It’s pretty obvious that your body has gone through a transformation on par with an HGTV home renovation when you can no longer see your feet (slip-on shoes for the win) and you start having to pee every half hour. Welcome to the third trimester.
Massive changes are a given in the homestretch of pregnancy. Some of the ways your body is adapting as it prepares to give birth are well-known, while others are a little less obvious.
During this time, your baby is growing from the size of the head of cauliflower to a smallish pumpkin (if they’re still a tenant in your womb by week 40), so your body has no choice but to make room, which can be challenging, to say the least. Kick your feet up (please, it’ll help the swelling) and read on to find out what you can expect of your body in the third trimester.
Peeing Even More (and More Often)
You’ve already felt the effects of having to pee more in earlier trimesters, but in the third, you will find yourself in the bathroom just so much. During my third trimester, I had to pee at least three times between getting into bed and actually falling asleep. (I somewhat remember wishing I had a bedpan.) Dr. Bijal Toprani, physical therapist with Hinge Health, says my experience is common. Not only will you feel like you live in the bathroom now, but you also may leak urine.
Why? Well, as Dr. Toprani explains, part of the reason you’re peeing so much is because you have a much higher blood volume, which means your kidneys are working overtime, causing your body to flush more liquid, thus the frequent interruptions to your day—and night. Then there’s the growing baby in your uterus (as if you could forget). Imagine a bowling ball on top of a leaky water balloon. “[The uterus] sits directly above your bladder, so the increased weight pushes down on your bladder,” Dr. Toprani says.
What can you do?
You have two options here, neither of which is great when it’s 4 a.m. and you need to pee for the third time. But, you can either go to the bathroom or hold it in. We talked about this a lot in terms of second trimester body changes, but it’s really okay to decide not to go if you just want to go back to sleep.
With that said, limiting fluids before bed may help, but be sure to drink enough during the day so you meet your water needs and don’t get dehydrated. You probably know this because your thirst doesn’t lie, but you need a ton of water while pregnant (eight to twelve cups, according to ACOG).
Shortness of Breath
If shortness of breath hasn’t caught up to you yet, it probably will now, even if you were running marathons (or you know, fast walking around the neighborhood) before pregnancy. This can be strange, especially if you’re not used to feeling a little winded when you climb stairs or carry a laundry basket around the house.
“Your diaphragm, the primary muscle involved in the mechanics of breathing, sits right between your lungs and your abdominal cavity,” Dr. Toprani explains. “Therefore, when your growing baby is taking up quite a bit of room in the abdominal cavity, it can push against your diaphragm, leading to a sensation of breathlessness.” In other words, your baby is making it hard for your lungs to fully expand.
What can you do?
Pay attention to how you’re breathing. There’s a connection between the diaphragm and your pelvic floor. Essentially, they move together, so as your diaphragm descends, so does the pelvic floor. The same is true when the diaphragm contracts (this is why you can sometimes feel it in your pelvic floor when you cough or sneeze. Belly breathing—where you take a deep breath and imagine filling your abdominal cavity—can relax and stretch the pelvic floor muscles and make it easier to breathe. Focusing on your posture also helps your lungs to expand, and propping yourself up with pillows behind your back at night also helps.
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Heartburn
Oh, the heartburn. I never knew what would set mine off (except marinara sauce—that one was a guarantee), but it would get especially bad at night to the point that I kept gummy antacids on my bedside table (much better than the chalky chewable ones, IMHO).
Most pregnant people will experience heartburn to some degree, especially in the third trimester. “Increased progesterone affects the smooth muscle tissue of the esophageal sphincter making bile more susceptible to flowing back up the esophagus,” says Dorina Kroll, physical therapist and owner of Potomac PT & Rehab. Also, there’s the fact that the stomach shifts up, making room for the baby and uterus. “This increased upward pressure can exacerbate heartburn symptoms.”
What can you do?
Like me, many women notice heartburn gets worse at night, which is often caused by either having a large dinner or the position you’re in (often lying down), says Kroll. “Consider eating more frequent, smaller meals to help manage heartburn symptoms, especially later in the day. You can also prop yourself up in bed to prevent backflow of acids from your stomach during bedtime,” she adds.
The upside of this symptom is that it comes with a fun fact: have you ever heard the pregnancy myth that says heartburn means your baby has lots of hair? Weirdly, studies show1 that there is some truth to that. Basically, the hormones that cause hair growth in utero also relax the esophagus sphincter, allowing more acid to rise up. My tip? Just picture those lovely locks you’re growing as you reach, yet again, for the antacids.
Constipation and Hemorrhoids
No third trimester body changes list would be complete without talking about your bathroom habits. Once again, progesterone is to blame. This pregnancy hormone relaxes muscles, helping the hips and pelvis get ready for birth. Unfortunately, your intestines don’t get the memo that this relaxation does not include them, which means they don't work as hard to push waste out. Basically, your poop just hangs out in there, causing constipation and bloating (sorry for that visual). On top of that, the pressure of the growing baby can also slow digestion.
Here’s where things take a turn. Constipation tends to lead to hemorrhoids, which Dr. Kandis B Daroski, physical therapist with Hinge Health, describes as painful, itchy varicose veins in or around the anus. This occurs when there is increased weight and pressure downward thanks to both a growing baby and straining during bowel movements.
What can you do?
