Some pain or discomfort is normal during the second trimester of pregnancy. Spotting and very small amounts of blood may also be harmless. However, there are certain types of pain, bleeding, and vaginal discharge that you should not ignore. Learn how to tell the difference between normal pregnancy problems and serious medical concerns.
There are a number of situations during pregnancy that demand medical attention. If you experience the symptoms below, don’t hesitate to call your doctor or seek emergency care.
When to Seek Emergency Medical Attention
Always seek emergency care if you are experiencing the symptoms of a miscarriage. Symptoms of a miscarriage include:
- enough vaginal bleeding to soak more than one feminine pad in an hour
- unbearably severe pain in the abdomen or pelvic region
- clots or clumps of tissue (typically gray or pink in color) passed from the vagina
If you pass clots or clumps from the vagina, try to save the material in a jar or plastic bag to give to the doctor for analysis. He or she may then determine the cause of the problem.
There are three types of miscarriage. If a miscarriage has been threatened, there was bleeding before 20 weeks of pregnancy with no cervical dilation and no expulsion of any of the fetal parts. If a miscarriage has been completed, there was complete expulsion of fetal parts from your body. If a miscarriage has happened incompletely, there was partial expulsion of the fetal parts before 20 weeks. In the case of incomplete miscarriages, the next step may be to allow the remaining products of pregnancy to pass naturally or to perform a dilation and curettage to complete the miscarriage.
Note: If you have miscarried before and notice bleeding or cramping, you should seek emergency medical attention.
Always seek emergency care if you are experiencing the symptoms of an ectopic pregnancy (a pregnancy outside the uterus). Symptoms of an ectopic pregnancy include:
- cramps and 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
- one of the above symptoms combined with nausea and vomiting, pain in the shoulder, weakness or lightheadedness, or rectal pressure
- rapid and weak pulse, clamminess, fainting, and sharp pain (these symptoms may arise if the ectopic pregnancy is in the fallopian tube and the tube ruptures, causing septic shock)
Emergency care is not always necessary. However, some signs require the evaluation of a doctor. Always call your doctor for advice if you are experiencing signs of miscarriage. Early signs of miscarriage include:
- cramps and pain in the center of the abdomen with vaginal bleeding
- severe pain or pain that lasts for more than a day (even without bleeding)
- bleeding that is as heavy as a period
- spotting or staining that lasts for three days
Although you may not experience an emergency, there will probably be times during your pregnancy when you are uncomfortable or in pain. Many women have pain during the second trimester even when nothing is medically wrong. Abdominal pain, back pain, headaches, leg cramps, and hand pain do not always signal a problem. Learning to identify and relieve these normal discomforts will help you throughout your pregnancy.
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Abdominal pain can either be a normal symptom of pregnancy or a sign of something serious, like preterm labor or ectopic pregnancy. It is important that you tell your doctor when you feel any type of abdominal pain, because of the potential for a serious complication.
When you feel pain in your abdomen during the second trimester, it usually is related to the tension on the ligaments and muscles in the pelvis. These get stretched as the uterus expands to hold the growing baby. If you move quickly, you can “pull” them. This may feel like a painful pang in your pelvis or a cramp down your side that can last for several minutes. This kind of pain is not harmful to you or your baby.
Sometimes abdominal pain is related to past pregnancies or surgeries. 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 can 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)
- pneumonia (lung infection)
Sometimes these diseases are harder to diagnose during pregnancy because the location of pain characteristic to each has been shifted. This happens when the growing uterus pushes nearby organs out of its way. If you are experiencing serious pain that does not feel like it is in your uterus, show or tell your doctor exactly where the pain is located. If you have one of the above infections, you may need antibiotics or surgery to fix the problem.
Warning: If you are experiencing regular or painful contractions in the pelvis or abdomen, call a doctor immediately. These may be a sign of preterm labor (Mayo Clinic, 2011).
Back pain is very common during pregnancy (Ostgaard, et al., 1991; Wang, et al., 2004). Pregnancy hormones cause the joints in the pelvis to become soft and lax in preparation for childbirth. As your uterus gets bigger in the second trimester, your center of gravity changes. 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 (Mayo Clinic, 2011):
- Practice good posture 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 long 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 left side, bending at your hips and knees, and place a pillow between your legs to reduce pressure on your back.
- Strengthen your stomach muscles. 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.
