Lets Get Taboo: The Less Desirable (But Common) Symptoms of Pregnancy

I know we don’t like talking about these things, but they’re simply a fact of (some) pregnancies. Chances are, you will or have experienced at least one of these things during pregnancy. All of these things are somewhat taboo topics – nobody likes to talk about their vaginal discharge, the gas they pass or infections that occur – but they happen. So it’s important we talk about it.

Even as a nurse, I have a hard time talking about these things from a personal perspective – even though I talk about things like UTIs and bowel movements on a day to day basis! I’ve admitted before to my use of Google – and I’ve definitely had to Google some pregnancy symptoms that occurred to me to be like “is this normal or do I need to follow up?”. So I’ll try and answer that for you here – however, keep in mind – each pregnancy is unique and you should always follow up wth your healthcare provider if something seems off, unusual or concerning. Some of these things do require follow up at all times – to make sure you are using the right treatment, and so on.

As a note – this list is not exhaustive. I too feel that nausea/vomiting is undesirable, but it really deserves it’s own dedicated post. I am also sure there are many symptoms I am not covering here. If I’m missing something that really impacted you, let me know on Instagram (@kateontheblog) or Twitter (@EITWblog).

Disclaimer: this is not medical advice. Please seek medical advice from your trusted healthcare provider.

Chafing

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Lets start this off with a more benign one – chafing. This won’t happen to everyone, but it probably happens to a lot of us. As our belly’s get bigger, and our thighs in some cases (to help support!), and who knows where else. I personally did not experience any chafing with my first pregnancy, but this pregnancy I did in my thigh area and it was uncomfortable!! Chafing can occur to anyone, anywhere there is likely to be skin friction. Of course I’ve had chafing before – especially in the summer when it’s hot and the sweat makes it a ripe environment for this to occur.

My chafing occurred between the legs, but I have seen people report it elsewhere too – another hot spot during pregnancy tends to be under the belly. For me – it seemed to be related to both friction and moisture (aka sweat). If you have never had chafing before, it is an uncomfortable rash that occurs as a result of these things.

Does this require follow up?

Unless you have some next level serious chafing (think rashes with open sores as well or signs and symptoms of infection), likely no. It’s luckily something you can deal with it at home for the most part. However – if you feel something is amiss, it doesn’t hurt to get an assessment too. When a rash appears in your groin area especially, it may be worth the investigation!

What can I do to deal with it?

Try and prevent it first. If you often fall victim to chafing, then prepare for this, especially if you’re going to be enjoying the bulk of your pregnancy in the warmer weather. Some ways to prevent are to wear looser and less restrictive clothing (to prevent sweating that contributes to it), avoid cotton and opt for spandex or polyester, and making sure to keep the areas of concern dry. This may mean you need to change your pants or clothes more often than normal.

If the chafing has already gotcha, then you can use soothing treatments. There are a whole handful of different creams you can try – one that came recommended to me was the Monistat brand chafing gel (I’ve plugged my Amazon affiliate link here – be aware that I earn if you purchase the product). However, there are a plethora of other optionshere is a more exhaustive article on the topic. Another good resource? Pharmacist!

You can also look for some specialty clothing like anti-chafing shorts and thigh bands. I like a good biker short to avoid chafing since they’re a bit longer (great during a workout or for lounging at home) – my personal favourites are the Aerie brand options like these. During pregnancy, I was able to wear my regular size however you may need to size up depending on how you carry! I am sure that many of other brands also make their own – Knix would probably be a good brand to check out for stuff like that.

Increased Vaginal Discharge

I know people don’t like talking about vaginal discharge, but it is a part of life if you have a vagina. All discharge is slightly unique I’d say – some people have more or less; whiter or slightly less white; and so on and so forth. I’ll talk about the colour/odor and signs of infection in the section below, but for now let’s just talk quantity.

One thing you may notice very early on in pregnancy is an increase in vaginal discharge. This usually just progresses until the end of pregnancy. Having more discharge in pregnancy is healthy and normal.

What is “normal” discharge?

Like I said, everyone will have slightly different discharge – just like we have slightly different snot and poop (sorry but it’s true). However, you should expect your discharge to be white (or white-ish) or clear in colour; thinner; and with no bad odour (you may have heard the term leukorrhea for this). Sometimes – your discharge may appear more “yellow” in pregnancy and it can be normal, however if you notice it is yellow it is advised that you see your doctor to rule out any infections first.

I imagine that most vagina-owners know their “regular” discharge – so you’ll notice if it goes too off your beaten path.

During pregnancy, you may notice that your discharge does increase sometimes significantly. It increases in response to increased hormones like progesterone and increased pelvic blood flow, and helps with things like prevention of infection. You may notice you feel wet at times because of the amount (especially by third trimester).

What can I do to deal with it?

Management of increased vaginal discharge may just involve wearing a pantyliner or changing underwear more frequently. Monitor your discharge for any changes – keep in mind that near the end of pregnancy, you may begin to notice your mucus plug or “bloody show” – the mucus from your cervix, which can be a sign that labor is near (however it can happen a few times).

