Prenatal Care Part 2: Rectus Diastasis, Varicosities, Carpal Tunnel and more.
Following on from our last blog post in which we discussed pains in pregnancy, in particular pelvic girdle pain. We want to provide some education about some other common conditions in pregnancy.
Round ligament pain:
Often described as a dull ache, sudden, sharp stabbing pain or cramp like pain in the lower abdomen or hip. This can be attributed to the round ligament. The round ligament is a fibrous muscular band that supports the growing uterus and maintains position of uterus during movement. The ligament can stretch or spasm in response to sudden movement/change in direction causing the pains described above.
- Moving slowly
- Posterior pelvic tilts during spasms
- Abdominal bracing during movement
- Abdominal support garment
The round ligament pain can often be mistaken for pubic symphysis pain so if you are unsure what is causing your pain you may need an assessment to determine the appropriate management.
These are practice contractions of the uterus for labour - they are completely NORMAL. They often commence around 20 weeks and may not be noticeable until >30/40 weeks. They tend to increase in intensity and frequency with rapid movements/ fast walking. Unlike the round ligament pain they wont reduce with the strategies mentioned above, but on the other hand unlike labour they do tend to reduce with resting.
Rectus diastasis (RD) or diastasis of recti abdominis muscles (DRAM):
RD or DRAM is the increased distance between bellies of rectus abdominus to allow for enlarging uterus. Is a very common part of pregnancy and occurs in 70-100% of women. SO the question we are often asked, is there anything you can do to minimise it?
Unfortunately there is not a huge amount of evidence to guide us but we do recommend using compressive supports during pregnancy such as tubigrip or some pregnancy support tights. It’s also important to reduce heavy lifting and straining after 20 weeks. In our postnatal care series we will be discussing the management for DRAM in the postpartum period.
Lower limb varicose veins are associated with symptoms such as night pain and cramps, tingling, numbness and achy legs. They occur in 40% of pregnant women and will usually resolve 3-4 months after delivery.
- circulatory exercises
- avoiding prolonged standing
- elevate legs during the day
- When resting sleep on left side as this will reduce the pressure on the inferior vena cava as it on the right side of the body
- compression stockings
Vulvar varicosities are varicose veins in and around the vular they are less common than LLVV however they can be very painful.
- rest with legs raised
- sanitary pad insitu with firm fitting underwear to apply pressure
- frequent pelvic floor contractions to allow circulation
- avoid prolonged sitting
- manage constipation
Carpal tunnel syndrome in pregnancy:
Predominantly related to increase in upper limb fluid retention in late pregnancy, which causes compression of the median nerve. Symptoms include pain, pins and needles, numbness, weakness of grip strength and atrophy.
- most people can get symptomatic relief with a night splint that reduce exacerbation from prolonged wrist flexion in sleeping positions
- Oedema management: circulatory exercises to promote movement of fluid.
Carpal tunnel can also affect women in the postnatal period and this will be discussed in our postnatal care series.