The Second Trimester of Pregnancy: Pain, Bleeding & Discharge Health Article

There are a number of situations during pregnancy when you shouldn't hesitate to call your doctor or seek emergency medical attention.

Call Your Doctor If:

• you are experiencing signs of miscarriage. These include cramps and pain in the center of the abdomen, which is accompanied by vaginal bleeding, severe pain, pain that lasts for more than a day (even without bleeding), bleeding that is as heavy as a period, or staining that lasts for three days.

Seek Emergency Medical Attention If:

• you are experiencing the symptoms of a miscarriage with enough bleeding to soak several pads in an hour, unbearably severe pain, or clots or evidence of fetal tissue (typically gray or pink in color) passed from the vagina. If the latter is the case, try to save the material in a jar or plastic bag to give to the doctor for analysis. He or she can then determine if the miscarriage is threatened (bleeding before 20 weeks with no cervical dilation and no expulsion of any of the fetal parts), has been completed (complete expulsion of the fetal parts), or has happened incompletely (partial expulsion of the fetal parts before 20 weeks-the next step may either be to allow for spontaneous passage of the remaining products of pregnancy or a dilation and curettage to complete the miscarriage). If you have miscarried before and notice bleeding or cramping, you should seek emergency medical attention.
• you are experiencing the symptoms of an ectopic pregnancy (a pregnancy outside the uterus). This includes crampy, colicky (spasmodic) pain with associated tenderness; pain that starts on one side and spreads across the belly; pain that worsens with taking a bowel movement or coughing; light bleeding or spotting that is brown in color, is either constant or intermittent and precedes the pain by weeks; as well as other symptoms such as nausea and vomiting, pain in the shoulder, weakness and lightheadedness, and rectal pressure. If the ectopic pregnancy is located in the fallopian tube and the tube ruptures, septic shock can follow, with such signs as rapid and weak pulse, clamminess, and fainting, in addition to sharp pain.

Pain

In addition to the above situations when severe pain indicates an emergency, there will probably be times during your pregnancy when you are uncomfortable even though nothing is medically wrong or abnormal. Headaches, back pain, some abdominal pains, and leg cramps do not necessarily signal a problem. Learning how to relieve these discomforts will help you throughout your pregnancy.

Headaches

You still may be experiencing the headaches that started during the first trimester. Or they may be just beginning now. Hormonal changes, tension, fatigue, hunger, and stress are all culprits. Try to relax, stay rested, and eat regularly. Otherwise, you can relieve headaches in the following ways:

• If you have a sinus headache, apply warm compresses to aches in the areas of your head occupied by the sinuses, including either side of the nose, the middle of the forehead, and the temples.
• If the headache is due to tension, try applying cold compresses to aches along the back of your neck.
• Learn relaxation exercises, which involve closing your eyes and imagining yourself in a peaceful place. Reducing stress is a key component of a healthy pregnancy. If you feel the stress in your life is overwhelming, the methods you have used to reduce stress have been inadequate, or even if you just want someone to talk to about your concerns, consider talking to a counselor or a therapist.
• Eat nutritiously and get plenty of sleep.
• Speak with a physician before you begin using pain relievers, even if you have taken over-the-counter medications such as ibuprofen (Motrin), aspirin (Bufferin), acetaminophen (Tylenol), or naproxen sodium (Aleve) for pain before you were pregnant. Acetaminophen is probably your best bet during pregnancy, but again, it is best not to use medications during pregnancy, unless your doctor has specifically instructed you to do so.

Talk to your doctor immediately if the headache is particularly severe, lasts for more than a few hours, is associated with a fever, swelling in the face and hands, or changes in your vision (a sign of preeclampsia).

Back Pain

Under the influence of the pregnancy hormones, the joints in the pelvis become soft and lax in preparation for delivery. As your uterus gets bigger in the second trimester, your center of gravity changes and you begin to carry yourself differently to accommodate the weight. In addition, your abdominal muscles may separate as the uterus presses up against them, weakening the abdominal wall. All of these factors can contribute to back pain, strain, and discomfort.