Yeast and Bacterial Vaginosis

Yes, unfortunately yeast infections are more common in pregnancy. Don’t worry though – yeast infections do not impact your pregnancy (whereas some other infections can) but they are simply unpleasant and frankly, annoying.

Signs of a yeast infection include: tan, yellow, green or even white discharge that is of a thicker consistency than normal; it may have a sweet or yeasty scent; it may be even more increased than normal pregnancy discharge; and it may cause irritation of your vagina and/or vulva including redness, burning, itching or discomfort.

Yeast infections tend to be more common in pregnancy because of the hormonal changes and an increase of sugar in discharge (which encourages yeast growth).

I think I have a yeast infection – what do I do?

The issue with yeast infections is that they share symptoms with other infections. If you’ve had a yeast infection before, you might be familiar with the symptoms and sensation – however it’s important to see your doctor/midwife/care provider to rule out any other cause of infection just to make sure. Usually, a quick swab can help to determine the cause – pro tip: for a vaginal swab, you can ask to do this yourself if you feel uncomfortable for any reason with having your provider perform it.

Once you know it’s a yeast infection – you would follow your providers guidance for treatment. Often in pregnancy, this involves use of an over-the-counter (OTC) cream or suppository treatment. Do not buy Diflucan, which is the one-time oral medication, as this is generally not recommended in pregnancybut please speak to your provider for further guidance (or again, a pharmacist when it comes to the OTC products)!

Yeast infection prevention

Once you get rid of your yeast infection, it’s important to prevent it from recurring – yeast can pass from the vaginal canal to your baby during birth (thrush) so you probably want to avoid that and also the symptoms!

Cotton underwear is a great option and loose clothing (which is usually easier during pregnancy). Keep your vaginal area dry – so re: your increased vaginal discharge, change your pantyliners or underwear often and as needed to prevent moisture build up. You do not need to douche nor should you use any scented products in your self-cleaning vagina. You should keep the area clean though. You may need to avoid baths with scented bath soaps or bath bombs (alternative – unscented/gentle soaps and epsom salts).

Adding in a probiotic or yogurt with Lactobacillus acidophilus into your diet (to increase its population in the vagina) may also help with prevention, as well as limiting sugar intake.

Bacterial Vaginosis

When you see your provider, the swab will help to identify the infection (if there is one). Beyond yeast, it’s possible you have bacterial vaginosis, another common culprit of vaginal infection in pregnancy.

Bacterial vaginosis or “BV” is caused, similarly to yeast, by an imbalance in the vaginal flora – however, instead of domination by yeast we see an overtaking by an unwanted bacteria. BV has some overlapping symptoms with yeast – but there is usually a more fishy or unpleasant odour to the discharge associated with it. Discharge may also appear grey – however, I have seen and read mixed reports from women about how their BV presents. This is why it’s important to get a swab.

Another reason to get swabbed is because BV (and some STIs, which again – can present with similar symptoms as above) can impact your pregnancy. Low birthweight and premature birth may occur. So if you’re having odd symptoms – see your provider, get swabbed and get treated appropriately. BV is usually treated with an antibiotic in pregnancy, however speak to your provider to find out what is right for you (there are other supported treatments out there but the safety during pregnancy is not always known – so that is why your healthcare provider is the best resource).

Prevention of BV can be done primarily by – again – not douching. Similar steps as for yeast infection can also be taken (cotton underwear, clean and dry area, probiotic, etc).

Gas and constipation

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Lets move beyond the vagina to the colon! Always a fun topic. Two major pregnancy symptoms arise from the intestines & colon – gas and constipation. I think most people experience one of these – though I know some people experience the opposite of constipation, especially early or later in pregnancy! It all depends on the “luck” of the draw, I suppose.

One thing is for sure – either of these (or an upset stomach) are uncomfortable.

Why do this happen?!

You can pretty much always point the finger of blame at hormones. Often – progesterone, in the case of gas and constipation. This is because progesterone leads to relaxation of muscles – which slows down the GI tract. So not only do you get an increased buildup of gas, but you also may not have quite as much control over when you release it!! Toot.

Progesterone also contributes to constipation, as does the changes that are occurring internally as a result of baby’s growth in the later trimesters. Our body’s are also absorbing more water from the intestines, drying out stool. Oh – and we are also taking multivitamins and sometimes additional supplements like iron, which is a known culprit in contributing to constipation. So basically we have a lot working against us in regards to bowel movements.

How can I cope?

Not every pregnant woman will experience constipation, or it may be short lived. Personally – I had almost no issues in my first pregnancy, and with some careful management this time I’ve been able to avoid it most of the time. Gas, on the other hand, likely is unavoidable – I mean, we have gas anyways, but because it’s hormones contributing to the cause, you will likely experience gas. However, there are some things you can do to relieve the discomfort of both issues, and prevent or manage constipation.

The first recommendation you will usually hear from a care provider in regards to constipation, whether pregnant or not, is increased fibre in the diet and activity levels. Making sure you’re getting enough fluids will help with both constipation and gas symptoms as well, as these both help to get things moving. Another option is taking a probiotic – consult with your provider or pharamcist to make sure the one you choose is right for you. Metamucil (psyllium) is often a suggested daily option for prevention of constipation (again – always talk to your provider) with no known risks to pregnancy, however it may increase your gas and discomfort, and not resolve the problem.

