Exploring Osteopathic Approaches for Managing Gastroesophageal Reflux Disease (GERD): A Focus on Treitz Ligament Release

Introduction

Gastroesophageal reflux disease (GERD) is a chronic condition characterized by the backflow of stomach contents into the esophagus, leading to symptoms such as heartburn, acid regurgitation, and chest pain. Managing GERD can be challenging, often involving medications such as proton pump inhibitors (PPIs) and H2-receptor antagonists. However, these medications may come with limitations and potential side effects, prompting the exploration of alternative treatments like osteopathic manipulative treatment (OMT). One such technique gaining attention for its potential efficacy in GERD management is the Treitz Ligament Release Maneuver.

The Treitz Ligament Release Maneuver is an osteopathic technique designed to improve gastrointestinal mobility and function by addressing restrictions or tension in the ligament of Treitz and surrounding structures. Named after the suspensory ligament of the duodenum, which supports the junction between the duodenum and jejunum, this approach targets the structural integrity and mobility of the gastrointestinal tract.

The ligament of Treitz is a fibrous band of tissue that plays a crucial role in supporting the small intestine and facilitating digestive processes. Dysfunction or restriction in this ligament can potentially contribute to gastrointestinal symptoms such as bloating, abdominal discomfort, and altered bowel movements. By releasing tension and restoring mobility in this area, osteopathic practitioners believe they can optimize gastrointestinal function and promote better digestion and absorption of nutrients.

During a Treitz Ligament Release session, the osteopath employs various hands-on techniques, such as gentle stretching, myofascial release, or indirect manipulation, to assess and address restrictions in the ligament of Treitz and adjacent tissues. These techniques aim to promote relaxation, improve circulation, and enhance the body’s innate ability to self-regulate and heal.

One of the key mechanisms underlying the effectiveness of the Treitz Ligament Release Maneuver is its influence on the autonomic nervous system (ANS). The ANS plays a crucial role in regulating gastrointestinal motility and function, and by restoring balance and mobility in the ligament of Treitz and its associated structures, osteopathic practitioners aim to support optimal digestion and alleviate gastrointestinal discomfort.

While further research is needed to fully understand the mechanisms and effectiveness of the Treitz Ligament Release Maneuver, anecdotal evidence suggests that this osteopathic technique may offer benefits for individuals experiencing GERD symptoms or functional digestive disorders. As part of a comprehensive osteopathic approach to healthcare, Treitz Ligament Release highlights the importance of addressing structural imbalances and promoting mobility to support the body’s natural healing processes and enhance gastrointestinal health.

It is important to note that the Treitz Ligament Release Maneuver should be performed by trained professionals and tailored to the individual assessment of the patient. Patient positioning, breathing instructions, and the application of pressure are carefully executed to ensure optimal effectiveness and safety.

Defining gastroesophageal reflux

Gastroesophageal reflux disease (GERD) is a chronic condition characterized by the backward flow of stomach contents into the esophagus, leading to a range of symptoms and potential complications. This disorder affects millions of people worldwide and can significantly impact daily life and overall well-being.

The hallmark symptoms of GERD include heartburn and acid reflux. Heartburn is a burning sensation in the chest, often accompanied by a sour or bitter taste in the mouth. Acid reflux refers to the regurgitation of stomach acid into the esophagus, which can cause discomfort and irritation. Other common symptoms may include regurgitation of food or liquid, difficulty swallowing (dysphagia), and chest pain.

Several mechanisms underlie the development of GERD. One key factor is the dysfunction of the lower esophageal sphincter (LES), a muscular valve that normally prevents the backflow of stomach contents into the esophagus. When the LES fails to close properly or relaxes inappropriately, gastric acid can reflux into the esophagus, leading to symptoms of GERD. Additionally, factors such as hiatal hernia, obesity, and certain dietary and lifestyle habits can contribute to the development or exacerbation of GERD.

Chronic GERD can lead to a range of complications, particularly if left untreated. One common complication is esophagitis, which is inflammation or irritation of the esophageal lining due to repeated exposure to stomach acid. Esophagitis can cause symptoms such as difficulty swallowing, chest pain, and bleeding. Prolonged inflammation may also increase the risk of developing esophageal strictures, which are narrowings or constrictions in the esophagus that can impair swallowing and lead to food impaction.

