THE DO’S AND DON’TS OF CARING FOR YOUR LEGS DURING PREGNANCY

Here's some quick anatomy:

The heart pumps blood outward to the rest of the body through arteries. These vessels are thick walled, and depending on where they are the blood pumping through them is under a fair amount of pressure. This is arterial, outgoing blood almost always flows in one direction.

Veins are different. They return blood to the heart, are thin walled, and aren’t under nearly as much pressure. They depend on uni-directional valves to keep blood flowing in the right direction. When these veins become stretched out due to too much pressure, as happens with pregnancy and obesity, or simply standing for long periods for many years, these valves weaken. Blood begins to trickle back down the legs, begins to pool, and the swelling and discomfort that accompanies vein disease can arise. Additionally, this added pressure stretches the veins out even further, causing them to bulge and making them all to visible.

 

This is the cause of nearly all vein disorders, and it also explains why most problem veins occur in the legs, ankles, and feet. They’re the lowest point in the body: this is where blood will tend to pool when venous valves aren’t working properly.

Who gets varicose veins and their smaller cousins, spider veins? Anyone can develop them, yet they tend to occur much more often in women. Anything that puts added pressure on the legs while standing is a risk factor, such as pregnancy and obesity. Having a job that requires standing for hours on end is another huge predictor. Genetics also plays a large part. If you’ve got a bad family history of vein disease, there’s a good chance you’ll develop vein problems, too. It’s ironic, but even too much sitting can cause varicose and spider veins--especially if one sits with their legs crossed most of the time. Why? The muscles of the legs, mainly the calves, act as “pumps” to help blood work against gravity and move towards the heart, and sitting certainly doesn’t work the large muscles of the legs. It always pays to vary your position throughout the day, sitting down if you stand for long periods, and taking short walks if you’ve been sitting for awhile. Vary your routine.

Pregnancy is a special case, with several factors coming into play at once. First and foremost is the weight of the developing fetus and the fluid which surrounds it. This will put lots of added pressure on the main abdominal vein, the vena cava. This in turn raises the pressure in the legs. A woman’s blood volume also increases greatly while pregnant, which raises this pressure even more.

Then there are hormonal changes. There’s a lot more of the hormone progestin in the body when a woman is pregnant. This hormone is notorious for wreaking havoc on the venous system, since it relaxes all veins in the body, which tends to pull apart the one way valves inside of the leg veins. It’s a perfect setup for vein disease. Note that the progesterone is also the active ingredient in most oral birth control medications, so this process can occur without pregnancy.

Should I exercise even if I have varicose veins? Will this make it worse?

Exercise is actually one of the best, easiest things you can do to keep the process of varicose and spider vein formation at bay. It’s positive effects reduce the risk in multiple ways. Exercise is associated with weight loss, which directly reduces pressure on the leg veins. Working out also balances a person’s hormones. Yet the greatest benefit comes from the actual motion of the exercise itself. The large muscles of the legs act as a sort of pump when they contract, helping blood more towards the heart. This makes exercise a great bet for vein health as well as overall well being.

Walking is perhaps the single best exercise to improve circulation in the legs, thus improving vein health and stalling vein disease. It’s also low impact, and nearly everyone can do it. Even if a person has health issues which interfere with walking, water-walking in a swimming pool works just as well. You’ll get all the benefits of walking with even less impact.

Yet not all exercises help, and some in fact can have a detrimental effect. All of the following can increase abdominal pressure, which in turn increases the overall pressure in the veins of the leg.

  • Sit-ups and crunches
  • Lunges
  • Heavy lifting movements, such as deadlift and squats.
  • Yoga, if excessive abdominal posing is undertaken.

This isn’t to say that these exercises should be avoided entirely, but should be done in moderation if one has or is prone to varicose and spider veins.

Are any supplements good for treating / preventing vein problems?

B-complex vitamins can help by strengthening the vein walls, reducing the likelihood that your veins will become stretched out. These include nutrients like niacin, folate, riboflavin, and pantothenic acid. These are all technical names for what we commonly know as B vitamins.

Why do I experience swollen ankles and feet during pregnancy? Can this cause vein problems?

Some swelling a.k.a. edema, is normal during pregnancy. There’s excess weight on the legs from the developing fetus, and hormonal changes can cause a woman to retain more water. This will almost always be more pronounced in the calves, ankles, and feet, since they’re the lowest points of the body, and blood has to work against gravity the hardest to travel back towards the heart.

Of particular importance it the weight of the fetus and the fluid around it. This directly puts pressure on the main abdominal vein, the vena cava. This is responsible for carrying all blood back to the heart, so any pressure put upon it will make this return harder. This transletes into increased pressure inside the veins of the leg, which will absolutely contribute to swelling.

This is why a woman is most likely to develop excessive swelling at around the 3rd trimester. That’s when these multiple factors are in play the most. As with anyone, this swelling will be worst at the end of the day, after standing and walking throughout the day.

After giving birth, things return to normal fairly quickly. Your normal fluid balance will return, and any excess swelling you experienced during your pregnancy will stop.

At what point should I become concerned about excess swelling?

