By Dr Saurabh Joshi
The thick blue and red veins highly visible during pregnancy are known as varicose veins. They are a common, usually harmless part of pregnancy for some women. They can be sore to the touch, itchy and make your legs feel tired and achy; symptoms that can get worse if you’ve been on your feet for a long time. Some women don’t experience the symptoms at all, but they still have to deal with those less-than-lovely lines on their legs. They happen when the uterus applies pressure to the large vein (the inferior vena cava) that carries blood back to the heart from your feet and legs. As the uterus grows towards the later part of pregnancy, the mechanical obstruction on the inferior vena cava and pelvic veins worsen the venous dilatation.
Varicose veins in pregnancy are quite prevalent with approximately 70 per cent of pregnant women suffering from them. The sight of dilated veins can be distressing. Not only this, they can cause discomfort, painful legs, skin changes, thrombophlebitis and even Deep Venous Thrombosis (DVT).
Varicose veins are tortuous, large veins seen on legs or feet. They are a part of the varicose veins disease. Several factors that are unique to the pregnant state increase its incidence. The increased production of estrogen and progesterone causes smooth muscle relaxation and dilatation of the vessels. The dilatation can further cause the incompetence of the valves. The increased blood volume associated with pregnancy can further complicate the insufficiency. As the uterus grows towards the later part of pregnancy, the mechanical obstruction on the inferior vena cava and pelvic veins worsen the venous dilatation.
The sight of dilated veins can be distressing. Not only this, they can cause discomfort, painful legs, skin changes, thrombophlebitis and even Deep Venous Thrombosis (DVT).
Here are some ways to reduce varicose vein pain and avoid making the veins worse:
· Move around as much as possible if you have to stand or sit for a while.
· Don’t cross your legs when sitting.
· Elevate your feet often.
· Wear maternity support hose. These special pantyhose gently compress the leg muscles and squeeze the veins to help push the blood back toward the heart. They differ from regular pantyhose because they apply gradual amounts of pressure to the leg, with the most compression at the ankle and less far up the leg. It’s important to avoid tight socks or knee-highs that squeeze at a particular spot on the leg, as this can cut off circulation.
· The right kind of compression stockings can offer relief to most symptoms. Choosing the right stocking is important. The pressure offered by stockings varies as per the severity of varicose veins. The specialist doctor will be in a better position to guide you.
· Get daily low-impact exercise if your doctor says it’s okay.
· Sleep on your left side to keep the pressure off of the inferior vena cava, which is on the right side of your body.
The commonly offered procedures for the treatment of varicose veins are not advised during pregnancy. An ultrasound is needed during pregnancy to rule out any suspected DVT.
The persistence of varicose veins beyond four months of delivery will need a visit to a specialist and its appropriate management. Persistent varicose veins can be treated by minimally invasive methods like Endovenous Laser Ablation treatment or Sclerotherapy.
(The writer is an interventional radiologist of vascular diseases at The Vein Center, Mumbai.)
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