The impact of GERD on quality of life can be profound. Individuals with GERD may experience decreased appetite due to discomfort or fear of triggering symptoms. The presence of symptoms, especially at night, can also disrupt sleep patterns and lead to fatigue and daytime drowsiness. Sleep disturbances associated with GERD may result from nighttime reflux episodes, coughing, or discomfort when lying down. Over time, inadequate sleep can contribute to mood disturbances, impaired cognitive function, and decreased overall well-being.

Moreover, GERD symptoms can interfere with social activities, work performance, and leisure pursuits. The need to avoid certain foods or beverages to prevent symptom exacerbation may limit dietary choices and impact social interactions. Additionally, individuals with GERD may experience anxiety or embarrassment related to their symptoms, particularly if they occur in public settings.

Citation: Bjørnæs KE, Reiertsen O, Larsen S (2016) Does Osteopathic Manipulative Treatment (OMT) have an Effect in the Treatment of Patients Suffering fromGastro Esophageal Reflux Disease (GERD)?. Int J Clin Pharmacol Pharmacother 1: 116.

Treitz Ligament Release: An Osteopathic Approach to stop gastroesophageal reflux

The primary goal of Treitz Ligament Release is to optimize gastrointestinal function, thereby reducing the frequency and severity of GERD symptoms. By enhancing gastrointestinal mobility, this osteopathic approach aims to prevent the stagnation of stomach contents and reduce the likelihood of acid reflux and heartburn. Additionally, improved digestive function and nutrient absorption may alleviate discomfort and inflammation in the esophagus caused by prolonged exposure to stomach acid.

Moreover, Treitz Ligament Release emphasizes the interconnectedness of the body’s systems, recognizing the role of structural imbalances in contributing to GERD. By addressing musculoskeletal dysfunctions and promoting mobility in the ligament of Treitz and adjacent tissues, this technique aligns with the holistic principles of osteopathy, focusing on the body’s self-healing capabilities and natural ability to restore balance.

While further research is needed to fully understand the mechanisms and effectiveness of Treitz Ligament Release, anecdotal evidence suggests its potential benefits for individuals with GERD. As part of a comprehensive osteopathic approach to healthcare, Treitz Ligament Release offers a promising avenue for alleviating gastrointestinal symptoms and improving overall well-being.

Understanding the Ligament of Treitz

The ligament of Treitz, named after the Czech anatomist Václav Treitz, is a crucial fibrous band of tissue that plays a significant role in gastrointestinal anatomy and function. Situated at the junction between the duodenum and the jejunum, two segments of the small intestine, this ligament provides structural support and stability to the gastrointestinal tract.

Functionally, the ligament of Treitz acts as a dynamic anchor point, helping to maintain the position and orientation of the duodenojejunal junction within the abdominal cavity. It serves as a stabilizing structure, ensuring proper alignment and coordination between the duodenum and the jejunum during the digestive process.

One of the key functions of the ligament of Treitz is to facilitate the passage of food from the stomach into the small intestine and coordinate the subsequent phases of digestion and absorption. As ingested food enters the duodenum from the stomach, the ligament of Treitz helps to anchor and support the duodenal segment, allowing for efficient mixing and propulsion of chyme (partially digested food) through the small intestine.

Dysfunction or restriction in the ligament of Treitz can have implications for digestive processes and overall gastrointestinal health. When the ligament becomes tense or restricted, it may lead to impaired mobility and function at the duodenojejunal junction. This can result in gastrointestinal symptoms such as bloating, abdominal discomfort, and altered bowel movements.

In cases where the ligament of Treitz is excessively tight or constricted, it may impede the normal passage of food through the small intestine, potentially causing intestinal obstruction or discomfort. Conversely, laxity or weakness in the ligament may contribute to anatomical instability and predispose individuals to conditions such as intestinal herniation or volvulus (twisting of the intestine).

Moreover, dysfunction in the ligament of Treitz can disrupt the coordinated movement of the small intestine and affect the efficiency of digestion and nutrient absorption. This may manifest as symptoms of malabsorption, including diarrhea, weight loss, and deficiencies in essential nutrients such as vitamins and minerals.