Remember that some swelling is normal, especially during the 3rd trimester of pregnancy. Some swelling in the hands is even considered normal. This makes sense, since your body’s hormonal balance is changing and you’re retaining more water. Even so, call your doctor’s office if you experience the following:

  • Swelling of the face
  • Puffiness of the tissue surrounding the eyes.
  • Large amounts of swelling in your wrists and hands.
  • The sudden appearance of excessive swelling in the calves, ankles, and feet.

These symptoms could be signs of a blood pressure disorder known as preeclampsia, which can occur during pregnancy. This can affect the developing fetus, so seek medical attention immediately.

It’s also essential to see your doctor if one leg is swells suddenly, or if one leg is more swollen than the other, especially if this is seen in the calf area. This is usually accompanied by pain and tenderness. This could be a sign of a blood clot, which is potentially life threatening. Don’t wait, call for immediate assistance.

Pregnacy Vein Care Picture

WHY DO VEINS WORSEN DURING PREGNANCY

Why do I experience swollen ankles and feet during pregnancy? Can this cause vein problems?

Some swelling a.k.a. edema, is normal during pregnancy. There’s excess weight on the legs from the developing fetus, and hormonal changes can cause a woman to retain more water. This will almost always be more pronounced in the calves, ankles, and feet, since they’re the lowest points of the body, and blood has to work against gravity the hardest to travel back towards the heart.

Of particular importance it the weight of the fetus and the fluid around it. This directly puts pressure on the main abdominal vein, the vena cava. This is responsible for carrying all blood back to the heart, so any pressure put upon it will make this return harder. This transletes into increased pressure inside the veins of the leg, which will absolutely contribute to swelling.

This is why a woman is most likely to develop excessive swelling at around the 3rd trimester. That’s when these multiple factors are in play the most. As with anyone, this swelling will be worst at the end of the day, after standing and walking throughout the day.

After giving birth, things return to normal fairly quickly. Your normal fluid balance will return, and any excess swelling you experienced during your pregnancy will stop.

At what point should I become concerned about excess swelling?

Remember that some swelling is normal, especially during the 3rd trimester of pregnancy. Some swelling in the hands is even considered normal. This makes sense, since your body’s hormonal balance is changing and you’re retaining more water. Even so, call your doctor’s office if you experience the following:

  • Swelling of the face
  • Puffiness of the tissue surrounding the eyes.
  • Large amounts of swelling in your wrists and hands.
  • The sudden appearance of excessive swelling in the calves, ankles, and feet.

These symptoms could be signs of a blood pressure disorder known as preeclampsia, which can occur during pregnancy. This can affect the developing fetus, so seek medical attention immediately.

It’s also essential to see your doctor if one leg is swells suddenly, or if one leg is more swollen than the other, especially if this is seen in the calf area. This is usually accompanied by pain and tenderness. This could be a sign of a blood clot, which is potentially life threatening. Don’t wait, call for immediate assistance.

Are varicose veins ever dangerous or life threatening?

Not directly. The caveat here is Deep Vein Thrombi (DVT). These are essentially large blood clots which form in the deep vein system of the legs. DVTs themselves are often harmless, and can be present for years with zero symptoms. It’s when they break away, and travel elsewhere in the body that problems can develop, at least one of which is life threatening. When a DVT lodges itself in the lungs it’s known as a Pulmonary Embolism (PE), which can prove fatal. Blood clots can also form in more superficial veins. These may cause local pain and swelling, but they usually resolve on their own and aren’t dangerous. At worst, they have to be removed via small access incisions.

If minimally invasive procedures like RF and sclero aren’t right for you, for whatever reason, there are more invasive procedures available. What this usually means is high ligation and stripping, where a vein is tied off and physically removed via surgery. This does work, but can requires general anesthesia and lengthy hospital stays. Scarring is also sometimes extensive. All of these are reasons why stripping has fallen out of favor.

Chronic Venous Insufficiency has strong anecdotal evidence of being genetically influenced, but this type of evidence is the weakest type. More studies are needed to prove an absolute connection, yet this idea is accepted by most as general wisdom. All that’s left to do is determine exactly how much of an influence genetics exert.

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Wearing Compression Hose During Pregnancy Image

COMPRESSION HOSE DURING PREGNANCY

Should I wear compression garments when flying? Traveling by car for long distances?

This is always a good idea. Long periods of immobility, as when flying or sitting in a car for hours are one of the prime risk factors for Deep Vein Thrombosis (DVT) formation. If these blood clots break free of the vein walls they’re attached to, the results can be devastating.  So while it may be uncomfortable to wear prescription stockings during travel, it’s a small price to pay for potentially avoiding serious medical consequences.

At any rate, stockings are good at controlling the symptoms of varicose veins, which is especially important as we get older. The skin naturally becomes thinner and more easily damaged, and surface varicose veins are easily nicked. This can cause alarming amounts of bleeding, and a trip to the emergency room is usually in order, but this bleeding is rarely extensive enough to be dangerous. After a varicose vein is damaged, it’s typical Possible adverse effects:

  • Superficial blood clot. When this occurs in the shallow, superficial veins it may require drainage, yet doesn’t pose a health risk.
  • Air bubbles. During the procedure, small air bubbles may enter the bloodstream. These resolve on their own and aren’t dangerous.
  • Allergic reaction. Some patients are allergic to latex or the local anesthetic used (lidocaine, bupivocaine).
  • Mild inflammation. Some redness, swelling, and generalized inflammation will occur around the incision sites. As mentioned, Tylenol is usually all that’s needed.

