Pregnancy

Symptoms of indigestion in pregnancy

Symptoms of indigestion and heartburn in pregnancy are the same as for anyone else with the condition. The main symptom is pain or a feeling of discomfort in your chest or stomach. This usually happens soon after eating or drinking, but there can sometimes be a delay between eating a meal and developing indigestion.

You may experience indigestion at any point during your pregnancy, although your symptoms may be more frequent and severe during later pregnancy, from 27 weeks onwards. As well as pain, indigestion may cause:

• heartburn, a burning sensation caused by acid passing from the stomach into the oesophagus
• feeling uncomfortable or heavy
• belching (burping)
• regurgitation (food coming back up from the stomach)
• bloating
• nausea (feeling sick)
• vomiting (being sick)

Causes of indigestion in pregnancy

The symptoms of indigestion (dyspepsia), including heartburn, are caused by stomach acid coming into contact with the sensitive protective lining (mucosa) of your digestive system.

The stomach acid breaks down the mucosa, which causes irritation and leads to the symptoms of indigestion. When you're pregnant, you are more likely to have indigestion due to:

• hormonal changes that your body is going through
• your growing womb (uterus) pressing on your stomach
• the relaxing of the lower oesophageal sphincter (ring of muscle) that acts like a gate between your stomach and your oesophagus, allowing stomach acid to leak back up

You may be more likely to get indigestion in pregnancy if:

• you had indigestion before you were pregnant
• you have been pregnant before
• you are in the latter stages of pregnancy

Your GP or midwife will usually be able to diagnose indigestion or heartburn from your symptoms and by asking you some questions. For example, they might ask:

• how the symptoms are affecting your day-to-day life
• what your usual eating habits are
• if you have tried any treatments already
• if you experienced indigestion or any other stomach conditions before you were pregnant

Your GP or midwife may also examine your chest and stomach. They may press gently on different areas of your chest and stomach to see whether this is painful.

Treatments for indigestion and heartburn in pregnancy

In some cases, changes to your diet and lifestyle may be enough to control indigestion, particularly if the symptoms are mild.

If you have severe indigestion, or if changes to your diet and lifestyle don't work, your GP or midwife may suggest using medication to help ease your symptoms. Several indigestion medicines are safe to use during pregnancy. However, check with your GP, midwife or pharmacist before taking anything they have not recommended.

The types of medicines that may be prescribed for indigestion and heartburn during pregnancy are:

Antacids

Antacids are a type of medicine that can provide immediate relief from indigestion. They work by neutralising the acid in your stomach (making it less acidic) so that it no longer irritates the protective lining (mucosa) of your digestive system.

Alginates

Some antacids are combined with another type of medicine known as an alginate. This helps relieve indigestion caused by acid reflux. Acid reflux occurs when stomach acid leaks back up into your oesophagus and irritates its protective lining.

Alginates work by forming a foam barrier that floats on the surface of your stomach contents. This keeps stomach acid in your stomach and away from your oesophagus. In most cases, antacids and alginates can effectively control the symptoms of indigestion during pregnancy.

Choice and dosage

A number of antacids are available over-the-counter from your pharmacist without a prescription. Ask your pharmacist for advice about which ones are suitable for you.

You may only need to take antacids and alginates when you start to experience symptoms. In other cases, your GP may recommend that you take these medicines before your symptoms are expected, such as:

• before a meal
• before bed

It is safe to use antacids and alginates while you are pregnant as long as you do not take more than the recommended dose. Follow the instructions on the patient information leaflet that comes with the medicine to ensure that you take it correctly. Side effects from antacids are rare, but can include:

• diarrhoea
• constipation

Iron supplements

If you are prescribed an antacid medicine and you are also taking iron supplements, do not take them at the same time. Antacids can prevent iron from being properly absorbed by your body. Take your antacid at least two hours before or after your iron supplement.

Acid-suppressing medicines

If antacids and alginates do not improve your symptoms of indigestion, your GP may prescribe a different medicine that suppresses the acid in your stomach. There are two acid-suppressing medicines that are safe to use during pregnancy:

• ranitidine
• omeprazole

As with antacids and alginates, follow the dosage instructions on the patient information leaflet or packet.

Ranitidine

Ranitidine is usually prescribed as tablets to be taken twice a day. Follow the dosage instructions, as your medicine may not work if you only take it when you have symptoms. Ranitidine rarely causes any side effects.

