* EIGHT MONTH PREGNANT PHILIPPINE LADY ASKS ABOUT PELVIC PAIN

"Hello. How r u.  I'm pregnant 8months coming, why I feel so like difficult moving is like pain, but before for my few, I feel not like this, t.  I do not understand. Please explain.

can we Chat now if don't mind if u are not bzy😀ty." 

 (Ms. Aliyah, Philippines)

Dear Ms. Aliyah,

I am glad when you sent your message, I was online, and we were able to promptly Facebook chat.  After asking you many questions concerning your past and present obstetric and gynecology history, I do believe your pregnancy is progressing normally; however, I believe your pain, this past month, is due to a combination of excess weight gain and multiple gestation history. 

You said your lower abdominal pain is " Just annoying , difficult moving" and " If I go to stand, it's pain."  When I asked is your baby moving, you said, " Yes,always moving  I'm scared to get CS."   CS (cesarean section) is a procedure only done if a vaginal delivery develops or has the potential for severe complications.  You said "No" to vaginal bleeding; however, you mentioned, "This 1 week already, my vagina get itchy... And then ever nite, icannot get sleep."  You said the "Itchy outside vagina" however when I asked is the vaginal itchiness the pain you mentioned, you said, no pain " I think inside."  After you told me 'No" vaginal discharge and " no fever,"  I focused questions on the bladder.

I asked if you have sex during pregnancy, you said, " Yes always Hah, of course my husband only."  I asked if you experienced pain during sex, and you said, " I mean if get starting, its pain, but later on no more already."  When I asked if you pee, you said, " Yes I always go pee" however you repeated,  "If I go to stand up, only, I feel my tummy like difficult to moving Is like fatigue It's like weary It's my body heavily."   You said you pee often more than usual, " Yes in nite and day I always go pee," which may indicate episodes of urinary frequency.  Thus, I asked if you could send blood work information, and upon viewing the sent lab results, all your blood cell levels are normal; thus, you do not have anemia, a medical condition that often causes fatigue and tiredness, nor do you have a urinary tract infection.  Judging by your answers to my questions, there may be a very slim chance for a developing interstitial cystitis (painful bladder syndrome); but, your answers to my questions DID NOT positively confirm that possibility.  Interstitial cystitis is often diagnosed when a person has a normal urinalysis, bladder pain for six weeks or more, increased frequency of urination, pain during sex (called dyspareunia), and urgency to pee.  The pain is increased during exercise, sex, and when drinking alcohol (which you confirmed and I mentioned NO drinking during pregnancy). 

However, the more likely explanation for your lower abdominal pain is your history of multiple gestations.  You have given birth five times.  When I asked your normal weight prior to pregnancy, you said. " 42 kilos."  When I asked your weight today you said, "67" kilograms.   This sizeable gain in weight, different from your prior pregnancies, may offer an explanation to the " I feel my tummy like difficult to moving Is like fatigue It's like weary It's my body heavily" especially when " If I go to stand up."  Furthermore, any woman who has had multiple gestations (multiple births) has weakened musculature to support the uterus and other abdominal and pelvic organs, thus, due to gravity, you may be feeling the weight of the uterus and or organs in your lower abdomen.  When I asked if your doctor checked your heart, you said, " don't have history abount my heart."  

Bottom-line, after our discussion, I believe your pregnancy is proceeding normally, and during the remainder of your pregnancy, you should diet, eating healthy foods in smaller quantities, and exercise as tolerable.  Prior to beginning any exercise program, talk to your doctor.  I believe the excess weight, along with multiple gestations, is the cause of your present pain, and upon delivery, your pain should be diminished, if not disappear altogether. 

One item to note is I provided my opinion without any imaging reports.  Thus, please ask your doctor to do a X-Ray or CT of the abdomen and pelvic regions to make sure a cyst, fibroid, tumor, adhesions, or ligaments are not the cause of your pain. 

With that in mind, I am humbled by your question and trust.   Thank you.  Yes, upon birth, I would feel honored to receive a photo of your baby.  God Bless you and God Bless the Philippines.

Respectfully,

Dr. Roshin

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