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Publications
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Minor Ailments of Pregnancy (Self Help Leaflet) |
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This leaflet aims to explain some of the physical symptoms you may be experiencing during your pregnancy, or in the first three months after childbirth. We hope that the advice in this leaflet is helpful in making you more comfortable. This leaflet was written by expert physiotherapists who are members of the Association of Chartered Physiotherapists in Women’s Health (ACPWH).
To be a member of the ACPWH, a physiotherapist must have completed a post-graduate qualification, and have extensive experience in treating patients with women’s health conditions. These include back and pelvic pain during and after pregnancy, and pelvic floor muscle problems for women and men at any time of life.
If the advice in this leaflet is not enough to relieve your symptoms, you may like to contact your nearest ACPWH member. To do this, please click on ‘Contact Us’. Your midwife or GP should be able to refer you to a women’s health specialist physiotherapist.
Keeping generally fit, by taking moderate exercise every day, such as brisk walking or swimming, may help to minimise some of the minor discomforts (see Fit and Safe for mothers, below). Pelvic floor muscle exercises are also beneficial (see Pelvic floor muscle exercises, below).
The ACPWH also has a wide range of leaflets available for viewing online, and to purchase. These can be found at on our website by clicking here. These include leaflets on:
• Fit for Pregnancy -preparing for pregnancy
• Fit and Safe for mothers – exercising safely in pregnancy
• Pregnancy-related pelvic girdle pain - pelvic girdle pain during and after pregnancy
• Promoting continence with Physiotherapy –advice on bladder or bowel problems
• Pelvic floor muscle exercises – how to practise your pelvic floor muscle exercises correctly
• Fit for Birth - preparing for childbirth
• Fit for Motherhood - getting back to normal after childbirth
• The Mitchell Method of simple relaxation – how to rest during pregnancy and after
We hope that the information below is useful to you. Because there is little research on these conditions, the advice here is based on the opinions of expert physiotherapists.
WRIST & HAND PAIN (Including carpal tunnel syndrome)
SWOLLEN ANKLES
VARICOSE VEINS
VULVAL VARICOSITIES
LEG CRAMPS
RIBFLARE
Low back pain (LBP) or pelvic girdle pain (PGP)
COCCYDYNIA (PAINFUL TAILBONE)
RECTUS ABDOMINIS DIASTASIS
Condition
WRIST & HAND PAIN (Including carpal tunnel syndrome)
What is it?
Numbness, pain, pins and needles or tingling in the wrists or hands, usually worse in the hand you use to write with (dominant hand). Symptoms are usually worse at night and when you wake up in the morning. During the daytime some women notice difficulty holding onto objects.
Why does it happen?
Some women develop carpal tunnel syndrome, where the extra fluid in your body during pregnancy is compressing the median nerve in your wrist. This causes numbness, pins and needles or tingling sensations in your hands and wrist. Swelling can also make your fingers feel tight and painful.
Some women develop a tendonitis of the muscles to the thumb. This causes pain when you use your thumb. Other women can have nerve compression due to a problem with the joints in their neck or upper back, or from tennis elbow e.g. from an overuse injury such as using a computer for long periods without a break.
How can I help myself?
Try to keep your wrists straight when you are in bed – sleeping with your hands and wrists curled up can increase the pressure on the nerves. When you wake up, hold your arms over your head and open and close your fingers 10 times to relieve any swelling. Some women find that holding their hands under cold water can help. Other women alternate hot and then cold water for 30 seconds each, 10 times, to improve their circulation.
Poor posture can cause problems with your neck and upper back. Make sure that you wear a good-fitting bra, as this will help your posture. If you use a computer or do other repetitive work with your hands for long periods be sure to take regular breaks at your desk – use this time to open and close your hands or stretch.
If you have thumb pain, ice may be helpful. Wrap ice in a damp tea towel or face cloth to avoid an ice burn, and only use for 5-10 minutes. This can be repeated 3-4 times daily. Try to avoid repetitive activities which may increase your pain.
When do I need help?
If your wrist or hand symptoms are stopping you from sleeping or doing your daily tasks, you could ask to be referred to a women’s health specialist physiotherapist. Some women are given wrist splints to keep their wrists straight when they are in bed. Most wrist or hand pain settles immediately or within a few weeks after childbirth.
Condition
SWOLLEN ANKLES
What is it?
