Written by Dr.M.D.Mazumdar, MD
Varicose veins are a common feature in pregnancy especially in late pregnancy.
Older women who have been pregnant earlier are more likely to suffer from this problem.
Varicose veins are enlarged and engorged veins which can be seen on the skin as bluish, squiggly, swollen, lumpy lines. They occur mainly on the legs but can also occur on the vulva, opening of the vagina or even at the cervix (mouth of the uterus). When they occur at the mouth of the cervix, they can cause blood stained vaginal discharge or bleeding during pregnancy.
The most common locations for varicose veins during pregnancy are the legs, ankles and vulvas (external genital area). Hemorrhoids, which are varicose veins that occur in the rectum or around anus, are also common during pregnancy.
Varicose veins start off as spider veins - small faint bluish or purplish spiderweb like lines on the skin. They are not lumpy.
In later stages, ulcers may form ove the varicose veins due to stagnant blood flow.
Symptoms of Varicose Veins in Pregnancy
Bluish or purplish, irregular, lumpy lines on the skin.
Swollen areas on the skin which can be pressed easily without any pain.
When pressed with the fingertip, the swelling disappears. When the finger is removed, the swelling recurs immediately.
Itching over the swollen areas.
Sense of heaviness of the legs, especially when walking.
Sometimes there may be a dull ache.
Varicose veins on the cervix can cause mild bleeding or spotting in pregnancy.
Varicose veins at the rectum (hemorrhoids, piles) can cause bleeding while passing stool.
Infected or thrombosed hemorrhoids can cause pain or bleeding when passing stool.
Aching pain over the veins or lower legs.
Increased risk of swelling of the ankles (edema).
Causes of Varicose Veins in Pregnancy
The enlarging uterus presses on the veins carrying blood back to your heart from your legs causing stagnation of blood in the lower limbs.
Increasing levels of circulating hormones like progesterone and estrogen relax the walls of the veins causing them to bulge.
Increase in the blood volume during pregnancy. This increase is necessary to maintain the circulation of both the mother and the baby. But this increased volume puts more pressure on the veins of the legs and lower body which have to work against gravity to push the blood to the heart.
In older women who have been pregnant for a number of times or in older women pregnant for the first time, the muscles supporting the veins are already somewhat weak. As a result, the veins tend to bulge.
Damaged Vein Valves. Normally, veins pump blood from different parts of the body to the heart. They have valves which work to prevent the blood flowing back to the legs. These valves can become damaged and cause the blood to flow back and pool in the lower veins.
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Excessive weight gain puts more pressure on the veins.
Lack of exercise and a sedentary life-style can contribute to varicose veins.
Hereditary. Varicose veins may be hereditary. If your mother had varicose veins during pregnancy, you are more at risk of getting them too.
How to Prevent Varicose Veins in Pregnancy
Lie down as much as you can with your feet raised on a high pillow. This will put less pressure on your veins.
Exercise Although this sounds contrary to the above points, it is not. Exercise helps stimulate the muslces and the contraction and relaxation of the muscles will help the veins to pump blood more efficiently.
Take frequent breaks and move around as much as possible if you have to stand or sit for a while. If you have to stand for a long time, rest one foot on a low stool to take the weight off. Alternate the feet from time to time. Flex your ankles from time to time and roate it clockwise as well as anti-clockwise.
Limit the amount of sodium in your diet, which can cause swelling.
When you lie down, lie on your left side. Sleep on your left side to keep pressure off your inferior vena cava. This is the large vein that carries blood from your legs to your heart.
Do not sit with your legs crossed. The crimp at your knees could restrict blood flow.
Avoid tight-fitting clothes, especially around the upper legs and hips.
Wear maternity support stockings or compression stockings to prevent bulging of the veins. These stockings are specially constructed to create a gradually increasing pressure from the ankles upwards. This pressure helps compress the muscles and in gently squeezing the blood back to the heart.
Weight Control. Keep your weight gain under control. The normal total weight gain during pregnancy should not be above the 10 kgs (22 pounds).
How to treat Hemorrhoids in pregnancy
Apply Ice pack over the anus
Ask your doctor for local creams which can numb the area and decrease pain. Your doctor can also prescribe stool softeners which are safe in pregnancy.
Increase fiber and fluids in your diet
Sit in a warm, shallow bath (also called a sitz bath) for 10 to 20 minutes several times a day.
When should you consult your doctor?
Varicose veins are usually not serious. But do consult your doctor if you see:
Bleeding from the vein.
Open sore (ulcer) on the skin near the varicose vein.
Pain, swelling and redness in your leg, which could be signs of a blood clot.