Why do legs cramp when pregnant and what to do?

Unfortunately, pregnancy is not only a joyful expectation of the birth of a baby, but also a number of unpleasant moments. For example, toxemia, heaviness, leg cramps in pregnancy are not uncommon. Cramps can bother both in the daytime and at night, and the muscles after that are able to retain increased sensitivity for a long time. How to prevent cramps and can they be eliminated? What is the cause of their occurrence?

Doctors say: leg cramps in pregnancy appear at any term. Sometimes they do not have a clear cause and are associated directly with the "interesting" position, but in some cases can be a sign of a disease that requires immediate intervention of a medical specialist. Let's try to understand this issue in more detail. [1]

Epidemiology

If you believe the statistics, then leg cramps in pregnancy periodically bother nine women out of ten. At the same time, 60% of unpleasant sensations occur after prolonged walking, or with prolonged stay in an upright position. And in 30% of women cramps appear without any obvious reasons.

The problem is most often detected in the second half of pregnancy - from about 20-22 weeks.

Causes of the leg cramps in pregnancy

In most pregnant women, the occurrence of leg cramps is due to these causes:

• Micronutrient instability in the body, a lack of magnesium, potassium or calcium, or vitamin _B6. This is what can cause such instability:
  • I trimester - frequent vomiting, toxicosis, inability to properly absorb vitamins and trace elements or lack of their sufficient intake (for example, with a complete lack of appetite);
  • II trimester - active intrauterine development of the baby and the associated high need of the maternal body in micronutrients;
  • throughout pregnancy - improper nutrition, taking certain medications (e.g. Diuretics).
• Anemia. When hemoglobin levels drop, the oxygen supply to the muscles is impaired, causing periodic cramping, which is particularly bothersome in the legs (with no definite connection to the time of day).
• Hypodynamic stagnation of blood flow. Due to insufficient motor activity of a woman, stagnation in the circulatory system occurs.
• Varicose veins. Crampy muscle contractions are caused by stagnation of venous blood - found mainly at night or closer to evening.
• A drop in blood glucose levels. The state of energy hunger, when the flow of glucose into the blood is disturbed, can also cause leg cramps. Such troubles occur mostly at night or closer to morning.
• Inferior vena cava compression syndrome. From the 20th week of pregnancy, the enlarged uterus starts to put pressure on the inferior vena cava. This causes a slowing of blood flow in the legs, the appearance of edema and cramps. Interestingly, cramps in this situation bother the pregnant woman if she lies on her back or right side.
• Dehydration. Drinking small amounts of fluids throughout the day can cause leg cramps in pregnancy.
• Improperly fitting shoes, hypothermia of the feet, standing or walking for long periods of time.

Risk factors

Risk factors that can increase the danger of leg cramps in pregnancy include:

• excessive thinness, or on the contrary, excessive body weight;
• a sudden change in the intensity of physical activity;
• Improper nutrition and poor water balance;
• liver disease, thyroid disease, frequent nervous shocks and breakdowns, diabetes mellitus.

Pathogenesis

The pathogenetic mechanisms of muscle contraction, as well as the processes of regulation of this reaction by the nervous system are very complex and depend on the different content of certain ions in the cell and outside it. Any disruption and imbalance can cause the appearance of cramps, and the main cause is considered to be a disorder of mineral metabolism.

That's what this disorder is about:

• with the increased need for minerals in pregnancy;
• with toxemia, frequent vomiting, diarrhea;
• with eating disorders, lack of appetite, predominance of certain foods against the lack of others, etc.;
• taking medication (especially if not supervised by a doctor).

The most common mineral metabolism disorders are associated with deficiencies of components such as potassium, calcium, magnesium and vitamin B6. _B6.

• Potassium plays a special and important role in the processes of intracellular metabolism. With prolonged or frequent vomiting or diarrhea, with chaotic or prolonged treatment with diuretics can develop a deficiency of this trace element. The fault of potassium deficiency is often also the abuse of coffee, but in pregnancy this problem is often irrelevant, because the use of coffee in this period is usually severely limited, or even abandon the drink. Few people know, but the absorption of potassium worsens against the background of a lack of magnesium - another important trace element.

Potassium can be obtained from foods such as apricots, bananas, beans, broccoli, milk, and melon. The average daily human requirement for potassium is about 4.5 g.

• Calcium is a trace element, the normal absorption of which is impossible without the presence of magnesium and vitamin _D3. An increased need for calcium occurs in times of stress and during pregnancy. Violate the absorption of calcium products containing oxalic acid (eg, sorrel and rhubarb, spinach, etc.) or phosphates (caviar and canned fish, egg yolks, hard cheese, cocoa and sodas). Insufficient consumption of protein food also disrupts the absorption of the trace element, but the normal intake of iron contributes to good absorption of calcium in the gastrointestinal tract.

