pregnant women should always wear comfortable clothing, move around frequently if sedentary, drink plenty of fluids, and have time to rest and take breaks. Women with strenuous jobs, those who work with heavy machinery, or those who work with toxic chemicals should consult their healthcare providers and their job’s occupational department for restrictions or concerns. Pregnant women who maintain an active and productive lifestyle help make time pass faster and add to a feeling of personal well being.

Is pregnancy brain a real thing?

Unfortunately for us mom’s, pregnancy brain is a real medical condition caused by the hormonal havoc which often starts during pregnancy and continues into motherhood.  Between the hormonal changes, not getting enough sleep, multi-tasking and constant distractions a mother’s brain circuits misfire.

Estrogen, progesterone and oxytocin are the main hormones affecting the brain during pregnancy which starts “momnesia”. As a result, poor memory, problems concentrating, feeling overwhelmed, absentmindedness and impatience are common symptoms.

 

Pregnancy brain often continues beyond pregnancy for many people. How long does “pregnancy brain” take to wear off?

There may be times the “pregnant brain” doesn’t completely disrupt your life but there will always be the underlying presence of momnesia.

As long as you have kids, regardless of their age, momnesia is often a permanent medical condition.  

 

How will my breast change in pregnancy?

During pregnancy the hormonal effects, mainly estrogen, can make the breast tissue feel swollen, fuller, tender, and enlarged. The nipples can become darker, more prominent, tender and sensitive. Nipple discharge and crusty changes also occur throughout pregnancy. The areola can become darker along with the nipples. The veins of the breasts become more prominent.  Breasts enlarge 2 to 3 sizes during pregnancy and breastfeeding. The breast tissue tone can be noticeably saggy following breastfeeding. Stretch marks can be seen on the breast tissue during pregnancy due to the fast growth of the breasts.

 

 

How do I manage allergies in pregnancy?

Allergies affect 18-30% of women in the childbearing age groups.  Allergic diseases that complicate pregnancy include conjunctivitis, acute urticaria (hives, rash), anaphylaxis, food and drug allergy.  These disorders represent the most common group of medical conditions that complicate pregnancy.  The diagnosis of an allergy in pregnancy is often found through a detail medical history and assessing the symptoms experienced.  Once the diagnosis is made there are many things that can be done to treat the condition.

Avoid triggers. Limit your exposure to anything that triggers your allergy symptoms.

Try saline nasal spray. Over-the-counter saline nasal spray can help ease nasal dryness, bleeding and congestion. Use the spray as often as needed.

Rinse your nasal cavity with a neti pot. Neti pots are available in most pharmacies. Once or twice a day, fill the neti pot with an over-the-counter saline nasal solution. Then tilt your head over the sink, place the spout of the neti pot in your upper nostril and gently pour in the saline solution. As you pour, the saline solution will flow through your nasal cavity and out your lower nostril. Repeat on the other side. If you’d rather make your own irrigation solution, use water that’s distilled, sterile, previously boiled and cooled, or filtered using a filter with an absolute pore size of 1 micron or smaller. Also be sure to rinse the neti pot after each use with similarly distilled, sterile, previously boiled and cooled, or filtered water. Leave the rinsed neti pot open to air-dry.

Include physical activity in your daily routine. Exercise helps reduce nasal inflammation.

• 
  Use nasal strips at night. Over-the-counter adhesive nasal strips — such as Breathe Right and Breathe.

If none of these work, allergy medications are often given safely to women and include Claritin, Alavert and Benadryl.   Before you take any medication always discuss alternatives with your obstetrician or healthcare provider.

Is gallbladder disease more common during pregnancy?

Gallbladder disease may be more common during pregnancy. Estrogen is an important risk factor for gallstone formation; it increases the concentration of cholesterol in the bile leading to an increased risk of forming gallstones. 

Is liver disease more common during pregnancy?

Pregnant women can experience spider angiomata and palmar erythema-red spider-like appearance on the hands, chest and face. About two thirds of white women and only 10% of black women experience these symptoms. In addition, women may have reduced serum albumin concentration, elevated serum alkaline phosphate activity, and elevated cholesterol levels. These are common symptoms of liver disease, but they are not evidence of liver disease if they occur during pregnancy. 

What hair changes are common during pregnancy? 

Hair changes in pregnancy are very common, and body hair changes are common as well. Many women develop mild hirsutism that may be due to levels of male hormone production by the ovary and adrenal gland.

In nonpregnant patients, hair grows in the anagen phase and rests in the telogen phase. About 15-20% of all hairs are in the telogen phase at any given time. During pregnancy, however, more scalp hairs are in the anagen phase, so more growth is documented. During the telogen resting phase, it is normal for hair to fall out so new hair can regrow. During late pregnancy, fewer hairs are in the telogen phase; immediately postpartum, more hairs are in the telogen phase. This often results in a dramatic loss of hair immediately postpartum; this is termed telogen effluvium. Although this may be disturbing, it is normal.

Normal hair loss is probably in the range of 60-100 hairs a day and most patients do not notice a dramatic loss unless 40% of all hair is lost. This process spontaneously resolves in about 1-5 months, but has been reported to last more than a year. The frontal and parietal areas are usually most affected. No effective treatment is known.

Is more facial hair normal?

Hormonal changes are the cause of unwanted hair growth on your face. The hair on your head may improve in thickness and texture but you may notice hair growth on your face, breasts and abdomen. Once your pregnancy is over, extra body hair may fall out but waxing or tweezing can be done for safe hair removal. You should not laser your hair during pregnancy since it may affect skin pigment and can even cause scarring.

