Where did my ankles go?

Why do we swell during pregnancy and how do we manage it?

Every pregnancy is very individual. Some women have a fabulous pregnancy, they are told on a daily basis they are glowing and are able to exercise during the whole 9 month period. Other women feel horrendous and are unable to leave bed. Swelling is very individual as well, some women will experience swelling from early in their pregnancy, others it will come on near the end. Some women experience swelling after they have given birth and others don’t have any sausage fingers and toes at all. This blog is going to detail why swelling occurs, how to know when your swelling is abnormal, and some strategies to manage.

So why do women swell during pregnancy?

• Blood volume increases by 50%
• A large vein in our body (inferior vena cava) which helps bring alot of blood back to the heart, can be slightly compromised (squished) by your growing baby which means it is slower for blood ot be pumped around and blood can pool in the lower extremities
• You baby may be putting pressure on a large vein or artery which affects blood flow

Women can experience swelling in a number of different areas including:

• Feet
• Legs/Ankles
• Hands
• Fingers
• Face

There are also factors that can make the swelling that you may be experiencing worse. These can include: 

• Standing for long periods of time
• Heat
• Particular clothing or jewellery (ie take your wedding rings off before you need to cut them off)
• Diet high in sugar

Although swelling if normal in pregnancy women do need to stay alert as swelling can be an issue if: 

• Swelling occurs suddenly
• Swelling is accompanied with pain
• Swelling in combination with shortness of breath etc

The above can be signs of pre-eclampsia which is high blood pressure during pregnancy. It is important to tell your GP or obstetrician about your swelling if it suddenly increases or if you are concerned.

So what can you do to help you manage your swelling?

For lower limbs:

• Elevate legs on pillow
• Lay down with legs out straight
• At work have legs elevate on chair in front of you
• Try compression knee high or full length stockings (as long as they don’t cut into the back of your knees)
• Avoid clothes or shoes that cut into your feet or ankles
• Avoid clothes that are too tight around your waistband

For upper limb:

• Remove jewellery before it starts to cut into you
• Rest your arm on an arm chair or propped up on some pillows
• Try swimming or walking in a pool (this is for lower limb as well) – the water acts as a gentle compression

Other:

• Discuss your diet with your GP – you may be having too much sodium which leads to retaining fluid
• Try to keep cool, avoid being in the heat for too long
• Drink enough fluids

Case example:

A client presented for physiotherapy due to swelling in her lower limbs. The patient was 30 weeks pregnant. Luckily the patient who worked as a nurse had a very understanding work place which let her decrease her hours. This meant she was able to rest her legs more often. The patient would walk in her pool 2-3x per week, always elevate her legs after work, and wear compression stockings throughout her work days. The patient was able to continue working until 36 weeks. The patient gave birth to a beautiful baby boy and found her swelling decreased significantly in the first 5 days following birth with no ongoing issues.

Emily Georgopolous (APAM)

Physiotherapist

Featured in the Top 50 Physical Therapy Blog

References:

Mayo Clinic Guide To A Healthy Pregnancy Harms, Roger W., M.D., et al, Part 3.