Where does the body get calcium? There is plenty of it in greens, beans, nuts, figs, cottage cheese, hard cheese.

• Magnesium in pregnancy is especially necessary, as the need for the trace element in this period increases many times. Accelerate the excretion of magnesium from the body caffeine, excess potassium. The woman's body will require more magnesium against the background of a high-protein diet, taking hormones.

Magnesium deficiency can be made up by adding seeds and seeds, nuts, beans, any greens, carrots, onion feathers to your diet.

• Vitamin _B6 deficiency alone does not cause seizures. However, the lack of the vitamin hinders the absorption and cellular assimilation of magnesium. Pyridoxine acts as a kind of conductor that promotes the penetration and fixation of magnesium ions inside the cell.

Foods rich in the vitamin are: meat and offal, brewer's yeast, nuts and beans, avocado. Alcoholic beverages and nicotine impair the absorption of pyridoxine from food. [2]

Symptoms of the leg cramps in pregnancy

Most often cramping problem in pregnancy appears exactly in the legs, and especially - in the calf muscles. Cramps are painful muscle twitches, and in some cases it is even possible to see under the skin a strong tension of individual muscles. Areas of muscle spasm are found as painful masses, and it is completely impossible to resist such muscle contraction on one's own.

Cramps occur mainly in the evening or at night when a woman assumes a horizontal position. The spasm occurs at the level of muscle cells, which are intensely excited and thus contract.

During the entire period of pregnancy, the female body is under tremendous strain. The volume of circulating blood increases, the blood flow from the veins worsens, the water-electrolyte ratio changes, the consumption of vitamins and trace elements - for example, calcium, magnesium, vitamin D and other components involved in metabolic processes and helping to assimilate each other - increases.

The first signs of malfunction may appear as early as the first weeks of pregnancy, especially if there has been an imbalance of water and salt, nutritional deficiencies, venous diseases, etc. A typical beginning is the appearance of night cramps in certain muscle groups (most often in the calf muscles). In the morning, there may be a slight dull soreness in the calves caused by cramp muscle overstrain, as well as general weakness, drowsiness, and a feeling of fatigue.

Leg cramps at night during pregnancy can manifest themselves in different ways. For example, in some women it takes the form of a relatively long period of muscle tension, of the "leg cramp" type. Other women indicate a short series of weak contractions, in which the muscles seem to "shiver".

The localization of leg cramps varies: from fingers to foot, ankle, calf muscles, hamstring, etc. Depending on the duration and type of muscle spasms, cramps are subdivided into such symptomatic varieties:

• Myoclonic contractions are rhythmic and arrhythmic twitches, jerks, and shudders that are not accompanied by pain.
• Clonic contractions are rhythmic spasms that can build up into a "long-lasting" seizure, similar to muscle tremors.
• Tonic contractions are a condition known to many people as "leg cramps", when a muscle spasms and does not release it for some time. Such leg cramps in the morning in pregnancy occur most often, accompanied by pain and extreme discomfort.
• Mixed type tonic-clonic cramps in pregnancy in the calves of the legs are almost uncommon, as they belong to epileptic and epileptic-like pathologies.

Severe leg cramps in pregnancy can be provoked by various factors, from malfunctions in the nervous system and blood vessels to banal vitamin and mineral deficiency. Depending on the clinical manifestations, the doctor prescribes the appropriate diagnosis and only then proceeds to correct the pathological condition.

Complications and consequences

Leg cramps in pregnancy are not always a harmless symptom. Even the lack of any vitamin or microelement in the body of a pregnant woman can result in dysfunction of certain organs, including vital organs.

It is not always possible for a woman in pregnancy to eat a high-quality and nutritious diet, eat greens, fruits and vegetables. The reason for this is hormonal changes, stress, toxicosis, digestive disorders. In addition, the load on the vascular network increases significantly - for example, everyone knows that the first signs of varicose veins often occur during pregnancy.

To prevent the development of unfavorable consequences and pathological complications, you should not treat cramps on your own. Any drugs and procedures during pregnancy should be prescribed only by a doctor, after conducting the necessary diagnostics. For example, if a woman's body additionally needs vitamins, the doctor will help to choose a vitamin and mineral complex that will help to get rid of leg cramps, and at the same time will not harm the intrauterine growth and development of the baby.