Most pregnant women notice some swelling of their feet and ankles by the end of their pregnancy. This can range from mild to severe.
Why does it happen?
Swollen ankles are very common in pregnancy, due to the higher volume of fluid retained by your body and changes in your hormone levels. This fluid tends to collect in your feet and ankles by the end of the day, particularly if the weather is very warm.
How can I help myself?
Try to rest with you feet and ankles raised, and practise circling your ankles or pedalling your feet up and down to increase your circulation. Avoid wearing tight clothes or shoes which may cut into your feet and ankles. Reducing how much salt you eat may also help.
When do I need help?
If your ankles, hands or face swell suddenly you should contact your midwife or GP.
Condition
VARICOSE VEINS
What is it?
Enlarged and bulging veins, usually in your legs. These may be painful.
Why does it happen?
A varicose vein occurs when the valves in your veins are unable to shut properly, and blood collects behind the valve. This stretches the wall of the vein and causes it to bulge. This is due to your changing hormones, the increased amount of blood which circulates during pregnancy, and compression on the blood vessels in your pelvis as your baby grows.
How can I help myself?
Avoid standing for long periods, and sitting or lying with your legs or ankles crossed. Brisk walking (although you should avoid becoming breathless or too hot) may be helpful. Varicose veins usually resolve improve or disappear after your baby is born.
When do I need help?
If your varicose veins are very painful or limiting your daily activities, your midwife may suggest that you wear support tights.
Condition
VULVAL VARICOSITIES
What is it?
These are varicose veins of the vulva (the female external genital area). You may find that they ache, and can occasionally be very painful. However they will not affect your ability to have a vaginal delivery.
Why does it happen?
These develop in the same way as varicose veins in the legs, as a result of the hormonal, pressure and fluid volume changes of pregnancy.
How can I help myself?
It is sensible to avoid standing for long periods, and to avoid constipation. It may be helpful to wear supportive maternity underwear.
When do I need help?
If your pain is severe, sometimes a maternity belt can be useful to support your tummy and hopefully help your blood to circulate better. Vulval varicosities usually disappear after your baby is born.
Condition
LEG CRAMPS
What is it?
A sudden painful tightening, usually in your calf muscle. This often happens when you are in bed. This is much more common in pregnancy.
Why does it happen?
Even though this is common in pregnancy, the exact cause is not known.
How can I help myself?
It may help to stretch your calf muscles before you get into bed. Sit on your bed with your leg straight out in front of you. Using a towel hooked over your foot, pull your foot towards your head, keeping your knee straight. You should feel a moderate stretch in your calf muscle. Hold this position for 10 – 15 seconds, and then relax. Repeat this three times on each leg.
When you get the cramp, stretch the muscle straightaway by pulling your foot up. This should help the cramp to ease.
When do I need help?
There is little else that can be done to help with leg cramps during pregnancy.
Condition
RIBFLARE
What is it?
Discomfort and aching over your lower ribs during pregnancy, usually just on one side.
Why does it happen?
During pregnancy the shape of the chest and ribcage begins to change. This allows more room for the diaphragm, which is being pushed up by your growing baby. The changing angles of the ribs can cause some discomfort.
How can I help myself?
Avoid sitting in one position for long periods - change your sitting or resting position regularly. Always sit with good posture, preferably in a well supporting chair. Your lower back should be supported by the chair, or with a small rolled up towel.
Stretches can help to relieve your pain. Sit on a dining room style chair, lift one arm over your head, and lean the top half of your body sideways, away from the ache. Sometimes it can help to turn your body a little at the same time. Hold this position for 10-15 seconds, and then relax. Repeat this 2 or 3 times.
When do I need help?
If your symptoms are stopping you from doing your normal daily activities you should ask to be referred to a women’s health specialist physiotherapist.
Pain from ribflare usually disappears after childbirth.
Condition
Low back pain (LBP) or pelvic girdle pain (PGP)
What is it?
Pain in your lower back, you may also have pain in your buttock or leg. If the pain is severe you may also have pins and needles, tingling or numbness in parts of your leg.
Some women have pain that is felt at the back of your pelvis, in your hips or around your pubic bone. You may have pain in just one of these places, or feel a band of pain all of the way around your pelvis. This is pelvic girdle pain. The pain may travel down the back of your leg, inner thigh muscles or low tummy muscles.
