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INFORMATION

Patient Information Sheet │ English

Backache

Lower back pain is a very common complaint during pregnancy, particularly during advanced pregnancy, when the weight of the growing baby pus strain on a woman I s back muscles. During pregnancy, your body produces a hormone, relaxin, which makes your ligaments softer and more elastic. This makes joints more susceptible to strain and pain.
To minimise backache, get regular exercise, make a conscious effort to stand or sit up straight, wear low-heeled shoes and get plenty of rest. Ease aches and pains by relaxing in a warm bath or having an aromatherapy back massage.

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Cracked nipples

For relief from cracked and some sore nipples, air your breasts for 10 minutes after each
feed and then place a used Rooibos tea bag over the nipples. Leave on inside the breast-pad
until the next feed.

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During breastfeeding

To help ensure a good flow of breast milk, keep up your liquid intake with at least four cups
of Rooibos tea and four glasses of water a day. Drinking too much can actually suppress milk
production, so limit your fluid intake to 2 litres a day. Always have a thermos of Rooibos tea,
rather than drinks containing caffeine (such as coffee’ I normal” tea), will help to prevent and treat tummy cramps in the breastfeed baby.

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Haemorrhoids

Haemorrhoids (Piles) During & After Pregnancy.

Few people talk about one of the most common problems experienced during pregnancy-­haemorrhoids. Also known as piles, haemorrhoids are thought to affect more than half of people in the Westernised world, and a large percentage of pregnant women. Determining how many people are affected is not always easy, because haemorrhoids are one of those subjects people prefer to keep to themselves.

While haemorrhoids are more irritating than dangerous, it is important to have a doctor confirm that any symptoms you have (such as rectal bleeding) are indeed caused by haemorrhoids, and not by more serious condition.
Those most likely to develop haemorrhoids include Westernised people who eat a low-fibre diet, the elderly, pregnant women, those chronically straining with constipation, people with heavy lifting jobs and those who are overweight.

What are Haemorrhoids?

Haemorrhoids (piles) are swollen, congested and enlarged (but normally present) blood vessels in and around the anus and lower rectum that stretch under pressure. Veins inside and around the opening of the anus (back passage). They can be described as “varicose veins” of the rectum. These blood vessels lie just below the surface of the anus lining, and may cause pain, irritation and itching and may even bleed slightly.

The blood from haemorrhoids is bright red in colour, and may show up on the stool or on toilet paper after a bowel movement. Sometimes, haemorrhoids develop ulcers/sores and produce mucous which may be seen on toilet paper. Sufferers may feel as if they have a lump or bump hanging down from the anus.

Haemorrhoids can occur just inside the rectum (internal haemorrhoids) making them undetectable to you, they may prolapse or protrude outside the rectum (protruding haemorrhoid), or may appear as a lump under the skin in the area of the rectum (external haemorrhoids). Haemorrhoids that protrude through the anus may cause continual discomfort and difficulty in cleaning the area.
Excessive straining, itching or rubbing around the anus can cause bleeding and irritation in the affected area. Haemorrhoids can make proper cleaning pf the area difficult, resulting in skin irritation and even infection. It is important for haemorrhoid sufferers to take extra care to wipe the area clean with soap and water and dry thoroughly after every bowel movement.

Many anorectal problems, including fissures, fistulae, abscesses, or irritation and itching (pruritu ani), have similar symptoms and are incorrectly referred to as haemorrhoids.

Signs and Symptoms of Piles

  • Anal itching and irritation.
  • Pain when sitting, or when passing a motion.
  • Bright red blood on the stool, or toilet paper or even in the toilet bowl.
  • Sensation of a tender or hard lump in the anal region.

Why do They Occur?

Haemorrhoids develop when increased pressure causes the blood-vessels in the anal region to become dilated and stretched, and then to protrude through the walls of the anal region. The blood in these swollen vessels may even clot and so form a firm or nodule. Pile containing clots are particularly likely to bleed.

Why are they more common in pregnancy?