Diagnostics of the leg cramps in pregnancy

Detecting the cause of leg cramps in pregnancy is most often not difficult, but it will require a number of diagnostic measures. In particular, it is necessary to assess blood parameters - such as hemoglobin levels, color index, serum iron levels and basic trace elements. If the doctor suspects lower extremity varicose veins, he may prescribe Doppler ultrasound followed by a consultation with a vascular surgeon or phlebologist.

Tests your doctor may recommend:

• General clinical blood test (will help to recognize inflammatory processes, anemia, get a general idea of the health of the body);
• blood glucose levels;
• general examination of urine, Nechiporenko analysis (to assess the performance of the kidneys, which are directly involved in the regulation of water-electrolyte balance);
• Blood biochemistry (a test to assess liver and kidney function).

Instrumental diagnostics may include Doppler, or ultrasound of the venous vessels. This is necessary to assess the quality of blood flow and diagnose possible venous insufficiency.

It is likely that other diagnostic tests may be needed in each individual case. This is a matter for the gynecologist to decide: if necessary, the patient will be referred to a specialized specialist who will prescribe other diagnostic procedures.

Differential diagnosis

Differential diagnosis should be made with such diseases and conditions:

• water-electrolyte imbalance;
• avitaminosis, disorders of mineral metabolism, anemia;
• digestive disorders;
• toxicosis, vascular spasms;
• ARVI;
• prolonged state of hypodynamia, or on the contrary, a sharp excessive muscular load;
• varicose veins of the lower extremities.

Treatment of the leg cramps in pregnancy

The first thing that a pregnant woman should do in case of leg cramps is to consult a doctor. It is advisable to consult your gynecologist first, or make an appointment for a consultation with a therapist, phlebologist, nutritionist - depending on the suspected cause of the disease.

Self-medication should not be done categorically, because during pregnancy there is a high risk of harming the growing baby. It is better to see a doctor, undergo the necessary diagnostics, consult with specialized specialists (neurologist, endocrinologist, etc.).

As a rule, after examination, the doctor prescribes medication, vitamin complexes to replenish the deficiency of substances. Sometimes the problem can be eliminated without the use of drugs, simply by adjusting the diet, adjusting the rest regime. In addition, you can conduct a course of massage sessions or reflexology, at the discretion of the doctor.

What to do?

What can you do on your own to get relief from leg cramps in pregnancy?

• Remove the possible cause of the cramp (e.g., remove shoes).

• Give your feet an elevated position (above head level), try to pull the entire plane of the foot towards you.
• Breathe deeply, take a full breath, don't be nervous.
• Give your calves a small massage (you can do this with your hands or with a small massager).
• Apply a warm heating pad to your feet, or take a warm shower.
• Relax, drink a cup of warm tea or water.

If the cramps do not go away, or even turn into pain, then you need to consult a doctor.

Medicines that your doctor can prescribe

Treatment of leg cramps in pregnancy can vary significantly, depending on the cause of the painful condition. For example, in case of varicose veins, the doctor may recommend the use of such medications:

• Venotonics, or phlebotropics, or phleboprotective agents are a number of drugs that can improve vein tone, reduce specific venous manifestations and syndromes. Treatment with venotonics is effective if varicose veins are just beginning to develop. Typical representatives of venotonics are Detralex, Troxevasin, Venoruton.
• Venotonizing external preparations are ointments, creams or gels such as Heparin ointment, Venoruton gel and so on.

Most often, leg cramps in pregnancy are a complex problem, so mineral and multivitamin preparations are prescribed almost always. Especially popular are such drugs as Magne _B6 (Magnicum), Calcium _D3 Nicomed, as well as combined vitamin and mineral complexes. We will talk about vitamins separately below.

Detralex	Preparation of diosmin, hesperidin. It has venotonic and angioprotective properties, reduces vein distensibility, eliminates venostasis, increases capillary resistance, improves lymphatic drainage. Detralex in cramps in pregnancy are taken under the supervision of a doctor, 2 tablets per day (morning and night, with food). Possible side effects are dyspepsia.
Troxevasin capsules	Troxerutin preparation, capillar-stabilizing and venotonizing agent with anti-inflammatory and antioxidant activity. Take 2 capsules per day, with food. Duration of therapy - about a month.
Venoruton capsules	The drug strengthens capillaries and stabilizes their permeability, eliminates edema, leg cramps, trophic disorders. It is usually taken in the amount of one capsule three times a day, for two weeks. Possible side effects are dyspepsia, headache.
Heparin ointment	The drug is external, is a direct anticoagulant, has anti-inflammatory and local analgesic properties. In pregnancy, the ointment is used with extreme caution, in very small amounts under the supervision of a doctor. Side effects: skin redness, local irritation, allergies.
Magnicum	A preparation with magnesium lactate and pyridoxine hydrochloride. For seizures take one tablet twice a day, with water. Adverse reactions are rare and are expressed in allergies or digestive disorders.
Calcium D3 Nicomedes	A combination drug prescribed for the prevention and treatment of calcium and vitamin D deficiency. In cramps in pregnancy, one tablet of the drug is usually prescribed twice a day. Rare side effects may be expressed in minor digestive disorders.