Addressing dysfunction or restriction in the ligament of Treitz often requires a multidisciplinary approach, involving careful assessment and management by healthcare professionals such as gastroenterologists, surgeons, and osteopathic practitioners. Manual therapies such as osteopathic manipulation may be employed to release tension and restore mobility in the ligament and surrounding structures, thereby alleviating gastrointestinal symptoms and improving overall digestive function.

Mechanisms and Goals of Treitz Ligament Release

Treitz Ligament Release is a manual therapy technique utilized by osteopathic practitioners to address restrictions or tension in the ligament of Treitz and surrounding structures. This ligament, also known as the suspensory ligament of the duodenum, plays a crucial role in supporting the junction between the duodenum and the jejunum, segments of the small intestine. By targeting this specific anatomical region, Treitz Ligament Release aims to achieve several mechanisms and goals to promote gastrointestinal health and overall well-being.

1. Release of Tension: The primary objective of Treitz Ligament Release is to release tension or restrictions in the ligament of Treitz and its associated structures. Over time, factors such as poor posture, chronic stress, or repetitive movements can contribute to the buildup of tension in these tissues, leading to decreased mobility and potential dysfunction. By applying gentle manual manipulation, osteopathic practitioners seek to alleviate this tension and restore normal mobility to the ligament and surrounding tissues.
2. Facilitation of Structural Alignment: Treitz Ligament Release can also help facilitate structural alignment within the gastrointestinal tract. Restrictions or adhesions in the ligament of Treitz may contribute to abnormal positioning or movement of the small intestine, potentially impacting digestion and nutrient absorption. By addressing these structural issues, the technique aims to promote optimal alignment and function of the gastrointestinal system, supporting the body’s ability to effectively process food and absorb nutrients.
3. Enhancement of Gastrointestinal Mobility: Another key mechanism of Treitz Ligament Release is the enhancement of gastrointestinal mobility. The ligament of Treitz serves as a point of attachment for the small intestine, and restrictions in this area can impede normal movement and peristalsis. By releasing tension and restoring mobility in the ligament and surrounding tissues, the technique aims to promote smooth and coordinated movement of the gastrointestinal tract, facilitating the transit of food and digestive secretions.
4. Optimization of Digestive Processes: Treitz Ligament Release is also believed to optimize digestive processes by promoting better circulation and nerve function in the gastrointestinal system. Improved mobility and alignment in the ligament of Treitz may enhance blood flow to the small intestine, supporting the delivery of oxygen and nutrients to digestive tissues. Additionally, by reducing tension and restoring nerve function, the technique may help normalize gastrointestinal motility and enhance the secretion of digestive enzymes, facilitating the breakdown and absorption of nutrients.
5. Support of Nutrient Absorption: Finally, Treitz Ligament Release aims to support the absorption of nutrients by promoting optimal gastrointestinal function. Restrictions or dysfunctions in the ligament of Treitz can impair the movement of digested food through the small intestine, potentially leading to malabsorption or nutrient deficiencies. By addressing these issues and promoting better mobility and alignment, the technique aims to create an environment conducive to efficient nutrient absorption, supporting overall health and well-being.

Techniques and Application

During a Treitz Ligament Release session, the osteopath may employ various hands-on techniques, such as gentle stretching, myofascial release, or indirect manipulation, to assess and address restrictions in the ligament of Treitz and adjacent tissues. These techniques are performed with the intention of promoting relaxation, improving circulation, and enhancing the body’s innate ability to self-regulate and heal.

Influence on Autonomic Nervous System and Overall Well-being

By focusing on the ligament of Treitz and its associated structures, Treitz Ligament Release is thought to influence the autonomic nervous system, which plays a crucial role in regulating gastrointestinal motility and function. By restoring balance and mobility in this region, osteopathic practitioners aim to support optimal digestion, alleviate gastrointestinal discomfort, and enhance overall well-being.

While further research is needed to fully understand the mechanisms and effectiveness of Treitz Ligament Release, anecdotal evidence suggests that this osteopathic technique may offer benefits for individuals experiencing gastrointestinal symptoms or functional digestive disorders. As part of a comprehensive osteopathic approach to healthcare, Treitz Ligament Release highlights the importance of addressing structural imbalances and promoting mobility to support the body’s natural healing processes and enhance gastrointestinal health.

Clinical Considerations and Patient Positioning

This maneuver, carried out by health professionals such as osteopaths, aims to release tensions or restrictions that may impact the Treitz ligament and surrounding structures. It is often applied in the context of gastrointestinal disorders, including gastroesophageal reflux disease (GERD) and other conditions related to abdominal tension.