Staying hydrated is key in managing constipation and warding off hemorrhoids. “A well-balanced, high-fiber diet that includes foods like beans, bran, whole grains, and plenty of fruits and veggies can help you stay regular and prevent straining,” Dr. Daroski says, adding that it’s important to listen to your body and go to the bathroom when you have to. “By holding off when the urge hits, water can be reabsorbed from your stool, making it harder to pass. If hemorrhoids become painful, you can try sitting in a warm shallow bath to provide relief,” she says. Your doctor will also likely give the okay for topical treatments like Preparation H that can reduce swelling and stop itching.
A Change in Your Bra’s Band Size
Yes, your breasts themselves are much fuller (and may be leaking milk), but you may also notice a change in your bra’s band size. Now is the time to invest in bras with a lot of stretch. They are your friends.
“Towards the end of your pregnancy as your uterus and baby grow up into your diaphragm, the ribs on the lower part of your rib cage can flare out a bit,” says Ashley Rawlins, physical therapist and clinical specialist at Origin. The rib cage can grow as much as two to three inches2 during pregnancy. “This is made easy by the (you guessed it!) hormones which help to soften the connective tissues throughout your body, allowing for more mobility in the joints of the ribcage.”
I won’t lie to you, rib pain was excruciating for me during pregnancy and definitely my most annoying physical change. (Good news is, it totally resolved on its own postpartum).
What can you do? Rawlins says it’s normal for the ribcage to flare a bit during pregnancy to accommodate your growing baby, but it can cause some strain and pain in your thoracic region. “It can help to focus on proper breathing mechanics (despite your baby being in the way) and to strengthen the deep core muscles that help to naturally bring the ribs back together in a direction opposite of the flare, aka rib depression.”
Try child's pose with an exercise ball under your hands or try row motions with or without light weights.
Read More: A Guide to Your Boobs from Pregnancy Through Postpartum
Swelling
Most people who’ve had babies can recall looking down at their calves (while lying down, no chance you can see them standing anymore) and finding that they look more like tree trunks than ankles. Swelling happens all over the body, but especially in areas below the uterus.
“Blame it on the uterus…again,” Dr. Daroski says. As the uterus expands, it puts more pressure on surrounding blood vessels. “These vessels work to pump blood and fluid from your lower legs, back to the heart. With more pressure on them, they can become less effective at doing this which results in swelling in your limbs,” she says.
What can you do?
Exercise is a great way to get blood pumping and reduce swelling, even better if it involves water. “Many pregnant women find swimming or aquatic exercise to be very beneficial in improving and managing swelling but also for off-weighting pressure on their low back,” says Dr. Daroski. She also advises against standing without movement for prolonged periods of time, but if you cannot avoid it try compression socks to help with blood flow (these are also a must for reducing swelling on flights).
And if you need another reason to kick up your feet, resting with your feet elevated (ideally above the heart level, so maybe stacked on a bunch of pillows) can manage swelling.
Separation of the Abdominal Muscles (Diastasis Recti)
Diastasis recti is when your abdominal muscles separate, which sounds really intense and painful but is actually quite common.
“Diastasis recti occurs as your growing belly puts stress on the linea alba (a strong fibrous structure that sits between the two recti abdominis muscles),” Dr. Daroski says. Just how common is it? Well, one study showed3 that 100 percent of pregnant women had abdominal muscle separation at week 35.
Rawlins adds that you may notice the separation (a bulging or cone shape between your rectus abdominis muscles) during activities that cause your intra-abdominal pressure to increase —- like doing a sit-up, leaning back to wash your hair, or straining to poop, for example. Don’t panic. It’s usually not painful and can be reversed after delivery.
What can you do?
Both Rawlins and Daroski say there’s nothing you can do to avoid diastasis recti totally, but there are some things you can do to set yourself up for the best healing.
Even though it may not be intuitive with your growing belly, try to engage your muscles when doing everyday activities like lifting a box from Amazon or getting in and out of bed. And keep your core strong with exercises like planks. Lastly, “you can reduce the amount of tension on the linea alba by focusing on maintaining good posture throughout the day. Avoid standing with too much arch in the low back,” Daroski says.
Increased Pelvic Pressure
When you consider the cantaloupe-sized human sitting in your lower-abdomen region, it makes sense that you’d feel pressure in your pelvis. “The third trimester is when the baby has the most growth, and the pelvis continues to prepare for the delivery. Toward the end of the third trimester, the baby will often begin to descend into the pelvis from the abdomen,” says Dr. Jennifer Anger, urogynecologist and co-author of A Woman's Guide to Her Pelvic Floor: What the F*@# is Going On Down There.4 She adds that this pressure is part of the reason for that telltale pregnancy waddle.
The pressure itself can be very uncomfortable (and no, your baby is not going to just fall out, even though it feels like it), but the added strain on the pelvis can lead to other side effects including hemorrhoids (oh, great), leg swelling, and urinary frequency.
What can you do?
Dr. Anger says to continue to do Kegel exercises to help strengthen the pelvic floor. Going into water (even a bath) can help to temporarily relieve the pressure, too.
Try to Relax and Get Through the Third Trimester
Often the third trimester is known for already uncomfortable things—pelvic pressure, rib pain, constipation—getting really uncomfortable. Just know that the not-so-fun feelings are finite. Once the baby comes, many of these body changes will get better or go away entirely. For now, it’s just about resting when you can, and trying whatever works to ease some of the discomfort. And, remember, while pregnancy may feel like an endless slog now, in the grand scheme of your life, it’s more like a fleeting moment.