Pain in your tailbone (coccyx) can also be caused by a low back problem, or a problem with the muscles or joints in your pelvis.
You may have low back pain and pelvic girdle pain together. Your pain may start during pregnancy, or in the first few months after childbirth.
Why does it happen?
There are many different causes of LBP and PGP, and every woman is different. Changes to your posture and the way that you move during pregnancy may contribute to your pain. Some muscles naturally become weak during pregnancy, and others can work too hard. This imbalance can be part of your problem. Sometimes the joints in your pelvis or lower back may not move as well as they should which can also cause pain.
Women who had low back pain before pregnancy should not necessarily expect their pain to be worse during pregnancy. Some back pain is better during pregnancy, or it may remain the same as usual.
How can I help myself?
Make sure that you stand and move with good posture – make sure that your bump isn’t pulling you forwards as this can pull on your lower back. A good exercise for this is pelvic tilting – stand with your hands resting on the back of a chair or your kitchen counter, so that you are leaning forwards a little. Keep your knees soft. Practise tucking your bottom under (as if you are tucking your tail between your legs) to reduce the arch in your lower back. Now relax. Repeat this six times, 3 or 4 times each day. If your pain gets worse after doing this exercise then you should stop the exercise.
Make sure that you use your legs to help you lift toddlers, babies or objects around the house. Try to keep your back straight.
A good fitting bra will help your posture.
When do I need help?
If your lower back pain or pelvic girdle pain is stopping you from doing your normal daily activities you could ask to be referred to a women’s health specialist physiotherapist. It is usually better to seek help sooner than later.
Condition
COCCYDYNIA (PAINFUL TAILBONE)
What is it?
A tender or painful tailbone (coccyx). The pain is usually felt if you sit for long periods, especially if you slump. Other activities which are painful may include getting up from sitting, changing position, getting in and out of bed, opening your bowels, coughing, sneezing, or touching your tailbone.
Pain may vary from mild to severe. You may develop coccydynia during pregnancy or after delivery.
Why does it happen?
There are several different causes of coccydynia (see also ‘low back pain and pelvic girdle pain’ information).
As your baby grows your joints and muscles have to move in different ways. This can contribute to coccydynia. Some women find their pain starts after delivery – the tailbone can be bruised, and make it very difficult to sit comfortably. Your tailbone can also be bruised if you have a fall.
How can I help myself?
Sitting with good posture, in a firm upright chair can help to keep the pressure off your tailbone. Support your lower back by placing a rolled up towel between your lower back and the chair. Avoid slumping, as this puts more pressure on your tailbone. If you are unable to sit on a normal chair, try sitting on two pillows with a small gap between them. Alternatively, you could purchase a ‘coccyx cushion’ which is shaped like a wedge, with a small cut out for your tailbone. If you have had your baby, it may be helpful to feed your baby while you are lying down.
Keep practising your pelvic floor muscle exercises. Avoid heavy lifting, constipation, and sitting or standing for long periods.
Ice can be useful if you have bruised your tailbone (for example after delivery, or after a fall). Be sure to wrap the ice in a damp cloth to avoid an ice burn. Do not leave ice on for more than 10 minutes, and do not sit directly on top of the ice pack (this compresses your tissues and increases the risk of an ice burn). Ice can be applied 3-4 times daily.
When do I need help?
If you try the advice above but your pain continues, you could ask to be referred to a women’s health specialist physiotherapist.
Condition
RECTUS ABDOMINIS DIASTASIS
What is it?
Separation of your abdominal (tummy) muscles during pregnancy.
Why does it happen?
This is a normal change which happens as your baby gets bigger. Your tummy muscles have to stretch to make space for your baby. Most of the stretching in your tummy muscles resolves once you have had your baby.
How can I help myself?
Pelvic floor muscle exercises may help, as these muscles work with your deep abdominal muscles and help to support your tummy. You may also find Pilates or Yoga useful during pregnancy.
It is important not to gain too much weight while you are pregnant as this can also put more strain on your stomach muscles. Avoid heavy lifting where possible. Try to turn on to one side first, and then push yourself up with your arms to get in and out of bed, or the bath, instead of relying on your stomach muscles alone.