It is crucial to emphasize that these techniques require the expertise of trained professionals and are tailored to the individual assessment of the patient. Treitz ligament release is part of a holistic approach to improving mobility and anatomical function, thereby contributing positively to the patient’s overall health.

A key aspect of this approach concerns the functional balance of the diaphragm, particularly in relation to the lower esophageal sphincter (LES). The left and right pillars of the diaphragm play a key role in closing this sphincter, establishing a significant muscular connection between the trunk and the diaphragm.

Detailed Procedure: Treitz Ligament Release Maneuver

The technique involves placing the patient in a supine position, with the operator standing at the head or side of the table. Gentle, controlled movements are applied, grasping and moving the margins of the lower rib cage, respecting the natural limits of rotation. This maneuver, synchronized with the patient’s deep breathing, promotes optimal muscle connection.

To enrich this approach, a higher or lower vector can be integrated into the rotation of the rib cage. This allows palpable movement on both sides of the diaphragm during deep breathing, ensuring full mobilization of both leaves of the diaphragm.

The position is held for approximately three deep breaths, eliminating residual fascial preferences and redefining respiratory effort. These techniques, integrated with manual therapies such as osteopathy, aim to promote mobility and function of the diaphragm, thus contributing to the patient’s overall well-being. The comprehensive approach to Treitz ligament release offers considerable potential to improve gastrointestinal health and promote the patient’s physical balance.

 This technique must be repeated three times

1. Patient Positioning:
   • The patient lies on their left side on a treatment table.
   • The practitioner stands on the right side of the patient, facing the rear of the patient.
2. Operator’s Hand Placement:
   • The practitioner’s left hand’s hypothenar eminence (fleshy part near the base of the little finger) is placed on the patient’s sternum.
   • The practitioner’s right palm is placed on the patient’s spine, specifically at the level of the 10th thoracic vertebrae.
3. Breathing Instructions:
   • The patient is instructed to inhale deeply.
   • Then, the patient exhales slowly.
4. Application of Pressure:
   • During the exhalation phase, the practitioner applies pressure with the left hand’s hypothenar eminence on the sternum in a cranio-dorsal (toward the head and back) direction.
   • Simultaneously, the practitioner’s right palm moves along the spine at the level of the 10th thoracic vertebra in an anterior (forward) direction.
5. Maintaining Position:
   • At the end of the exhalation, both hands of the practitioner remain in their respective positions.
6. Extension and Fixation:
   • During the next inhalation phase, the practitioner maintains the extension position.
   • Then, during the subsequent exhalation, the practitioner gradually extends the spine and fixes it in place.
   • At the same time, pressure on the sternum continues in a cranio-dorsal direction.
7. Repetition:
   • This technique is typically repeated as needed for optimal effectiveness.

Compilation of additional ailments effectively addressed through the application of the Treitz Ligament Release Maneuver

While the primary focus of the Treitz Ligament Release Maneuver is on addressing gastrointestinal dysfunction and visceral disturbances, there is anecdotal evidence and clinical experience suggesting that this technique may also be beneficial in treating other musculoskeletal and functional issues. However, it’s important to note that the evidence supporting the efficacy of the Treitz Ligament Release Maneuver for conditions beyond gastrointestinal complaints is limited and largely based on individual case reports or clinical observations. Here are some ailments that have been reportedly treated using this maneuver:

1. Low Back Pain: The Treitz Ligament Release Maneuver may help alleviate tension and restrictions in the connective tissue around the lumbar spine, potentially reducing symptoms of low back pain. By addressing fascial restrictions and improving biomechanical alignment, this technique may contribute to the relief of musculoskeletal strain and discomfort in the lumbar region.
2. Pelvic Dysfunction: Dysfunction in the pelvic region, including pelvic pain, sacroiliac joint dysfunction, or pelvic floor dysfunction, may benefit from the Treitz Ligament Release Maneuver. By releasing tension in the abdominal and pelvic fascia, this technique may improve pelvic biomechanics and alleviate symptoms associated with pelvic instability or muscular imbalances.
3. Digestive Disorders: In addition to its primary use in addressing gastrointestinal dysfunction, the Treitz Ligament Release Maneuver may be employed in the management of various digestive disorders, such as irritable bowel syndrome (IBS), constipation, or gastroesophageal reflux disease (GERD). By releasing tension in the duodenojejunal junction and surrounding structures, this technique may promote gastrointestinal motility and reduce symptoms of functional digestive disorders.
4. Thoracic Outlet Syndrome (TOS): Thoracic outlet syndrome, characterized by compression of the neurovascular structures passing through the thoracic outlet, may benefit from the Treitz Ligament Release Maneuver. By addressing fascial restrictions and improving thoracic mobility, this technique may help alleviate symptoms such as shoulder pain, arm numbness or tingling, and weakness in the upper extremities.
5. Postural Dysfunction: The Treitz Ligament Release Maneuver may be incorporated into comprehensive treatment strategies for addressing postural dysfunction and biomechanical imbalances. By releasing fascial restrictions in the abdominal and thoracic regions, this technique may facilitate improved postural alignment, reduce muscular tension, and enhance overall movement efficiency.
6. Functional Somatic Syndromes: Conditions characterized by a combination of physical symptoms and psychological distress, such as fibromyalgia or chronic fatigue syndrome, may benefit from the holistic approach of osteopathic manipulative treatment, including the Treitz Ligament Release Maneuver. By addressing somatic dysfunctions and promoting relaxation of the autonomic nervous system, this technique may contribute to the management of symptoms associated with functional somatic syndromes.
7. Visceral Dysfunction: Beyond gastrointestinal issues, the Treitz Ligament Release Maneuver might also be beneficial in addressing other forms of visceral dysfunction, such as liver congestion, gallbladder dysfunction, or splenic disorders. By releasing tension in the surrounding fascia and improving blood flow and lymphatic drainage, this technique may support the function and health of various visceral organs.
8. Adhesive Capsulitis (Frozen Shoulder): Adhesive capsulitis, commonly known as frozen shoulder, involves inflammation and stiffness of the shoulder joint capsule, leading to restricted range of motion and pain. The Treitz Ligament Release Maneuver, when applied in conjunction with other manual therapy techniques, may help improve shoulder mobility and alleviate discomfort by releasing restrictions in the surrounding soft tissues and enhancing joint function.
9. Cervical Spine Dysfunction: Dysfunction in the cervical spine, such as cervicalgia, cervical radiculopathy, or cervical facet joint dysfunction, may benefit from the Treitz Ligament Release Maneuver. By addressing fascial restrictions and improving mobility in the cervical region, this technique may contribute to the reduction of pain and stiffness and the restoration of normal neck function.
10. Headaches: Certain types of headaches, such as tension headaches or cervicogenic headaches, may be associated with musculoskeletal tension and dysfunction in the neck and upper back. The Treitz Ligament Release Maneuver, when integrated into a comprehensive treatment approach, may help alleviate headache symptoms by releasing tension in the cervical and thoracic fascia and promoting optimal biomechanics in the head and neck region.
11. Postoperative Adhesions: Following abdominal surgery or other surgical procedures involving the abdominal or pelvic regions, patients may develop postoperative adhesions, leading to pain, restricted mobility, and functional limitations. The Treitz Ligament Release Maneuver, when applied with appropriate caution and gentle techniques, may help reduce adhesion formation and promote tissue mobility and healing in the postoperative period.
12. Stress and Anxiety: While not a direct physical ailment, stress and anxiety can manifest as physical tension and discomfort in the body, affecting overall well-being and quality of life. The Treitz Ligament Release Maneuver, as part of a holistic treatment approach, may help promote relaxation, reduce muscular tension, and alleviate symptoms associated with stress-related somatic complaints.
13. Respiratory Dysfunction: The Treitz Ligament Release Maneuver may aid in addressing certain respiratory dysfunctions, such as restricted breathing patterns, thoracic tightness, or dysfunction of the diaphragm. By releasing tension in the thoracic and abdominal fascia, this technique may improve respiratory mechanics and enhance overall lung function.
14. Circulatory Disorders: While not a direct treatment for circulatory disorders, the Treitz Ligament Release Maneuver may contribute to improving blood flow and lymphatic drainage by releasing restrictions in the abdominal and pelvic regions. Enhanced circulation can support the body’s natural healing processes and may be beneficial for individuals with conditions such as venous insufficiency or lymphedema.
15. Reproductive Health: The Treitz Ligament Release Maneuver might have implications for reproductive health, particularly in addressing pelvic congestion syndrome, menstrual disorders, or discomfort associated with pregnancy. By releasing tension in the pelvic and abdominal fascia, this technique may promote improved blood flow to reproductive organs and alleviate symptoms related to hormonal imbalances or pelvic congestion.
16. Neurological Conditions: While not a primary treatment for neurological conditions, the Treitz Ligament Release Maneuver may be used adjunctively to address musculoskeletal issues and improve overall nervous system function. By releasing fascial restrictions and reducing muscular tension, this technique may help alleviate symptoms such as neuropathic pain, muscle spasms, or functional limitations associated with neurological disorders.
17. Postural Orthostatic Tachycardia Syndrome (POTS): POTS is a condition characterized by an abnormal increase in heart rate upon assuming an upright posture, often accompanied by symptoms such as dizziness, fatigue, and lightheadedness. The Treitz Ligament Release Maneuver, when incorporated into a comprehensive treatment plan, may help address associated musculoskeletal dysfunctions and improve autonomic nervous system regulation, potentially reducing symptoms and improving quality of life for individuals with POTS.
18. Adrenal Fatigue or Dysfunction: Adrenal fatigue, although not universally recognized as a medical diagnosis, is often associated with symptoms such as fatigue, insomnia, and hormonal imbalances. The Treitz Ligament Release Maneuver, when used as part of a holistic approach to wellness, may help reduce stress-related tension in the abdominal and pelvic regions, supporting adrenal health and overall stress resilience.
19. Athletic Performance Enhancement: Athletes and active individuals may benefit from the Treitz Ligament Release Maneuver as part of their training regimen to optimize biomechanics, reduce muscular imbalances, and enhance overall athletic performance. By releasing fascial restrictions and promoting optimal movement patterns, this technique may help prevent injuries, improve flexibility, and optimize athletic function.
20. Chronic Pain Syndromes: Chronic pain syndromes, such as fibromyalgia, complex regional pain syndrome (CRPS), or myofascial pain syndrome, often involve a complex interplay of physiological, psychological, and social factors. The Treitz Ligament Release Maneuver, as part of a multimodal treatment approach, may help address muscular tension, improve tissue mobility, and reduce pain perception in individuals with chronic pain conditions.