During pregnancy, women may develop haemorrhoids for several reasons:

  • The increasingly heavy uterus (womb) puts pressure on the veins taking blood from the lower body to the heart. When the walls of these veins are weakened by increased blood pressure, the results can be a bulging blood vessel such as a varicose vein or haemorrhoid.
  • The hormone progesterone, which is produced during pregnancy, relaxes the walls of the veins, causing them to swell.
  • Progesterone also slows down the digestive system, increasing the pregnant woman’s tendency to become constipated. When she strains to pass a hard stool, added pressure is put on the blood vessels in the rectal area.
  • Iron supplements, which may be needed during pregnancy, may cause constipation. This also results in straining during bowel movements.
  • As the uterus grows, it can press on the bowel and slow down the passage of stool, resulting in straining during bowel movements.

After Pregnancy

In some cases, the haemorrhoids that develop during pregnancy shrink after delivery, causing no further symptoms. However some women develop haemorrhoids for the first time after delivery. This is because of immense pressure put on the weakened blood vessel walls during the straining of labour and delivery. Women may find that they have haemorrhoids, or even painful varicose veins in their vaginal and perineal area, after delivery.
Constipation may also develop after delivery, due to the effects of pain-killers, or due to reluctance to pass stool because of pain in the vaginal and perineal areas. This ultimately results in a vicious cycle of straining during bowel movements, avoiding bowel movements because of pain, worsening constipation and consequent straining. This constant straining can cause new haemorrhoids to develop.

Minimising Haemorrhoids

Because haemorrhoids are worsened by constipation and the resultant straining during bowel movements, the most important step towards minimising haemorrhoids is to avoid constipation. Drink plenty of fluids and increase your fibre intake to improve bowel function. Cut down on processed foods.

You could also try a soothing sitz bath to clean the area and soothe the irritated skin. Use a specially- designed sitz bath that fits over the toilet, or simply sit in a bath of warm or ice­ cold water for 10 to 15 minutes, three be used, to clean the rectal area and help to reduce the swelling. If a haemorrhoid is extremely painful after a bowel movement, you could try applying an ice pack to the area for a few minutes.

Creams and suppositories can help to reduce swelling, inflammation and itching. Treatments are usually available in topical cream for external haemorrhoids or suppository form for internal haemorrhoids. Fibre supplements may also be useful. To reduce constipation.
Do NOT strain when attempting to pass a motion, and don’t linger on the toilet because it puts pressure on the area. In addition do not scratch or wipe vigorously- or the condition may well worsen.

Do Kegel exercise daily: Tense the muscles around your vagina and anus and hold for eight to 10 seconds before releasing and relaxing. Repeat 25 times. Not only will these increase circulation in the rectal area and strengthen the muscles around the anus (thereby decreasing the chance of haemorrhoids), but they also strengthen and tone the muscles around the vagina and urethra, which aids in postpatrum recovery.

Avoid sitting or standing for long stretches of time during your pregnancy. If your job involves sitting, get up and move around for a few minutes every hour or so. At home, lie on your side when sleeping, reading, or watching TV to take the pressure off your rectal veins and help increase blood return from the lower half of your body.

Medical Treatment

Consult your doctor if you notice any changes in bowel movements or rectal bleeding, as these could be symptoms of more serious conditions. These doctor may examine the anus and rectum to look for swollen blood vessels that indicate haemorrhoids. The doctor may also perform a digital rectal examination with a gloved finger, to check for abnormalities. Examinations may also be done using anoscope or proctoscope (fibre-optic devices that a doctor passes through the anus to examine the inside of the bowel)

If haemorrhoids are diagnosed, the initial treatment will focus on relieving the symptoms. Treatment might include sitting in warm water several times a day, applying a topical haemorrhoid cream or using suppositories, and increasing the amount of fibre in the diet.

If these measures do not relieve the symptoms, further treatment may be needed. Whilst much depends on the severity of the piles and where they are situated, procedures that are commonly used to treat haemorrhoids include:

  • Rubber band ligation- in which a rubber band is placed around the base of the haemorrhoid. The band cuts off circulation, and the haemorrhoid withers away within a few days.
  • Infrared coagulation- in which the haemorrhoid is burnt off using a special infrared device.
  • Sclerotherapy – in which a chemical solution is injected around the blood vessel to shrink the haemorrhoid.
  • Haemorrhoidectomy- in which the haemorrhoids are surgically removed.