Here's how you can improve back pain:

• Practice good posture both while standing (shoulders back, pelvis in) and sitting (elevate feet slightly and try to avoid crossing your legs.)
• Get up every once in a while when you are sitting for extended periods.
• Lift heavy objects by bending at the knees, rather than the waist.
• Try not to reach for things over your head.
• Sleep on your side, bending at your hips and knees, and place a pillow between your legs to reduce pressure on your back.
• Strengthen your stomach. One of the keys to a strong back is a strong abdomen.
• Talk to your doctor. You may need to use a back brace or some other form of support to relieve the pressure on your back.

Abdominal Pain

Abdominal pain can either be a normal symptom of pregnancy or it can be a symptom of something serious, like preterm labor or ectopic pregnancy. When you feel pain in your abdomen during the second trimester, it usually is simply related to the tension on the ligaments and muscles in the pelvis as the uterus expands to hold the growing baby. These ligaments support the uterus, and get longer and stronger during pregnancy. If you move quickly, you can pull them, which you will experience as a painful pang in your pelvis or a cramp down your side that can last for minutes. This kind of pain is not harmful to you or your baby. It is important that you tell your doctor when you feel any type of abdominal pain, however, because of the potential of something more serious.

If you have had surgery for infertility or other types of abdominal surgery, you may experience pain from the pulling of the remnants of scar tissue (adhesions).

Pregnant women also have the same types of abdominal infections that other women develop. Infections that can cause abdominal pain include: cholecystitis (inflamed gallbladder), appendicitis (inflamed appendix), hepatitis (inflamed liver), pyelonephritis (kidney infection), and pneumonia (lung infection). Sometimes these diseases are harder to diagnose during pregnancy because the location of pain characteristic to each has been shifted due to the ever-growing uterus pushing structures out of its way.

Leg Cramps

Though no one knows exactly what causes them, leg cramps are common in this trimester and the next. It may be that you do not consume enough calcium, you have too much phosphorous in your diet, or that you are tired; or it may be that the uterus is pressing on the nerves that go to the legs. Regardless of the cause, you may wake up in the middle of the night with bothersome cramps.

Ways you can avoid or get rid of cramps include:

• exercising your calves;
• alternating between sitting and standing;
• wearing support hose;
• flexing the ankle and toes upward with a straightened knee to stop the cramping;
• massaging or applying a warm compress to the leg that is cramping;
• discussing with your doctor the option of reducing the amount of phosphorous in your diet by cutting down on such foods as milk or meat, though making sure you still get enough calcium; and
• telling your doctor if the cramps feel particularly painful or fail to go away. It could be that you have a blood clot in a leg vein that needs to be treated.

Pain and Numbness in the Hand

Numbness and pain in the thumb, index finger, middle finger, and half of the ring finger can be a sign of carpal tunnel syndrome. Usually this condition is diagnosed in people who regularly perform repetitive tasks such as typing or piano playing, but it is also common in pregnant women. During pregnancy, the tunnel that surrounds the nerve to these fingers can become swollen, causing tingling, numbness, and pain. In the evening, after your arm has been dangling by your side all day, your symptoms may worsen due to gravity. Shaking out your arm when you experience the carpal tunnel symptoms may help. Alternatively, you may want to talk to your doctor about splinting your wrist or taking Vitamin B6. If your symptoms don't get better after you deliver, you may consider surgery.

Numbness and tingling can also be caused by poor posture: as your shoulders droop and your head is thrust forward, you put pressure on the nerves under your arms, causing tingling. Practice standing up straight with your head and spine erect. A supportive bra and proper bed rest are also important.

Bleeding

Nosebleeds and Nasal Congestion

Like so many of the complaints of pregnancy, nasal stuffiness and nosebleeds are believed to be due in large part to the work of estrogen and progesterone. These hormones cause increased blood flow and swelling of the blood vessels in the mucous membranes. Particularly in cold, dry weather, this can mean that you feel more congested than normal. You may want to try the following to ease your symptoms:

• use a humidifier to help with the dryness that can make symptoms worse;
• talk with your doctor about taking supplemental vitamin C, which helps strengthen blood vessels and makes them less likely to break;
• blow your nose gently by closing one nostril while you blow the other;
• curb nosebleeds by leaning forward and applying gentle pressure to the nose by squeezing it with the thumb and forefinger for five minutes (repeat if necessary); or
• call your doctor if the bleeding doesn't stop, or is heavy or frequent.