Omeprazole

Omeprazole is usually prescribed as a tablet to take once a day. After five days, your symptoms should have improved. If not, your dose may need to be increased. In some cases, omeprazole may cause side effects such as:

• headaches
• diarrhoea
• nausea
• vomiting

Self-help tips for indigestion in pregnancy

You may not need medicine to control your symptoms. Your GP or midwife may suggest some of the following changes to your diet and lifestyle. In many cases, these changes can be enough to ease your symptoms.

Stop smoking to banish indigestion

Smoking when you're pregnant can cause indigestion and seriously affect your health, as well as the health of your unborn baby. Smoking increases the risk of:

• your baby being born prematurely (before week 37 of your pregnancy)
• your baby being born with a low birth weight
• cot death, or sudden infant death syndrome (SIDS)

When you smoke, the chemicals you inhale can contribute to your indigestion. These chemicals can cause the ring of muscle at the lower end of your oesophagus to relax. This allows stomach acid to leak back up into your oesophagus more easily (known as acid reflux).

If you smoke, quitting is the best thing that you can do for your own and your baby's health. You can speak to your GP or midwife for more information, or you can call the NHS Smokefree Helpline, which offers support and encouragement to help you quit smoking. You can call them on 0300 123 1044 or go to the NHS Smokefree website.

Here are 8 steps to take to help you stop smoking right away.

Avoid alcohol to ease indigestion

Drinking alcohol can contribute to the symptoms of indigestion. During pregnancy, it can also put your unborn baby at risk of developing serious birth defects. Find out more about alcohol and pregnancy.

The Department of Health recommends that all pregnant women avoid drinking alcohol completely during pregnancy. It advises that if you do choose to drink while you're pregnant, to minimise risks to your baby you should not drink more than 1-2 units of alcohol once or twice a week, and should not get drunk.

The National Institute for Health and Care Excellence (NICE) recommends that pregnant women and women planning to become pregnant should avoid drinking alcohol in the first three months of pregnancy because there may be an increased risk of miscarriage.

One UK unit is 10ml (or eight grams) of pure alcohol. This is equal to:

• half a pint of beer, lager or cider at 3.5% alcohol by volume (ABV: you can find this on the label)
• a single measure (25ml) of spirit, such as whisky, gin, rum or vodka, at 40% ABV
• half a standard (175ml) glass of wine at 11.5% ABV

You can find out how many units there are in different types and brands of drinks with the Drinkaware unit calculator.

If you have difficulty cutting down what you drink, talk to your midwife, doctor or pharmacist. Confidential help and support is available from local counselling services (look in the telephone directory or contact Drinkline on 0300 123 1110).

Eat healthily to avoid indigestion

You are more likely to get indigestion if you are very full, so regularly eating large amounts of food may make your symptoms worse. If you are pregnant, it can be tempting to eat more than you would normally, but this may not be good for you or your baby. You don't need to "eat for two".

During pregnancy you do not need to go on a special diet, but it is important to eat a variety of different foods every day to get the right balance of nutrients that you and your baby need. Find out more about eating a healthy diet in pregnancy and foods to avoid.

Change your eating habits

In some cases, you may be able to control your indigestion by making changes to the way you eat. For example:

• it may help to eat smaller meals more frequently, rather than larger meals three times a day
• avoid eating within three hours of going to bed at night
• sit up straight when you eat because this will take the pressure off your stomach

Drinking a glass of milk may relieve heartburn (the burning sensation from stomach acid leaking up into your oesophagus). You may want to keep a glass of milk beside your bed in case you wake up with heartburn in the night.

Avoid indigestion triggers

You may find that your indigestion is made worse by certain triggers, such as:

• drinking fruit juice
• eating chocolate
• bending over

Make a note of any particular food, drink or activity that seems to make your indigestion worse and avoid them if possible. This may mean:

• eating less rich, spicy and fatty foods
• cutting down on drinks that contain caffeine, such as tea, coffee and cola (find out more about caffeine and pregnancy)

Prop your head up

When you go to bed, use a couple of pillows to prop your head and shoulders up, or raise the head of your bed by a few inches by putting something underneath the mattress.

The slight slope should help prevent stomach acid from moving up into your oesophagus while you sleep.