Avoiding Constipation

  • Exercise regularly, as this helps to keep bowel movements.
  • Drink plenty of water- up to two litres a day.
  • Increase your intake of fibre. Fibre holds water and allow for formation of softer, bulkier stools that can pass through the colon more rapidly. Wheat bran, cereals, whole wheat, fresh vegetables and fresh and dried fruit are good sources. If this does not help, ask your doctor about a fibre supplement.
  • A dessert spoonful of linseed (readily available at most supermarkets) which has been soaked in a glassful of water overnight and swallowed first thing in the morning, every morning, is highly recommendable for those who are readily inclined to become constipated.
  • Try to move your bowels at the same time every day. Do not ignore the urge to move your bowels, as this can worsen constipation.
  • Do not use laxatives, unless your doctor prescribes them. Some laxatives cause dangerous dehydration and electrolyte imbalances. In addition, your body may come to depend on laxatives for bowel movement, and lose the ability to pass a stool unaided.

Disclaimer: If any queries please contact your doctor

Heartburn

Heartburn is one of the most common discomfort experienced during pregnancy, affecting up to 80cra of all pregnant women. It may begin as early as the first trimester and symptoms may worsen as the pregnancy progresses. During pregnancy, the hormone progesterone relaxes the lower oesophageal sphincter (LOS) – the valve through which food passes into the stomach. This allows stomach acids to pass upwards into the oesophagus (food pipe), causing burning discomfort. In later pregnancy, the growing baby and uterus take up more and more space, cramping the stomach, making digestion slower and reflux worse.
To avoid heartburn, eat smaller meals more often, avoid spicy and fatty foods, citrus and caffeine, try chewing a non-mint chewing gum, and wait at least an hour after eating before lying down. Fortunately, heartburn usually clears up completely after delivery.

Heartburn During Pregnancy

Heartburn is one of the most common discomfort experienced during pregnancy, with up to 80’Yo of all pregnant women experiencing it at some point.
In many women, heartburn is experienced for the first time during pregnancy. It Can begin as early as the first trimester, with symptoms coming and going with varying degrees of discomfort until your baby is born. In many cases, the symptoms progressively worse as the pregnancy progresses.
Fortunately, it usually clears up completely after the delivery. Although it can be worrying, uncomfortable and even painful for you, heartburn is relatively and cannot affect your baby.

What is Heartburn

Heartburn is described as a feeling of burning discomfort, usually localised behind the breastbone. It also sometimes moves up toward the neck and throat.
This feeling is caused by gastro-oesophagus which means that digestive acid from the stomach, into the long muscular tube (oesophagus) that transport food from the mouth to the stomach. The delicate lining of the oesophagus becomes irritated by the acid, causing the discomfort we recognise as heartburn.

Symptoms of Heartburn

The common burning sensation of heartburn is experienced most often after meals. Sometimes, the acid moves far enough up the oesophagus to reach the mouth and the throat, causing a bitter, sour or salty taste in the mouth, and causing hoarseness or laryngitis.
The symptoms of heartburn are the same in pregnant women as in anyone else However, pregnant women may experienced heartburn more frequently, and often experience it when lying down. Heartburn may also develop after the movement that increase the pressure on the abdomen, such as straining, lifting coughing or bending over. It often worse at night, and in third trimester of pregnancy

Cause of Heartburn in Pregnancy

Between the lower part of the oesophagus and the stomach is a valve called the
lower oesophageal sphincter (LOS) . Normally this is a ‘one way valve’ that allows food to enter the stomach, but does not allow the stomach content to move out of the stomach again. However, if the (LOS) relaxes, the stomach acid will pass upwards into the oesophagus, causing the burning discomfort.
Factors such as fatty food ,cigarette, alcohol, chocolate and caffeine can relax The LOS, increasing the reflux. Reflux can also occur as a result of poor diet, hiatal hernia and obesity.

During pregnancy, the LOS can also relax due to the effects of hormone progesterone, which relaxes the walls of the uterus. Unfortunately this hormone also relaxes other muscle tissue, including the LOS, as well as slowing down the wavelike contractions of the stomach. This means that food takes longer to digest and more acids builds up in the stomach at the same time as the LOS is more relaxed than usual.
In later pregnancy, the growing baby and uterus up more and more space, cramping the stomach and making digestion even slower. The result in increased acid in the stomach and more severe reflux more often.