Warning: If you are experiencing lower back pain accompanied by painful urination, you may have a bladder or kidney infection. Low, dull, consistent back pain may be a sign of preterm labor. Severe back pain coupled with vaginal bleeding or discharge may also indicate a serious problem. Call your doctor immediately if you experience any of these symptoms (Mayo Clinic, 2011).
Many women experience frequent headaches during pregnancy. 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. You can also try to relieve headaches in the following ways (American Pregnancy Association, 2007):
- If you have a sinus headache, apply warm compresses to aches in the sinus areas of your head. These include both sides 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, like 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 or you just want to talk about your concerns, consider calling a counselor or a therapist.
- Speak with a physician before you begin using pain relievers. This is important even if you took over-the-counter medications for pain before you were pregnant. Common headache medicines include ibuprofen (Motrin), aspirin (Bufferin), acetaminophen (Tylenol), or naproxen sodium (Aleve). Acetaminophen is probably the safest option during pregnancy, but do not take pills during pregnancy unless your doctor has specifically told you to do so (Harms, 2012).
Warning: Call your doctor if the headache is particularly severe or lasts for more than a few hours. Also note whether your headache comes with a fever, swelling in the face and hands, dizziness, nausea, or changes in vision. These may be signs of preeclampsia or another serious complication (Mayo Clinic, 2011).
Although no one knows exactly what causes them, leg cramps are common in the second and third trimester. Possible causes may be that you do not consume enough calcium, have too much phosphorous in your diet, or are tired. Instead, 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.
You can avoid or get rid of cramps by (Mayo Clinic, 2011):
- exercising your calves
- staying hydrated
- alternating between sitting and standing
- wearing support hose
- wearing comfortable, supportive shoes
- 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 about reducing the amount of phosphorous in your diet by cutting down on such foods as milk or meat
- making sure you get enough calcium (by eating fortified cereal or spinach) and magnesium (by eating beans or semisweet chocolate) (USDA)
Warning: Tell your doctor if the cramps feel particularly painful, fail to go away, cause swelling, feel warm to the touch, or change the skin color of your leg (to white, red, or blue). You may have a blood clot in a leg vein that needs to be treated (Mayo Clinic, 2011). This is known as deep vein thrombosis, and without treatment it can be deadly. Consult a doctor immediately.
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 (Ablove, et al., 2009). 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.
Numbness and tingling in the hand 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 can be a scary symptom during pregnancy. In some cases, bleeding can be harmless. It can happen when pregnancy hormones cause you to develop more sensitive, expanded blood vessels. In other cases, bleeding can indicate a serious problem with the pregnancy. If you experience any bleeding, call a doctor for advice.
Light bleeding or spotting (which can be brown, pink, or red) during the second and third trimester is not usually cause for concern. It typically occurs as a result of interference with the cervix during sex or a vaginal exam. Pink mucus or brownish discharge may both occur during the second trimester. They are caused by small amounts of blood leaving your body with normal discharge.
Vaginal bleeding (like a period), however, can be a worrisome sign that needs immediate medical attention (Mayo Clinic, 2011). Clots of blood or clumps of tissue in the blood may be symptoms of a miscarriage. 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 or if it is accompanied by pain, 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, or late miscarriage (American Pregnancy Association, 2008).
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 may mean 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 progesterone acting on the walls of the rectal veins, causing them to relax and expand. As you advance 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. Laughing, coughing, straining, and going to the bathroom may cause hemorrhoids to bleed.
If rectal bleeding is not caused by hemorrhoids, it may be caused by an anal fissure – a crack in the skin that lines the anal canal. Anal fissures are usually caused by constipation. Fissures are very painful, particularly during the strain of taking a bowel movement (Mayo Clinic, 2010).
Hemorrhoids and anal fissures can cause brown, pink, or red blood stains to appear on your underwear or toilet paper. If the bleeding is heavy or continuous, call a doctor for advice.
If you are diagnosed with hemorrhoids or an anal fissure, you should (Harms, 2011):
- Try to avoid constipation by remaining well hydrated and eating a diet high in fiber.
- 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 going to the bathroom.
- 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 your anus.
- Soothe 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 keeping yourself clean.
- Use only white, unscented toilet paper.
- Perform Kegel exercises to improve the circulation to the area.
Warning: Massive rectal bleeding can be a serious problem. It can be caused by ectopic pregnancies (Patterson, et al., 1978) or serious internal problems. Seek medical care immediately if you are bleeding heavily from the anus.