In situations of prolonged constipation – some laxatives can be recommended in pregnancy. Docusate (a stool softener) is often considered a safe option. If you think you need this, speak to your provider and/or pharmacist so you’re making a safe choice as there are some that are not well studied or recommended.

Stress and a tight pelvic floor can also contribute to constipation issues – so meditation, yoga, relaxation and pelvic floor physiotherapy may also be helpful. Some other tips to prevent gas can be found here.

Pro tip:

If you’re taking an iron supplement, take it with vitamin C to help with absorption. I am personally using Feramax and have found that it has less GI effects (not an ad, just my personal and clinical experience as well).

Smelly urine

This one was honestly new to me, with my second pregnancy. I swear I never noticed this before – but it ends up a lot of people do notice it and experience it (as revealed by a quick google search). Sometimes this is people’s “first sign” they are pregnant! Who knew!

Why does this happen and can it be managed?

Hello, hormones! But this time it’s actually Hcg, your pregnancy “pee stick” hormone, that’s contributing. The increase over time can lead to your urine having an odor, and you may notice this the most in early pregnancy (first trimester).

What may also be happening is that you’re just more sensitive to the scent of your urine.

You may also be dehydrated if you’re noticing it a lot – so make sure you’re drinking your H2O!

Other causes may be a UTI, especially if you have other symptoms; or even your prenatal vitamin (which can change the colour of your urine slightly sometimes too). If you have concerns or suspect an infection – see your provider.

Itchy breasts (and other itches!!)

Another common issue. We talk a lot about breast engorgement after baby is born, and breast growth during pregnancy – but not so much about the itch.

What causes it?

Stretch marks, or striae gravidarum when they occur in pregnancy, can occur on your breasts and these can sometimes cause itching or feelings of discomfort. Stretch marks and whether or not they occur is a topic for a blog post of its own – but they can be related to hormonal changes, genetics and stress on the tissue in the area. Risk factors may include higher weight either before becoming pregnant or before delivering (notably, not all studies have supported this claim); family or personal history; and a lower maternal age.

Itching can also occur without visible stretch marks just due to skin stretching and hormones or due to things like moisture build up under the breast or friction (similar to the chafing we talked about before).

There are also some conditions that may cause itching – however this itching does often affect areas in addition to the breasts. Eczema is a very common cause of itchy skin pregnancy – you may also notice other symptoms of it like dry, red patches of skin.

Another condition that can occur and cause itching in pregnancy is called pruritic urticarial papules and plaques of pregnancy – or PUPPP for short. “Urticarial” means it can also present with hives. It often will start on the belly and spread and the cause is currently unknown but it is expected to resolve after birth.

Itchy bumps that have a bug bite like appearance may be another skin condition of pregnancy called prurigo. Again – cause is not known. It tends to occur in 2nd or 3rd trimester and is more commonly found on the limbs (but sometimes on the abdomen and chest). It also is expected to resolve after the baby is born.

Thrush (yeast) may also cause itching of the breasts – particularly on the nipples.

Outside of these rather benign skin conditions, there is a potentially more serious cause of itching – cholestasis of pregnancy. Cholestasis affects the liver and the flow of bile from the gallbladder. Itching is one of the primary symptoms, but it may also be accompanied by jaundice (common with liver problems – but not necessarily with this condition) and pale stool. The itching is often worse in the evening, and generally starts on the hands and the feet.

Can it be prevented or treated?

In terms of stretch marks – there is not much support for prevention techniques. It seems to be more luck of the draw. You can read this study here for more information about prevention methods that have been explored. I do plan on doing a separate post on this topic in the near future, with a more thorough literature review.

Managing stretch marks should be done early on. There is more evidence around the treatment of them outside of pregnancy than during. Laser or light therapies, and some topic applications may be helpful. You can discuss this with your doctor.

Eczema again, cannot really be prevented, but can be managed safely in pregnancy. Your provider may give you advice for management at a family planning or fertility appointment if you have pre-existing eczema. Some treatments must be stopped a certain amount of time (3 months) before becoming pregnant, such as methotrexate. Eczema can develop during pregnancy too though. UVB, emollients and some topical steroid options may be prescribed for use during pregnancy safely. Speak to your provider to find out if you have eczema or how to manage pre-existing eczema.

PUPPP and prurigo cannot be prevented since the cause is not known. Topical steroids may be used to help relieve the itch with PUPPP, sometimes in addition to antihistamines (and the treatment for prurigo is similar).

Cholestasis is diagnosed by your provider and treated a variety of different ways depending on your pregnancy, health, and other factors. Like many of the conditions mentioned, it too is expected to resolve after pregnancy. It is very important to see your doctor for itching because of the risks of cholestasis, which include premature birth and other fetal issues. As mentioned, it may just present as itching – so it’s worth it to at least mention this to your provider and call if you have any severe itching that is concerning.

That’s all folks!

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