You should receive information on safe post-natal tummy exercises from the midwife or physiotherapist soon after delivery (see the ACPWH leaflets). If you have been practising Pilates or Yoga during your pregnancy, then you should be able to re-start the basic exercises within a few days of having your baby. Make sure that your tummy muscles are gently drawing in, and not bulging.
When do I need help?
If your tummy muscles are painful during pregnancy you could ask to be referred to a women’s health specialist physiotherapist. If you have had your baby and your muscles remain separated, feel very weak or painful, you may be referred to a women’s health specialist physiotherapist.
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Journal Issue 102 (Spring 2008) |
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Spring 2008 (Issue 102)
Issue 102 of the journal was published in Spring 2008.
 Non-printable pages can be downloaded and read but not printed.
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Contents |
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Editorial |
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Margie Polden Memorial Lecture: The psychology of incontinence – why successful treatments fail by P. Toozs-Hobson & K. Loane |
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The application of antenatal perineal massage: a review of literature to determine instruction, dosage and technique by L. E. Jones & N. Marsden |
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Pelvic girdle pain in three pregnant women choosing chiropractic management: a pilot study using a respondent-generated instrument and chiropractor’s assessment tool by C. G. Andrew, N. Eaton & G. Dorey |
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A retrospective postal survey of women’s experiences of physiotherapy management following a third- or fourth-degree perineal tear by A. Johnson & A. P. Rochester |
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The efficacy of a multidisciplinary approach to the management of constipation: a case series by R. W. C. Leung, B. K. Y. Fung, L. C. W. Fung, W. C. S. Meng, P. Y. Y. Lau & A. W. C. Yip |
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Prioritizing incontinence research: patients, carers and clinicians working together by B. Buckley, A. M. Grant, L. Firkins, A. C. Greene & J. Frankau |
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Pain: what, where, how and why? by L. E. Jones |
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Acupuncture for the treatment of overactive bladder by P. Graham & T. Cook |
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Speaker abstracts |
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Conference and course reports:
- The Rise and Fall of the Pelvic Floor (Pauline Walsh & Kate Wrigley)
- Faecal Incontinence: A NICE Guideline You Would Really Prefer Not to Discuss? (Katie Mann)
- ACPWH Conference (Rebecca Storer & Jo Racle)
- Clinical Interest and Occupational Groups Conference (Leslie Southon & Gail Stephens)
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From your executive |
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Round the regions |
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Area representatives 2008 |
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ACPWH research (Becky Aston) |
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ACPWH education and awards (Ros Thomas) |
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International Organization of Physical Therapists in Women’s Health (Gill Brook) |
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Gone walkabout: tales of a travelling physio (Teresa Cook) |
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Visit to Ralph Allen Press Limited (Ros Thomas) |
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What do you know about Baby Milk Action? (Teresa Cook) |
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Book, journal and DVD reviews |
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Website watch (Jenny Kinahan) |
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Notes and news |
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Letters |
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Papers in other journaks |
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Reading lsit |
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Writing for ACPWH Journal: Guidelines for authors |
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Journal back issues
The ACPWH has recently decided to make past issues of the Journal available online. The most recent journals are only available in a members only section of the website - see Members Only from the menu on the left.
Older journals are available here for download. If you would like to order a copy of a journal, please see the Journal section of the website by clicking here
The currently available journals are:
Spring 2007 (Issue 100)
Autumn 2007 (Issue 101)
Spring 2008 (Issue 102)
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Journal Historical Index
A historical index has been compiled of all the articles in previous journals.
This can be viewed on the website by clicking here or by downloading in Excel format by clicking here. |
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The ACPWH produces a bi-annual Journal which is available free of charge to all ACPWH members.
The Journal contains a number of papers sent in by individuals currently involved in research related to women's health.
The journal also contains news and reports about ACPWH, details of forthcoming events, and is a forum for members to communicate with one another.
A pdf document containing the guidlines for writing in the ACPWH Journal can be downloaded here: Writing for the ACPWH Journal: guidelines
Journal back issues
The most recent editions of the journal can be downloaded by ACPWH members only. In order to access these downloads, please login using the Members Login box to the left on this page. If you do not have your ACPWH website login, please click here for details.
Older journals are available to all visitors to this site, however some of the publications can be downloaded but it is not possible to print them. These can be accessed here.
To purchase an individual copy of the journal at a cost of £20, or back dated journals, please contact Katie at Fitwise,
» Send email to Katie at Fitwise
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