Diagnosis the Causes of Heartburn

If you experience heartburn for the first time during pregnancy, your doctor will probably not order any further investigation, beyond taking a through look at your medical history.
However, in highly exceptional cases, more tests might be needed to determine the cause of the heartburn. These tests might include:

  • Gastroscopy, using a flexible viewing tube passed through the mouth (you will be sedated). This may show signs of gastro- oesophageal reflux, such as redness or ulceration of the oesophageal lining.
  • Barium swallow/ meal- you swallow Barium, which shows up on spacial X-rays This rarely if ever done in pregnancy because of the wish to avoid X-ray if possible.

Avoiding Heartburn During Pregnancy

If you are prone to heartburn during pregnancy, there are steps you can take to minimise the discomfort. Most of these involve improving the digestion process, and so reducing the amount of acid in the stomach.

Eat smaller meals. Two or three larger meals will distend your stomach and increase discomfort. Rather have five or six smaller meals and snacks during the day.

Break food into smaller, more manageable portions and take smaller bites.

Eat slowly, do not rush, and chew food properly. The more you chew food properly. The more you chew the less time food stay in your stomach for proper digestion.

Drink only small amount of water with meals. You may swallow air as you drink, which makes heartburn worse.

Avoid spicy, or greasy food as these lower LOS tone.

Stay away from drinks containing caffeine, such as coffee and colas

Avoid citrus food and drinks such as oranges, orange juice and tomato juice.

These may irritate the lining of the oesophagus.

Avoid the alcohol and cigarettes.

Say no to chocolate, as this lowers LOS tone.

Try chewing a non- mint chewing gum. Chewing gum decreases the discomfort of heartburn. However peppermint can make it worse.

Do not eat while lying down.

Wait two hours before after eating before lying down, and immediately before bedtime.

Sleep at a slight incline. Prop your shoulders on a pillow or two, or elevate the head at the bed-time. This keep your stomach below your diaphragm, so that gravity will help to keep your stomach contents where they belong.

Try to avoid excess weight gain during pregnancy, as obesity worsens heartburn.

Wear loosely fitting clothing especially in the third trimester.

Treatment Options

If your heartburn doesn’t improve with smaller meals and avoiding factors such
as caffeine and citrus, you could also try natural treatment such as drinking a smaller glass of water or milk, or eating natural yoghurt or raw almonds at the first time of heartburn. This may help to neutralise the acid that causes the burning.
You can also treat heartburn with over-the counter antacids to neutralise the stomach acids. Normally, calcium/magnesium antacids act only on the acids in the stomach and are not taken up into the bloodstream, where they could affect the unborn child. Pregnant women therefore regard them a safe for use. However, as with all medication taken during pregnancy, you should consult your doctor or pharmacist first and try not to rely too heavily on this medication. Bear in mind that some antacids may be very high in sodium content that cause fluid retention. Excessive use of antacids could also reduce your body’s ability to absorb essential vitamins and minerals- such as iron from your food. Heartburn can also be treated with Alginate based products which are unlike antacids, as they work by forming a raft on top of the stomach contents, preventing the reflux of acid into the oesophagus thus avoiding the occurrence of heartburn. In addition, Alginate products usually contain low sodium, decreasing the risk of fluid retention.

When to call the Doctor

In most cases, heartburn peaks shortly before delivery and cleans up completely after the baby is born. However, if you suffer from heartburn after delivery, with symptoms surfacing more than twice a week or becoming debilitating, you could have gastro-oesophageal reflux disease (GORD). This has a physical cause and requires treatment by a doctor. With effective treatment, using a range of prescription medications, you may become symptom-free and avoid any potential complications.

Disclaimer: If any queries please contact your doctor

Morning Sickness

Around two-thirds of women experience nausea and vomiting (“morning sickness”) during the first few weeks of pregnancy. These arise from a combination pf hormonal changes, the effects of foetus and the increase in body weight.

To minimise nausea and vomiting, nibble on small meals regularly, and stick to dry toast, biscuits, fresh fruit and vegetables until you feel able to cope with heavier meals. Consider a nutritional supplement aimed at balancing your blood sugar levels, which may reduce tiredness and accompanying nausea. Only certain medicines are safe for treating morning sickness- your doctor will advise you. In many cases, these symptoms clear up after 14 weeks of pregnancy.