Contraindications for the Treitz Ligament Release Maneuver

1. Acute Abdominal Conditions: The Treitz Ligament Release Maneuver should not be performed on individuals with acute abdominal pain or conditions such as acute appendicitis, acute pancreatitis, or acute cholecystitis. Performing manipulative techniques in the presence of acute inflammation or infection can exacerbate symptoms and potentially lead to complications.
2. Abdominal Surgery: Patients who have recently undergone abdominal surgery, especially involving the duodenojejunal junction or nearby structures, should avoid this maneuver until adequate healing has occurred. Manipulative techniques in the postoperative period can disrupt the healing process, increase the risk of postoperative complications, or cause injury to the surgical site.
3. Abdominal Aortic Aneurysm: Individuals with an abdominal aortic aneurysm (AAA) should not undergo the Treitz Ligament Release Maneuver due to the risk of rupture or dissection of the aneurysm. Manipulative techniques that involve pressure or traction on the abdominal region can potentially increase the risk of catastrophic complications in patients with undiagnosed or unstable AAA.
4. Bleeding Disorders: Patients with bleeding disorders or those taking anticoagulant medications are at increased risk of bleeding complications during manipulative procedures. The Treitz Ligament Release Maneuver involves manual pressure and manipulation in the abdominal region, which may cause trauma to blood vessels and lead to hemorrhage in susceptible individuals.
5. Severe Osteoporosis: Individuals with severe osteoporosis or fragile bones may be at risk of fractures or skeletal injuries during manipulative techniques. The Treitz Ligament Release Maneuver requires the application of force and leverage, which can potentially exceed the structural integrity of compromised bones, leading to fractures or other musculoskeletal injuries.
6. Pregnancy: Special caution should be exercised when considering the Treitz Ligament Release Maneuver in pregnant individuals, especially during the later stages of pregnancy. Manipulative techniques involving abdominal pressure or torsion may pose risks to the developing fetus or contribute to uterine contractions, potentially triggering premature labor or other complications.