Vitamins for cramps in pregnancy

Vitamins in pregnancy play the role of the most important regulator of intracellular biochemical processes. In this case, most of the vitamins a woman gets from food, so both before pregnancy and in the period of pregnancy it is necessary to diversify the diet as much as possible, introduce a sufficient amount of plant foods: vegetables, fruit juices, berries, herbs, etc., if possible.

In some cases, it is necessary to fill the vitamin deficiency, using special vitamin and mineral complexes. Most often they not only help to get rid of leg cramps in pregnancy, but also improve the condition of the body as a whole, and even prevent the development of toxicosis. Synthetic vitamin preparations do not differ much from those vitamin substances that are present in food products. Sometimes they are even better perceived by the body and easier to digest.

What vitamins do pregnant women especially need to eliminate leg cramps? Of course, it is better to take a special analysis and check what specific substance the body lacks. But in most cases, no one wants to spend time to identify the problem, so you have to take at once a complex of vitamins recommended for future moms. Such a complex must necessarily include folic acid, vitamin D, magnesium, iron, calcium and potassium.

Why are complex vitamin preparations considered the best option for cramps in pregnancy? The fact is that in the vast majority of metabolic mechanisms, vitamins and minerals participate by interacting with each other. For example, magnesium should always be taken together with B vitamins, and calcium with vitamin D.

It is recommended to take complex preparations before conception and throughout the entire period of pregnancy: this often helps to prevent leg cramps in advance. If cramps have already appeared, they disappear in most women within a few days of taking a complex remedy. Which drugs are we talking about?

• Doppelhertz active - vitamins for mom;
• Now Foods Pregnancy Vitamins;
• Solgar Prenatabs;
• Alphabet Mom;
• Vitrum prenatal (or Vitrum prenatal forte);
• Elevit pronatal.

These drugs are most often used by women during pregnancy, but only a doctor can recommend their use (there are contraindications).

Physiotherapeutic treatment

Physiotherapy for leg cramps in pregnancy is used relatively rarely. Well help and relieve the condition of the usual contrast dousing of the lower extremities, alternating application of ice and external heat, light massage. Practice special exercises LFK, and in severe cramps - bed rest. In addition, wearing therapeutic underwear, bandages, etc. Is indicated.

Among physiotherapeutic methods, such procedures as ultraviolet irradiation, percutaneous electroneurostimulation, acupuncture are particularly popular. There are cases of successful application of low-frequency non-thermal magnetotherapy: this method perfectly relieves tissue swelling and pain, restores a healthy balance of sodium and potassium ions, alleviates muscle-tonic manifestations.

Ultraviolet exposure in the wave range of 320-280 nm is considered one of the most preferred procedures, because it does not lead to hypervitaminosis _D3 (the risk of its development is present in the internal administration of appropriate drugs). In painful cramps, UVB is carried out in erythema dosages: start with 2-3 biodoses with a further increase to 5-8 biodoses.

Sessions of electrophoresis with calcium and phosphorus in combination with general ultraviolet irradiation are recommended.

Folk treatment

Folk recipes for relief of leg cramps exist, but in pregnancy the possibility of their use should be discussed with a doctor. In general, such methods are approved by official medicine and help to significantly improve the condition of women in such an important period for them.

• If the cramps are caused by a lack of calcium in the pregnant woman's body, it can be replenished with eggshells. The shell should be fresh and well washed: it is calcined for 10 minutes in the oven or microwave, then ground in a mortar to a powder. This powder is taken daily, in the morning, in an amount of 1-2 g. Just before use, you need to add a few drops of lemon juice to it. You can eat the dose separately from other foods, or add it to cottage cheese, yogurt, salad.
• Lemon juice is an excellent remedy for leg cramps. In the morning and at night, it is applied to the calves and feet, both for prevention and treatment. After applying the juice, you should not wipe or wash it off: it should be absorbed into the skin.
• Take 20 g of dry crushed bay leaf, pour unrefined vegetable oil in the amount of 250 ml, leave to infuse for 12 days. Sometimes the potion should be shaken and stirred. When the drug is ready, it should be strained and used for rubbing legs with cramps.