Prescription medicines

Speak to your GP if you are taking medication for another condition, such as antidepressants or non-steroidal anti-inflammatory drugs (NSAIDs), and you think it may be contributing to your indigestion. Your GP may be able to prescribe an alternative medicine.

Never stop taking a prescribed medication unless you are advised to do so by your GP or another qualified healthcare professional who is responsible for your care.

Avoiding backache in pregnancy

There are several things you can do to help prevent backache from happening, and to help you cope with an aching back if it does occur.

The tips listed here can help you to protect your back – try to remember them every day:

• avoid lifting heavy objects
• bend your knees and keep your back straight when lifting or picking up something from the floor
• move your feet when turning round to avoid twisting your spine
• wear flat shoes as these allow your weight to be evenly distributed
• work at a surface high enough to prevent you stooping
• try to balance the weight between two bags when carrying shopping
• sit with your back straight and well supported
• make sure you get enough rest, particularly later in pregnancy

A firm mattress can also help to prevent and relieve backache. If your mattress is too soft, put a piece of hardboard under it to make it firmer. Massage can also help.

Exercises to ease backache in pregnancy

The gentle exercise below helps to strengthen stomach (abdominal) muscles and this can ease backache in pregnancy:

• start in a box position (on all fours) with knees under hips, hands under shoulders, with fingers facing forwards and abdominals lifted to keep your back straight
• pull in your stomach muscles and raise your back up towards the ceiling, curling your trunk and allowing your head to relax gently forward – don't let your elbows lock
• hold for a few seconds then slowly return to the box position
• take care not to hollow your back – it should always return to a straight, neutral position
• do this slowly and rhythmically 10 times, making your muscles work hard and moving your back carefully
• only move your back as far as you can comfortably

The National Institute for Health and Clinical Excellence (NICE) advises that exercising in water, massage therapy, and group or individual back care classes might help to ease back pain in pregnancy.

Some local swimming pools provide aquanatal classes (gentle exercise classes in water, especially for pregnant women) with qualified instructors. Ask at your local leisure centre. Being in water will support your increasing weight.

When to get help for backache in pregnancy

If your backache is very painful, ask your doctor to refer you to an obstetric physiotherapist at your hospital. They can give you advice and may suggest some helpful exercises.

Get tips on preventing back pain at work and find out how you can deal with stress at work.

Find out about more common problems in pregnancy, including pelvic joint pain (sometimes called SPD).
Healthtalkonline has interviews with women talking about their experiences of pelvic pain in pregnancy and how they coped.

Find out why antenatal classes are important, what to do on labour day and more.

Constipation in pregnancy

You may become constipated very early in pregnancy because of the hormonal changes in your body.

Avoiding constipation

There are a few things you can do to help prevent constipation. These include:

• eat foods that are high in fibre, such as wholemeal breads, wholegrain cereals, fruit and vegetables, and pulses such as beans and lentils (find out more about healthy eating in pregnancy)
• exercise regularly to keep your muscles toned (find out more about exercise in pregnancy)
• drink plenty of water
• avoid iron supplements as they can make you constipated – ask your doctor if you can manage without them or change to a different type

You can find out more about the symptoms of constipation and treatment of constipation, including the safe use of laxatives during pregnancy.

Cramp in pregnancy

Cramp is a sudden, sharp pain, usually in your calf muscles or feet. It is most common at night. Nobody really knows what causes it, but there are some ideas about causes of cramp and why it can happen in pregnancy.

Avoiding cramp

Regular, gentle exercise in pregnancy, particularly ankle and leg movements, will improve your circulation and may help to prevent cramp occurring. Try these foot exercises:

• bend and stretch your foot vigorously up and down 30 times
• rotate your foot eight times one way and eight times the other way
• repeat with the other foot

How to ease cramp

It usually helps if you pull your toes hard up towards your ankle or rub the muscle hard. You can find out more about treatment of cramp, but remember always to consult your midwife, GP or pharmacist before taking painkillers in pregnancy. See Can I take paracetamol when I'm pregnant?

Feeling faint in pregnancy

Pregnant women often feel faint. This is because of the hormonal changes occurring in your body. Fainting happens if your brain is not getting enough blood and therefore not enough oxygen.

You are most likely to feel faint if you stand too quickly from a chair or out of a bath, but it can also happen when you are lying on your back. You can find out more about causes of fainting.

