Although pregnancy is one of the most wonderful experiences and happy times in life for a woman, it can trigger a number of health issues. One of these is the risk of developing varicose veins during and after gestation.
What Are Varicose Veins Again?
Veins are pipes in the legs that return blood to the body (and the heart). There are enough veins in the legs to make fishnet stockings, and, when they are working correctly, they are not visible at all on the skin surface.
Varicose veins are protruding and unappealing blue veins that occur on the legs. They can affect both men and women at any age, but frequently start to appear after a pregnancy. They typically worsen with time and, if left untreated, they can even lead to more severe conditions such as phlebitis or damage to the skin in the lower leg.
Why Do Varicose Veins Occur?
When we stand up, the direction of the blood flow is against gravity, so we need valves in the veins to keep the blood moving in the correct direction. When these valves fail, the blood tends to flow the wrong way (so down the leg) and causes the veins to swell up. Patients recognize the issue when spotting blue bulging marks on the legs, which can ache and feel quite uncomfortable.
What Happens During Pregnancy?
Pregnancy does not directly cause varicose veins, but it does make them worse. Around one in three women will develop varicose veins during pregnancy.
While a woman is pregnant, aching, discomfort, swelling and heaviness in the legs are common. Some patients can develop prominent veins on the vulva, and even more serious conditions such as painful superficial thrombophlebitis and Deep Vein Thrombosis (DVT) can occur. Usually, the issues worsen in the later phase of pregnancy.
Once the pregnancy is over, the developed varicose veins can recede; however they often still cause uneasiness and look unattractive. It is then possible to get definitive treatment, which means surgery.
Why Can Pregnancy Make Varicose Veins Worse?
It is believed that there are two principal reasons why pregnancy makes a leaky vein worse: hormones and the pressure of a heavy uterus.
As a pregnancy advances, the body needs to produce hormones that make tissues and ligaments relax, so that, later on, the baby can pass through the birth canal. These hormones also affect leg veins – they cause the vein wall muscles to unwind. This makes the vein naturally expand, which augments the risk of them becoming varicose.
In the later stages of pregnancy, the uterus’ size enlarges. Consequently, the heavier uterus tends to push on the veins in the pelvis and limit the blood flow from the legs. This escalates the pressure on the leg veins and aggravates any failing valves.
Vulval Varicose Veins Explained
Sometimes during pregnancy varicose veins can occur on the vulval area. This happens most commonly in the last trimester. Vulval varices can be very sore and occasionally bleed during the delivery of the baby.
Vulval varices are usually caused by leaking valves in the pelvic area, rather than on the legs. Pelvic vein reflux is quite common during and after pregnancy, especially in women who have delivered a natural birth rather than having a Caesarean section. The reflux can trigger varicose veins both on the legs and on the vulva. When this happens, it can be particularly difficult to treat the veins. Moreover, these tend to reoccur more often than varicose veins in the top of the thigh.
Luckily, most vulval varicose veins improve after giving birth and only a minority of patients have issues that need treatment after pregnancy.
How Can Varicose Veins Be Treated During And After Pregnancy?
During pregnancy, definitive treatment (surgery) is not recommended, because it can put the baby at risk. For patients with problematic veins, it is usually suggested they wear compression stockings or tights until the pregnancy is over. These help to squeeze the blood, which consequently goes in the right direction, back up the leg. It is also sensible to take better care of the leg skin by applying a moisturizer every day.
After pregnancy, veins can be fixed by surgery. Over the last 10 years, treatment for varicose veins has moved away from the old fashioned ‘high tie and strip’ operation with its painful post operative course, hospital stay, and high rate of recurrence, to the modern era of minimally invasive surgery with lasers, glue, sclerotherapy, and other new treatments.
All these surgeries can all be performed under local anaesthetic on a walk in/walk out basis in about 30 minutes and usually patients are back to work within one week. This means that it is now much easier and quicker to treat varicose veins, so do not despair if you spot a forming varicose vein while pregnant – just get it checked by a vein specialist and it will all be fine.