How long after my sclerotherapy will I notice effects?

You’ll see some improvement almost immediately, but peak results take about 3 to 5 weeks to appear. Larger veins take longer: if sclerotherapy is being used on veins greater than 5 mm in diameter (which are probably too large for sclero and another procedure should be used), complete resolution could take up to 4 months. Sclero will work, but will take an excessive amount of time.

What causes a vein to burst and start bleeding? Can this happen after a procedure?

This isn’t common, but can happen with any surgical intervention. When the vein is very superficial (shallow), the blood may become trapped beneath the top layers of the skin, creating a dark brown / red stain.  Even so, the size of the veins being treated with treatments like sclerotherapy and laser resurfacing is so small that even if they burst, there’s no danger to the patient.

In reality, anyone can have a small vein burst for a variety of reasons, and in fact this is what happens in bruising. This is technically known as ecchymosis, and is obviously very common. This occurs due to trauma, or even wear and tear when veins become fragile with age.

There aren’t usually serious complications when small veins burst. Superficial (shallow) clots can occur, known alternately as superficial thrombophlebitis, phlebitis, or superficial venous thrombosis. There will be swelling, redness, and sometimes discomfort, yet the problem usually goes away on its own. Only occasionally to these small clots need to be removed.

What if I’m not a candidate for less-invasive procedures?

If Radiofrequency ablation (RF) and sclero won’t work for you, the next step is called ligation (tying off) and stripping (surgical removal). Ligation with stripping is very invasive, requires general anesthesia, has many more associated risks, and can leave dramatic scars. You’ll also be spending some length of time in the hospital to recover. It works, but isn’t a popular option.

How well do your veins heal?

Veins heal well enough, yet without the one-way valves which keep blood moving in the correct direction, towards the heart. The vein will still carry blood, but vein problems are more likely. In reality this usually doesn’t pose a problem, since there are miles of veins in the body, so blood has many pathways back to the heart. Often, damaged veins are simply reabsorbed into the body.

Do I need treatment?

It’s entirely up to you and your doctor. You may elect not to seek treatment if the cosmetic appearance of your legs doesn’t bother you, or if symptoms like achiness, swelling, fatigue, and cramping are minor. Also, it pays to exhaust conservative measures before committing to any invasive approach, namely Exercise, Elevation, and Elastic support hose--the three “E’s.”

Here are some suggestions:

  1. Regularly exercise, especially movements like walking which work the thigh and calf muscles. Then the calf muscles contract, they act as pumps assisting blood up the leg and back to the heart.
  2. Wear high quality, prescription, graduated compression garments....
  3. If you sit for long periods at work, get up and move about periodically.
  4. If you stand for long periods at work, take periodic sitting breaks.
  5. Don’t cross your legs while sitting.

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HOW TO REDUCE SWELLING DURING PREGNANCY

What can I do to reduce swelling during pregnancy? Here’s a fairly complete list of tips:

Elevate your feet whenever possible during the day, and sleep with them probbed up 6 to 8 inches above the level of your heart.

Avoid sitting cross-legged for long periods. In general, it pays to vary the positon your’re sitting in periodically.

When sitting for long periods, get up and walk around at intervals of about 90 minutes or so. Be sure to activate your calf muscles by “toeing up” if possible. Rotate your andles, and wiggle your toes to maximally improve circulation.

When standing for long periods, take short sitting breaks at about 90 minute intervals. When standing, be sure to switch your weight from leg to leg frequently. This will minimize blood pooling in your calves, ankles, and feet.

Don’t wear high heels. Wear comfortable, practical flat footwear instead. Wear roomy shoes which can accomodate any swelling that you may experience. Avoid tight socks as well.

Always wear thigh high, prescription strength support stockings. Be sure to put these on before rising from bed, when swelling is at an absolute minimum. Buy several pairs, since you’ll want to wear them daily.

Stay hydrated. This reduces the buildup of salts and other electrolytes in your body, which helps you retain less water overall. Go for 80 (or more) ounces of water daily. As a guide, you’ll know you’re well hydrated if your urine is clear or very pale yellow.

Eat less salt. A high sodium diet causes fluid retention.

Get regular exercise, preferably daily. Walking is the single best option, since it’s low impact and engages the calf muscles, which act as pumps to assist blood back up the leg veins towards the heart. If you can’t tolerate regular walking, water walking in a pool is just as effective.

Lie on your side, not your back. This will take the weight of the developing fetus off of your vena cava, the main vein in your abdomen. This will decrease the pressure inside of your leg veins.

Eat healthy, and maintain a reasonable body weight.

After your postpartum exam, come in for a Doppler Ultrasound to assess the vein damage done during pregnancy and see what can be done to repair the damage and prevent symptoms from getting worse!

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