Avoiding feeling faint

Here are some tips to help you cope:

• try to get up slowly after sitting or lying down
• if you feel faint when standing still, find a seat quickly and the faintness should pass – if it doesn’t, lie down on your side
• if you feel faint while lying on your back, turn on your side

It’s better not to lie flat on your back in later pregnancy or during labour. Find out more about the symptoms that might mean you're going to faint, such as a sudden, clammy sweat, ringing in your ears and fast, deep breathing. You can also find out about treating faintness, including what to do to help someone who is about to faint.

Feeling hot in pregnancy

During pregnancy you’re likely to feel warmer than normal. This is due to hormonal changes and an increase in blood supply to the skin. You’re also likely to sweat more. It helps if you:

• wear loose clothing made of natural fibres, as these are more absorbent and breathe more than synthetic fibres
• keep your room cool – you could use an electric fan to cool it down
• wash frequently to help you feel fresh

Incontinence in pregnancy

Incontinence is a common problem both during and after pregnancy. Sometimes pregnant women are unable to prevent a sudden spurt of urine or a small leak when they cough, laugh or sneeze, or when they move suddenly, or just get up from a sitting position. This may be temporary, because the pelvic floor muscles (the muscles around the bladder) relax slightly to prepare for the baby's delivery. You can find out more about the causes of incontinence and preventing incontinence. You can help to prevent incontinence by doing pelvic floor exercises.

When to get help

In many cases incontinence is curable. If you have got a problem, talk to your midwife, doctor or health visitor. You could also call the confidential Bladder and Bowel Foundation helpline on 0845 345 0165, Monday to Friday, 9.30am to 1pm. The Bladder and Bowel Foundation provides a factsheet on how to do pelvic floor exercises (PDF, 663kb).

Urinating a lot in pregnancy

Needing to urinate (pass water, or pee) often may start in early pregnancy. Sometimes it continues throughout pregnancy. In later pregnancy it is the result of the baby’s head pressing on your bladder.

How to reduce the need to pass urine

If you find that you need to get up in the night to pass urine, try cutting out drinks in the late evening. But make sure you drink plenty of non-alcoholic, caffeine-free drinks during the day. Later in pregnancy, some women find it helps to rock backwards and forwards while they are on the toilet. This lessens the pressure of the womb on the bladder so that you can empty it properly.

When to get help

If you have any pain while passing water or you pass any blood in your urine, you may have a urine infection, which will need treatment. Drink plenty of water to dilute your urine and reduce pain. You should contact your GP within 24 hours of first noticing these symptoms. You can find out more about:

• symptoms of urinary infections
• treating urinary infections

Don't take any medicines without asking your midwife, doctor or pharmacist whether they are safe in pregnancy.

Skin and hair changes in pregnancy

Hormonal changes taking place in pregnancy will make your nipples and the area around them go darker. Your skin colour may also darken a little, either in patches or all over.

Birthmarks, moles and freckles may also darken. Some women develop a dark line down the middle of their stomach. These changes will gradually fade after the baby is born, although your nipples may remain a little darker.

If you sunbathe while you are pregnant, you may find you burn more easily. Protect your skin with a high-factor sunscreen and don’t stay in the sun for a long time. Find out more about keeping skin safe in the sun.

Hair growth can also increase in pregnancy, and your hair may be greasier. After the baby is born, it may seem as if you are losing a lot of hair but you are simply losing the extra hair.

Varicose veins in pregnancy

Varicose veins are veins that have become swollen. The veins in the legs are most commonly affected. You can also get varicose veins in the vulva (vaginal opening). They usually get better after the birth.

If you have varicose veins you should:

• try to avoid standing for long periods of time
• try not to sit with your legs crossed
• try not to put on too much weight as this increases the pressure
• sit with your legs up as often as you can, to ease the discomfort
• try support tights, which may also help to support your leg muscles – you can buy them at most pharmacies
• try sleeping with your legs higher than the rest of your body – use pillows under your ankles or put books under the foot of your bed
• do foot exercises and other antenatal exercises, such as walking and swimming, which will all help your circulation

Try these foot exercises:

• bend and stretch your foot up and down 30 times
• rotate your foot eight times one way and eight times the other
• repeat with the other foot

Find out more about preventing varicose veins.