Like many of the complaints of pregnancy, nasal stuffiness and nosebleeds are believed to be due in large part to estrogen and progesterone. These hormones cause increased blood flow and swelling of the blood vessels in the mucus membranes. Particularly in cold, dry weather, this can mean that you feel more congested than normal. You may also experience nosebleeds more often than you did before getting pregnant.
You may want to try the following to ease your nasal symptoms (Mayo Clinic, 2012):
- Use a humidifier to help with the dryness that can make symptoms worse.
- Blow your nose gently by closing one nostril while you blow through the other.
- Curb nosebleeds by leaning forward and applying gentle pressure to the nose. Try squeezing it with the thumb and forefinger for five minutes (repeat if necessary).
- Call your doctor if the bleeding doesn't stop, or is heavy or frequent.
- Seek emergency medical care if nasal congestion makes it hard to breathe.
The same changes in hormones and blood vessels that cause nasal bleeding can cause sensitive gums. If you experience bleeding when flossing or brushing your teeth, try using a softer toothbrush. Visit a dentist if you bleed a lot or have a lot of pain when flossing or brushing your teeth. Serious dental problems can be a sign of other health concerns that can complicate pregnancy.
Many women experience different types of discharge during the second trimester. Pay attention to the color, smell, amount, and frequency of vaginal or anal discharge. Some types of discharge may indicate an infection that need medical attention or treatment.
As the pregnancy progresses, you may notice increasing vaginal discharge. Typically it looks like egg white, is milky and a bit odorous. It may remind you of premenstrual discharge, only a bit heavier and more frequent (Kelly, 1990). This discharge is totally 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.
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 infections (STIs) may also occur during pregnancy, and because many of them can affect the fetus, it is important that they be treated.
You may have a condition that requires treatment if you have any of the following symptoms:
- The discharge looks like pus.
- The discharge is yellow, green, or smells foul.
- You notice a burning sensation when you urinate.
- Your labia are red, swollen, or itchy.
Unlike signs of infection, clear or pinkish watery discharge may be a sign of premature rupture of the amniotic sac (Mayo Clinic, 2010). Rupture of the sac may cause a trickle of watery discharge or a rush of lots of watery fluid from the vagina. This is commonly known as having the water break before labor begins.
Warning: If you experience a steady trickle or a rush of watery discharge during the second trimester, call a doctor immediately. It may be a sign of premature labor or a tear in the amniotic sac.
In addition to bleeding from the rectum, some women may experience anal discharge during pregnancy. Rectal discharge may be caused by STIs, bowel and gastrointestinal problems, or physical wounds in the rectum. If you are experiencing rectal discharge, consult a doctor.
Gonorrhea, chlamydia, and other infections that can be transmitted through sexual contact can cause an infection in the anus (HRSA 2011). These infections can cause lesions or sores that bleed. In addition, they may lead to discharge that is foul smelling, green or yellow, and thick. It may be painful to wipe or go to the bathroom. If you have these symptoms, discuss them with a doctor. If they are left untreated, they may cause serious problems for the baby. Most STIs can be treated with antibiotics.
Some pregnant women may experience anal discharge due to bowel problems or gastrointestinal disorders. These may result in mucus or watery discharge from the anus. Certain gastrointestinal problems or food poisoning may also cause frequent diarrhea or fecal matter with unusual colors or textures. Tell your doctor about any unusual characteristics of your bowel movements. Some conditions require immediate treatment.
Finally, if you have a hemorrhoid or anal fissure that has become infected, you may notice unusual rectal discharge. Infected wounds may cause brown, yellow, green, or white discharge. It may or may not have a foul smell. Infected sores are often very painful and require medical attention. Consult a doctor for treatment if you experience anal discharge of this nature.
Many women may experience discharge from one or both nipples during the second trimester of pregnancy. Breast tenderness and changes in nipple color is also common during pregnancy. Discharge is most common in women who have previously given birth. Nipple discharge is often clear, milky, or yellowish in color.
Discharge from the nipples is normally not a sign of a problem unless the following symptoms are present (MedlinePlus, 2009):
- The nipple changes in size or becomes inverted.
- The nipple is dry, cracked, or painful.
- The nipple has a rash or new bumps.
- Discharge is foul-smelling, bloody, green, or brown.
If you are not sure whether your nipple discharge is normal, call a doctor to discuss your symptoms.