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What are varicose veins?
Varicose veins are unusually swollen veins that may bulge near the surface of the skin. These blue, red, or purple veins sometimes look squiggly or ropelike and are most likely to show up on your legs, though in pregnancy it's possible to get them on your lower pelvic area, buttocks, or elsewhere. (Hemorrhoids are just varicose veins in the rectal area.)
Many women first develop varicose veins – or find that they get worse – during pregnancy. You may have little or no discomfort from varicose veins, or they may make your legs feel heavy and achy. The skin around a varicose vein may also itch, throb, or feel like it's burning. The symptoms tend to be worse at the end of the day, especially if you've been on your feet a lot.
What causes varicose veins during pregnancy?
As your uterus grows, it puts pressure on the large vein on the right side of your body (the inferior vena cava), which increases pressure in your leg veins.
Veins are the blood vessels that return blood from your extremities to your heart, so the blood in your leg veins is already working against gravity. And when you're pregnant, the amount of blood in your body increases, adding to the burden on your veins. Your progesterone level also rises, relaxing the walls of your blood vessels.
You're more likely to get varicose veins if other members of your family have had them. They're more common in women than men, and if you have them, they tend to get worse with each successive pregnancy and as you get older. Being overweight, carrying twins or other multiples, and standing for long periods can also make you more likely to get them.
The good news for some women is that varicose veins may improve or disappear after you give birth, especially if you didn't have any before you got pregnant. And if they don't get better, you can look into various treatment options after your baby is born.
You may have also noticed tiny blood vessels near the surface of the skin, especially on your ankles, legs, or face. These are called spider veins because they often appear in a spider-like pattern, with little branches radiating out from the center. (Though sometimes they may look more like the branches of a tree or separate thin lines with no specific pattern.)
These don't cause discomfort, and they typically disappear after delivery.
How can I prevent varicose veins in pregnancy?
You may be able to prevent, or at least minimize, varicose veins while you're pregnant if you:
- Exercise daily. Even just a brisk walk around the block can improve your circulation.
- Stay within the recommended weight range for your stage of pregnancy.
- Elevate your feet and legs to the level of your heart or higher whenever possible. Rest your legs on a tall stool or box when you're sitting and elevate your feet and legs with pillows when you're lying down.
- Don't cross your legs or ankles when sitting.
- Don't sit or stand for long periods of time. Take frequent breaks to move around.
Can compression stockings help prevent varicose veins?
Yes. Compression stockings put pressure on your veins and increase the blood flow from your legs. There are three kinds of compression stockings:
- Support pantyhose: These can be found online or in most stores and will provide the least amount of pressure.
- Over-the-counter gradient compression hose: Tighter at the feet and ankles and looser as they go up your legs, these make it easier for blood to flow back up toward your heart. As a result, they help prevent swelling and may keep your varicose veins from getting worse. They’re available online or at pharmacies and medical supply stores. You can ask your doctor or midwife to help you make sure yours fit properly. (Morning is the best time to check for a proper fit because that's when you have the least swelling.)
- Prescription-strength gradient pressure hose: These will offer the greatest amount of pressure at your feet, ankles, and lower legs. You may need a prescription from your doctor or midwife to buy them and your medical insurance may cover the cost. You’ll need to be fitted by a professional and can buy them at some drugstores and medical supply stores.
Put on the stockings before you get out of bed in the morning (while you're still lying down) and keep them on all day to prevent blood from pooling in your legs.
You may have heard advice that sleeping on your left side can help prevent varicose veins. The theory goes that because the inferior vena cava is on the right side of your body, lying on your left side takes the weight of your uterus off the vein, relieving the pressure on the veins in your legs and feet. Although providers sometimes recommend it anyway, there's no proof to support the claim that sleeping this way prevents varicose veins.
Are varicose veins in pregnancy ever serious?
Varicose veins may itch or hurt, and they can be unsightly, but they're generally harmless in the short term. Treatment, if needed, can usually be postponed until after you have your baby.
However, a small percentage of people who have varicose veins develop small blood clots near the skin's surface (superficial venous thrombosis). When this kind of clot develops, the vein may feel hard and cord-like, and the area around it may become red, hot, tender, or painful.
Call your doctor or midwife if you think you have one of these clots because they can be serious. During pregnancy, they can be treated with warm compresses and will usually subside in a few days or weeks. Occasionally the area surrounding a clot becomes infected. You may develop a fever or chills in that case, and you'll need to be treated promptly with antibiotics.
Also, call your provider right away if:
- Either leg becomes severely swollen.
- You develop sores on your leg.
- The skin near the veins changes color.
In rare cases, superficial venous thrombosis can progress to deep vein thrombosis (DVT), a more serious condition in which
a clot develops in deep veins, usually in the legs, and could become inflamed or travel to the lungs and be life-threatening.
Pregnancy makes DVT more likely whether or not you have varicose veins, but DVT isn't common: Your chance of developing it – either during pregnancy or in the weeks after you give birth – is about 1 in 1,600. (Women with blood clotting disorders, obesity, multiple gestation or who are on prolonged bedrest have a higher risk.)
If you develop DVT, you may have no symptoms, or you may have sudden, painful swelling in your ankle, leg, and thigh. It may hurt more when your foot is flexed or when you're standing, and you may have a slight fever as well. If you notice any of these symptoms, call your provider immediately.
You may need to have an ultrasound exam of the affected area. And if you do have one of these clots, you'll need to be hospitalized and treated with blood-thinning medication.
Left untreated, the clot could break away and travel to the lungs, resulting in a life-threatening condition called a pulmonary embolism. Signs of a pulmonary embolism include shortness of breath, painful breathing, a cough (or coughing up blood), a panicky feeling, and a rapid heartbeat. If you have any of these symptoms, call 911.
How should I treat my varicose veins after pregnancy?
After you give birth, it's a good idea to continue to wear compression stockings, exercise regularly, don't sit or stand for long periods of time, and elevate your legs whenever possible.
Varicose veins often improve within three to four months after giving birth, though sometimes it takes even longer – and sometimes they don't improve much at all. (This is more likely if you've had multiple pregnancies.)
If your varicose veins persist and become too uncomfortable to live with, or even if you're just unhappy with how they look, ask your provider to refer you to a specialist to find out about other treatment options.