Herbal treatment

• Improves the nutrition of the musculature of the lower limbs licorice rhizome. This plant is able to normalize the tone and nerve conduction of muscle tissue. To prepare a potion take 100 g of dried rhizome and insist in 500 ml of boiling water - until cooled. Take 1 tsp. Three times a day.
• Excellent anticonvulsant effect has a decoction of hawthorn fruit: 3 tbsp. L. Fruits pour 500 ml of boiling water, kept on low heat for five minutes, then insist under a lid for about three hours. Take 2 tbsp. L. Decoction 5 times a day, for 20 days.
• In case of leg cramps in pregnancy, take one portion of fresh juice of celandine plant and combine it with two portions of liquid petroleum jelly. The resulting remedy is rubbed on the legs in places where cramps appear. If the rubbing is repeated daily, the cramps will stop bothering within two weeks.

Homeopathy for cramps in pregnancy

Homeopathic remedies are safe and can be used during pregnancy under the supervision of a doctor. The most common remedies for leg cramps are homeopathic remedies:

• Zincum 6 alternated with Belladonna 3, initially every half hour, then less frequently, bringing it up to 2 times a day;
• Sulfur 3, Veratrum 3, Secale cornutum 3, Strontianus carbonica;
• Causticum 6 twice a day, 5 drops;
• Ignatia 6, Stramonium 6, Platinum 6.

Dosage and selection of drugs is carried out by a homeopathic doctor during an individual appointment.

Surgical treatment

The surgeon's assistance is sought mainly when leg cramps in pregnancy are associated with varicose veins. Deterioration of the condition requiring surgical intervention may be accompanied by:

• severe swelling of the legs;
• forming ulcers;
• multiple bruises on the legs;
• dry, itchy skin;
• with thrombosis in the vascular lumen.

If possible, radical methods of seizure treatment are postponed until after the birth of the child. During pregnancy, surgery is only performed in very extreme cases.

These surgical treatments can be used to eliminate varicose vein cramps:

• Sclerotherapy - it is prescribed to eliminate visible vasculature or medium-caliber venous vessels. Using a micro-needle, a sclerosing solution is injected into the vascular lumen, causing gradual resorption of the vein. Several treatments are usually required for a complete course of treatment, after which the progression of the pathology usually stops.
• Miniphlebectomy is the surgical removal of varicose vessels through skin punctures. Anesthesia is usually local and the procedure is relatively uncomplicated. It may be used as an adjunct to other basic therapies:
  • endovasal laser photocoagulation;
  • CHIVA;
  • ASVAL.
• Phlebectomy is a full-fledged surgical intervention, usually used for advanced varicose veins or when there are contraindications to other, laser-based treatments.

Prevention

If you follow certain preventive rules, you can try to avoid unpleasant leg cramps in pregnancy:

• Eat a proper and nutritious diet, often and a little at a time, without overeating. Instead of sugar, eat complex carbohydrates (cereals, durum wheat pasta) and fruits. Emphasize foods rich in calcium, potassium and magnesium: bananas, greens, fermented milk products, nuts and seeds, dried fruits, citrus fruits.
• Drink enough fluids every day. If you have swelling in your legs, consult your doctor - you may need to limit the amount of salt you consume.
• Load your body wisely: both excessive physical activity and its complete absence are equally dangerous.
• Choose the right shoes and clothes: they should be comfortable, not tight, lightweight, made of natural materials. Do not wear heeled shoes, tight synthetic pants (e.g., "loafers"), socks and socks with tight elastic bands.
• Periodically try to rest by raising the "foot" end of the bed. If there are obvious signs of fatigue in the legs, you can do a contrast bath or a light massage.
• In cold weather or if you tend to be constantly "chilly", you should wear warm socks - for example, when sleeping.

If you follow the above tips, then leg cramps in pregnancy will not bother you.

Forecast

As a rule, after childbirth, cramps go away and do not return. If there is any pathological cause of this discomfort, it is advisable to take measures and treatment. To do this, it is necessary to consult a doctor and possibly undergo diagnostics.

You should never "prescribe" medicines for yourself. Without knowing the true cause of the problem, such self-medication can only harm and even aggravate the problem.

The question about leg cramps in pregnancy should be addressed, first of all, to the gynecologist who observes the woman in the antenatal clinic. If he considers it necessary, he will appoint a consultation of a narrower specialist - for example, a neurologist, surgeon, endocrinologist, phlebologist. Treatment and prognosis in this case is determined strictly individually, based on the results of clinical and laboratory tests.