Varicose Veins
There are several causes of varicose veins in the general population, and pregnancy itself is considered a major cause. There are several specific physiological aspects of pregnancy that work together to create a very easy environment for certain veins to enlarge and possibly cause discomfort.
Most women who develop varicose veins do so early in the first trimester as a result of the major increase in blood volume that begins around six weeks of pregnancy. As pregnancy progresses, blood volume continues to increase and the uterus enlarges, which puts pressure on the pelvic veins. As such, varicose veins tend to get worse until term. Women may also have (low) blood pressure or vein valve issues that could further contribute to their formation.
While some varicose pains are only distinguishable by appearance, others can be painful, swollen, itchy, and achy – and may lead to swelling and/or leg cramps.
While there are no evidence-based viable methods for the prevention of varicose veins, some lifestyle modifications can help alleviate symptoms. For women suffering with extremely painful or large varicose veins, several methods are available for their removal in the postpartum period.
Women who are bothered by either the appearance or symptoms of their varicose veins should talk to their HCP. HCPs can help women manage their pain and any other associated symptoms that could be bothersome.
Background
An estimated 40% of women develop varicose veins during pregnancy, which appear as blue, purple, or red bulges through or directly under the skin. They most commonly appear on the legs but can also be found in the groin, vaginal (varicosities), or anal/rectal (hemorrhoids) areas.
Symptoms
Although not all varicose veins cause symptoms, they can be painful for some women and may ache, itch, or throb. Varicose veins can also lead to mild swelling, feelings of heaviness, night cramps, numbness, or tingling. Symptoms may peak at the end of the day or when sitting or standing for a long period of time.
Fortunately, varicose veins are not associated with any potential negative outcome of pregnancy, and how they look is not necessarily associated with the severity of symptoms.
Causes
Pregnancy itself is identified as a cause of varicose veins and there are many aspects of pregnancy that lead to varicose veins. Further, many women also have certain risk factors prior to pregnancy that make them more vulnerable to their development.
Veins are blood vessels that return blood back to the heart (arteries take blood away from the heart).
Blood from the legs must travel against gravity through the veins to reach the heart. This movement is helped by contractions of the lower leg muscles (known as the calf muscle pump) and the elasticity of the vein walls, which act together to pump the blood upwards.
Valves positioned along the length of the vein close as the blood is pumped through them to prevent blood flowing backwards when leg muscles relax. When these valves fail, blood flows in both directions (venous reflux) and collects in the vein, leading to swelling and discomfort. Decreased elasticity in the vein walls also contributes to valve failure and the development of varicose veins.
The exact mechanisms for why valves fail and walls weaken in some women but not others are not understood, but family history, genetics, prior pregnancies, and lack of physical activity are leading risk factors.
It is also assessed that progesterone may also play a role by relaxing both the walls and the valves.
Whether weight is a risk factor for varicose veins is debated. Although extra weight puts additionally pressure on veins, not all studies have found a connection between weight and the development of varicose veins during pregnancy.
However, the increased uterine and fetal weight can lead to varicose veins by pressing on the veins in the pelvic area which further blocks blood flow back to the heart.
This added pelvic congestion is likely the main cause of vaginal and vulvar varicosities during pregnancy as well, in which varicose veins develop in and around the vagina, groin, and vulva areas. Varicose veins can also develop inside the rectum and around the anus (hemorrhoids) for the same reasons described above.
Another pregnancy-related contributing factor is blood volume. Up to 80% of women that develop varicose veins do so during the first trimester as a result of the almost 50% increase in blood volume that occurs beginning around 6 weeks of pregnancy.
Total blood volume during pregnancy increases by about 1.5 liters to support fetal and placental development and protection from blood loss during delivery. Around 1 liter of blood is contained within the uterus and maternal blood spaces of the placenta.
Some researchers report blood pressure drops significantly by 6 to 7 weeks of pregnancy due to this increased circulation to the fetus and placenta. A decrease in blood pressure means that blood is slower to return to the heart which further increases the risk for varicose veins, as well as swelling and deep vein thrombosis.
Management
There are several lifestyle, pharmacological (medications), and/or surgical options available for the management of varicose veins (see Action section). However, there is a lack of evidence regarding most of these treatments, to include which options may be most effective. Fortunately, most varicose veins that develop during pregnancy will improve within the first year after birth, although some may remain.
Due to the lack of data, the most optimal way to manage varicose veins can be considered a two-step approach:
Relieve any current discomfort
Stop them from getting worse (these same methods also aid in prevention)
Compression stockings do not prevent varicose veins from forming, but they can help lessen the symptoms of pain and discomfort and may stop them from getting worse. Compression stockings can also help with swelling and are commonly recommended. These stockings can now be purchased in "high fashion" patterns (and grades) which can help women wear them more often during different activities.
Exercising improves blood flow which can help avoid blood pooling/collecting in the the lower body for an extended time. Walking is a highly recommended form of exercise for varicose veins (because it activates the calf muscle pump).
In the postpartum period, severe or painful varicose veins may be surgically removed or closed off through sclerotherapy, which involves injecting a liquid into the vein to close it off (in the postpartum period).
Action
Lifestyle modifications include making changes to daily activities, positions, and garments.
Women can try to:
Keep their feet up as much as possible, which helps relieve blood that has pooled in the legs
Lay on their left sides when resting or sleeping; this takes pressure off the inferior vena cava, improving blood flow back to the heart
Avoid crossing the legs and remaining in one seated or standing position for too long
Engage in routine physical exercise, which engages the muscles and helps circulate blood throughout the body
Avoid tight clothing around the waist, thighs, and legs, except for compression garments, which act differently
Reflexology or water immersion may also help improve blood flow and relieve symptoms
Women should read related pages to learn more:
Resources
Varicose Veins (National Heart, Lung, and Blood Institute)
Varicose Veins (Society for Vascular Surgery)
Skin Conditions During Pregnancy (American College of Obstetricians and Gynecologists)