Vaginal Bleeding

Light bleeding or spotting during this trimester and the next is not usually cause for concern. It typically occurs as a result of manipulation of the cervix during sex or a vaginal exam. Vaginal bleeding, however, can be a worrisome sign that needs immediate medical attention. For this reason, you should never be the judge of what is normal or abnormal bleeding; instead, call your doctor. If the bleeding is heavy, call your doctor immediately. If it is spotty, you can make the call sometime that day. Serious bleeding is most commonly caused by placenta previa, premature labor, and late miscarriage. (For more information, go toThe Second Trimester of Pregnancy: Complications)

Rectal Bleeding and Hemorrhoids

Rectal bleeding is not as worrisome as vaginal bleeding and is generally a sign of either hemorrhoids or anal fissure. Rectal bleeding could also, however, be a sign of something more serious. You should speak with your doctor if you are experiencing this symptom.

Rectal bleeding usually means you have hemorrhoids, either external or, less commonly, internal. Hemorrhoids occur in up to half of all pregnant women. They are varicose veins of the rectum and can cause pain, itching, and bleeding, often made worse by constipation. Hemorrhoids are caused by the action of progesterone on the walls of the rectal veins, causing them to relax and expand. As you progress further along in your pregnancy and the uterus presses on these veins, blood flow slows down and the veins dilate even more. Squeezing and constipation can make hemorrhoids worse.

If rectal bleeding is not caused by hemorrhoids, it is most likely caused by an anal fissure-a crack in the skin that lines the anal canal. Anal fissured are generally caused by constipation. Fissures are very painful, particularly during the strain of taking a bowel movement.

If you are diagnosed with hemorrhoids or an anal fissure, you should:

• try to avoid becoming constipated;
• try to alleviate pressure on the veins in the rectum by sleeping on your side, not standing or sitting for long periods of time, and not taking too long or straining when evacuating the bowel;
• take warm sitz baths up to two times a day. Sitz baths are basins that fit on your toilet and are filled with warm water in which you can soak;
• soak the hemorrhoids with ice packs or witch hazel, and only use topical medications if your doctor prescribes them. Your doctor may also prescribe stool softeners or a laxative;
• practice good hygiene by wiping thoroughly after bowel movements from front to back and by keeping yourself clean. Use only white, non-scented toilet paper; and
• perform Kegel exercises to improve the circulation to the area.

Vaginal Discharge

As the pregnancy progresses, you may notice you have increasing vaginal discharge. Typically it looks like egg white, is milky and a bit odorous, and it may remind you of premenstrual discharge, only a bit heavier and more frequent. This discharge is absolutely normal and is just another change your body goes through in response to the pregnancy hormones and the increased blood flow to the area. You can wear panty liners or change your underwear more often than usual if you find the discharge bothersome.

Though the kind of discharge described above is normal, there are some types of discharge that may mean you have an infection. You may have a condition that must be treated:

• if the discharge looks like pus;
• if it is yellow, green, or smells foul;
• if you notice a burning sensation when you urinate; or
• if your labia are red, swollen, or itchy.

Vulvovaginal candidiasis (yeast infection) is very common during pregnancy. Signs include a thick, cottage cheese-like discharge accompanied by itching, redness, and burning, as well as painful intercourse and urination.

Sexually transmitted diseases (STDs) may also occur during pregnancy, and because many of them can affect the fetus, it is important that they be treated.

Go to The Second Trimester of Pregnancy: Changes in Skin, Vision, & Gums, The Second Trimester of Pregnancy: Weight Gain & Other Changes and The Second Trimester of Pregnancy: Constipation, Gas & Heartburn