Difficult Pregnancy. . . Bed Rest . . . ICU . . .Prolonged Hospitalization. . Dizziness and Vertigo . . . How are they related?
Let’s start with a difficult pregnancy. As many of you likely know, the birthing process is not easy! I am now privy to this information personally as opposed to just someone educated writing about it as I had my first child in February! Some pregnancies result in unwanted c-sections, some result in long, painstaking labor and some result in bed rest. Bed rest can range from spending most of the day lying or sitting to staying in a hospital bed closely monitored by hospital staff as in a prolonged hospitalization or during an ICU stay. Among the many established physiological and musculoskeletal ramifications of bed rest, I would like to highlight two potential side effects in particular, dizziness and vertigo.
Definitions:
-Dizziness is an imprecise term used to describe a variety of disorienting symptoms. Dizziness is subjective and everyone experiences it differently. Some additional terms people use to describe dizziness include disequilibrium and lightheadedness.
-Vertigo is the illusion of movement of ones self or the environment, most frequently described as “spinning.” It is typically due to lesions that cause loss of function (e.g., vestibular neuritis) or mechanical problems of the inner ear (e.g. benign paroxysmal positional vertigo aka: mobilized crystals in your inner ear).
How do dizziness and vertigo relate to bed rest?
Rooted deep to our ears are two small organs frequently referred to as the “inner ear” or formally, the vestibular system. It is one of the systems we utilize for balance due to its ability to provide our brains with information about the position and motion of the head in reference to gravity. The brain uses this information in combination with other sensory systems, vision and pressure sensors in our extremities, to construct a picture of the entire body and surrounding environment. Movement of the head stimulates the vestibular system. You can think of it as a muscle that needs exercise, just like the rest of the muscles in our bodies. When an individual is put on bed rest, their mobility is restricted which in turn decreases the movement of the head thereby decreasing the stimulation to the vestibular system. This causes the system to become weak and provide poor information for balance. Clinically, this will present as dizziness and imbalance.
Dizziness may also originate from a drop in blood pressure when transitioning from lying on one’s back to sitting or from sitting for a prolonged period of time to standing, also known as orthostatic hypotension. Common symptoms include dizziness or lightheadedness. Dizziness is also a common side effect of many medications.
Briefly, there are two very common vestibular system disorders called Benign Paroxysmal Positional Vertigo (BPPV) and Vestibular Neuritis. BPPV is characterized by brief episodes of disabling vertigo that occurs when the head is moved into specific positions. This condition does not pose a specific threat to a pregnant mother other than increasing the risk of falling and sustaining a potential injury. Vestibular neuritis is characterized by acute onset of severe rotational vertigo that is exacerbated by head movement and associated with postural imbalance and nausea.
Main Causes of Dizziness During Pregnancy
Dizziness during pregnancy is most often due to the influx of additional hormones traveling in the body. These hormones act to relax and widen the blood vessels in the body to promote increased flow to the developing baby which reduces the amount returned to you. This will cause your blood pressure to lower and create dizziness similar to orthostatic hypotension. During the second trimester, this can be exacerbated if laying on your back as the weight of the baby will put pressure on the inferior vena cava, the large blood vessel that returns blood from your feet and legs back toward the heart. Additionally, dizziness may occur secondary to low blood sugar levels that occur as your metabolism changes and shifts food sources to the growing baby.
Can I Prevent Dizziness During My Pregnancy?
There are many simple solutions to avoiding dizziness during pregnancy including:
Avoid remaining in one position for too long (laying on the couch, standing, driving, flying, etc.) If you must, please consider getting up or moving your legs and arms frequently to encourage blood flow or move slowly to allow your blood pressure to rise.
Remember to snack frequently throughout the day to nourish the developing baby and keep blood sugar levels regular.
Be careful when taking showers as excessive heat can also cause a drop in blood pressure.
Again, try to avoid lying on your back during the second trimester to keep adequate blood flow to your body.
Treating dizziness and vertigo has become a specialty practice. It is the responsibility of specially trained physicians and physical therapists to identify and differentiate between the multiple potential causes of dizziness or vertigo discussed above. There are multiple maneuvers and specific tests that can be performed to quickly assess the origination of the symptoms. These providers can be researched on websites such as www.vestibular.org, www.balanceandmobility.com, and www.apta.org.
Article written by Kelsey Housman PT, DPT, vestibular physical therapist at APRS Physical Therapy in Bozeman, Montana.
REFERENCES:
An overview of the issues: physiological effects of bed rest and restricted physical activity. Med Sci Sports Exerc. 1997 Feb ;29(2):187-90.
Herdman, S. Vestibular Rehabilitation 3rd Edition. F.A. Davis. 2007.
“Bed Rest & Pregnancy.” WebMD. December 6, 2012. Accessed October 27, 2014. http://www.webmd.com/baby/guide/bed-rest-during-pregnancy
Pregnancy and Dizziness. American Pregnancy Association. Accessed October 27, 2014. http://americanpregnancy.org/pregnancy-health/dizziness-during-pregnancy/