Why does my hair and nails grow so fast during pregnancy?

Hormonal changes during pregnancy make hair and nails grow faster and stronger. Hair growth can occur in other places of the body, around the belly, nipples and face during pregnancy but these changes are not permanent. The texture and color of hair may also be affected during pregnancy. Most women will notice a significant amount of hair loss during the postpartum period or after breastfeeding stops. 

Nails may also break or split more easily during pregnancy. Keeping your nails shorter and trimmed may be helpful.

 

I have noticed a stronger sense of smell, is that normal?

It is not uncommon to develop a stronger sense of smell during pregnancy. You may notice an aversion to strong food odors or perfumes, and even sense a stronger body odor on yourself. Some notice their vagina has a different odor along with the normal increase in white milky discharge.  This is normal as your body and mucus membranes change throughout your body during pregnancy.

Are pimples and acne more common during pregnancy?

Hormonal changes make your skin oilier increasing your risk of pimples and acne on the face, back and chest especially in the first trimester. Most acne washes can be used to help control these skin breakouts. Products containing salicylic acid, benzoyl peroxide and azelaic acid are safe to use while pregnant.

What’s up with my vaginal discharge?

Your vaginal discharge will change during pregnancy. An increase in a white milky discharge is normal due to an increase in blood flow everywhere in your body, especially in the vagina and vulva. As long as the discharge is not yellow, grey or red-tinged, this is the normal discharge of pregnancy. If you need reassurance that you do not have an infection, follow up with your healthcare provider to get checked for infection. 

How do sleep patterns change in pregnancy? 

Women do have changes in their sleep, and while a pregnancy-related sleep disorder is not a specific diagnosis, it has been proposed as a new categorization by the American Sleep Disorder Association. Disruptions such as positional discomfort, contractions, leg cramps, gastric reflux, and more frequent urination may lead to disordered sleep patterns. Changes in the amount of total sleep required is not uncommon. Typically, the amount of sleep needed is increased in the first and second trimester and actually decreased in the third trimester. This may have to do with the patterns of sleep. The amount of REM and deeper staged sleep also changes in pregnancy. 

Why do I have to worry about Group B Strep during pregnancy? 

Group B Strep is one of the many healthy bacteria that live in the vagina and rectum, not causing any serious problems. 1 in 4 pregnant women carry GBS in the vagina. GSB is not the same bacteria that causes “strep throat” nor is it a sexually transmitted infection (STI). 

GBS can be passed to your baby during a vaginal delivery and, potentially, making the baby very sick. GBS is checked in pregnant women during their first prenatal visit and, again, at 36 weeks. If a pregnant woman is positive for GBS, they are treated with intravenous (IV) antibiotics during labor, protecting the baby from any harm.

Is it normal to have to get a larger shoe size during pregnancy? 

Due to the extra fluids that a pregnant body carries, many people notice an increase in the shoe size.  Some women are able to return to their normal size after pregnancy, while others cannot.

What does it mean to be carrying a baby low? 

“Carrying low” often is a description on how a woman is carrying her pregnancy.  If it’s her second or third pregnancy the abdominal muscles are stretched out, less supportive to the uterus, and the baby appears to be lower in the abdomen.  As the pregnancy progresses and the baby grows, it appears as though you are carrying lower since the abdomen muscles don’t support the uterus as well.

What are some of the reasons that my doctor may put me on bed rest?

Some of the reasons a doctor may put you on bed rest include preterm labor or excessive uterine irritability, poor fetal growth, low or high amniotic fluid levels, and hypertension of pregnancy.  The basic idea is to limit your activity that will take away from the blood flow to your growing fetus or reduce your activity that might stimulate the uterus to contract.

 

What is an amniotic fluid embolism (AFE)?

Amniotic fluid embolism (AFE) is a rare but serious obstetric emergency that happens when fetal material enters the mother’s bloodstream, triggering an intense inflammatory reaction and damage to the lung blood vessels. This can cause cell and endothelial injury, sudden changes in blood clotting (coagulopathy), formation of clots in the pulmonary arteries, and acute pulmonary hypertension. AFE is super uncommon, occurring in 1 in 8,000 to 1 in 80,000 deliveries—so it’s not something most pregnant women need to worry about constantly, but it is life‑threatening when it occurs. Typical warning signs are a sudden collapse: very low blood pressure, low oxygen levels, a plunging or absent pulse, and unresponsiveness. Risk factors that have been associated with AFE include advanced maternal age, cesarean delivery, assisted vaginal delivery, placental abruption, placenta previa, and eclampsia. AFE can be accompanied by massive bleeding, severe clotting problems, and, if combined with a pulmonary embolism, a worse and deadly effect. Quick recognition and aggressive emergency care are critical and can save lives.

What is the longest healthy pregnancy on record? 

A patient of mine asked me this “medical trivia” question the other day so I began a medical search and this was what I found.  Although there may be some skeptics out there Beulah Hunter’s name came up a few times with this remarkable medical story.

The normal human pregnancy lasts around 280 days, 10 lunar (4 week months) months or slightly more than nine months.  Traditionally a term pregnancy for a singleton is 38 to 42 weeks.  In 1945 a 25 year old woman, Beulah Hunter, gave birth after 375 days of being pregnant.  This is almost a year and a half.  It was substantiated by a physician who first documented her last menstrual cycle and the first time she tested positive for pregnancy.  These same physicians claim that the cause of this long pregnancy was the extremely slow development of the fetus.  Beulah Hunter’s pregnancy is the longest known in which a living and healthy child was born.