Does Morning Sickness only happen in the morning

  • “Morning” is a misnomer as the feeling of nausea can happen at any time of the day. It is largely caused by the hormonal changes taking place in the body, and its severity is highly variable.
  • Dry, plain biscuits, water and apples help alleviate nausea.
  • Often movement makes the nausea worse. Try not to eat whilst travelling or on arrival
    Anxiety has also been linked to morning sickness, and so relaxation methods may help.
  • Keep away from aromas which trigger nausea, like during cooking. In any event fresh fruit and vegetables (if thoroughly washed) are healthier.
  • Keep up your fluid intake.

Disclaimer: If any queries please contact your doctor

Painful perineum

If your perineum (area between vagina and anus) is uncomfortable after delivery, brew a pot
of strong Rooibos tea and add it to a sitz bath with a handful of coarse salt. Sit in the sitz
bath for at least 15 minutes. This will help to soothe the area. You could also soak a flannel in
strong, cold Rooibos tea and hold it against the perineum for 20 minutes.
To relieve swelling, also take an Arnica D6 tablet every two hours for the area to sunlight for
10 minutes twice a day to speed up healing.

Disclaimer: If any queries please contact your doctor

Pelvic pain

Pregnant women commonly experience sharp or tingling pain in the groin area and down the insides of the thighs later in pregnancy, usually worse after walking or standing for long periods. This is caused by the weight of the baby pressing on the pelvic nerves. Lying down should help to ease any such pains.

Pelvic pain classically gets worse when ”lightening” occurs at approximately 8 months in women having their first baby. This is when the baby’s head ”drops” into the birth passage of the mother’s pelvis.

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Stretch Marks

Stretch Marks, Pigmentation and Spider Veins Stretch marks (striae gravidarum), develop in 50% and 90% of pregnant women. These vary from pale pink lines to deep purple ridges on the stomach, breasts, hips and buttocks. Research suggests that avoiding excessive weight gain during pregnancy, along with maintaining a healthy skin, may help to minimise the appearance of stretch marks. Eat a healthy diet and drink lots of water to keep your skin healthy. Oils, creams or lotions high in vitamin E or linoleic acid massaged into the abdomen, buttocks and thighs regularly may also help to condition the skin and possibly minimise stretch marks. Another common pregnancy skin niggle is pigmentation. The ”mask of pregnancy” (melasma)- a blotchy, brownish pigment- may appear on the skin of the forehead and checks. Pigmentation may also increase in the skin surrounding the nipples and a dark line commonly appears down the middle of the abdomen from the navel to the pubic bone. Small spider like blood vessels (spider angiomas) may also appear in the skin. Usually above the waist, as may thin-walled, dilated capillaries, especially in the lower legs.

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Urinary Incontinence

Urinary Incontinence is leaking of urine from the bladder at inopportune moments. During pregnancy, the added weight and pressure of the uterus on the pelvic floor muscles and bladder can cause leaking of urine. Performing Kegel exercises (exercise that involve contracting and relaxing pelvic muscles) regularly is important, to strengthen the pelvic floor muscles and so avoid incontinence both during and after pregnancy.

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Using Rooibos

Rooibos for Baby – Treating colic

Rooibos tea can help to prevent and treat colic in babies. Offer baby 25ml to 50ml between
feeds. Give the tea using a syringe if baby is nursing, or drink it yourself so that baby gets it
via your breast milk.

Rooibos for Soothing skin conditions

If baby has itchy, dry skin rashes, brew a strong pot of Rooibos and add it to baby’s bath
water. The rash should show marked improvement within a few days. Baby soaps, shampoos
and creams containing Rooibos are also available, to help prevent rashes. Treat a small but
persistent patch of rash with a moistened Rooibos tea bag. Secure the tea bag to the
effected area with a bandage or plaster for two to three hours. Repeat until the rash clears
up, which is usually within two days.

Rooibos for Easing itches

If your baby contracts a contagious, itchy disease such as chicken pox or measles, make a solution of Rooibos tea and bicarbonate of soda. Dab the solution all over the itchy areas or
add it to the bath water.

Rooibos for Treating fever

If your baby suffers from frequent fevers, offer II ice lollies” made from a mixture of
Rooibos tea and fresh fruit juice. Freeze the mixture in moulds. These lollies will help them
to keep their liquid intake up, as well as cooling them down. They are also a good alternative
to other treats.

Disclaimer: If any queries please contact your doctor

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