Managing Varicose Veins During Pregnancy: Tips and Advice

Aug 16, 2023

Dr Tan Yih Kai

Up to 70% of pregnant women suffer from varicose veins in the legs during pregnancy. Varicose veins are enlarged veins that appear to be bulging, tortuous, and bluish in colour, running just underneath the skin. Veins in the legs have one-way valves, which ensure blood flows from the feet towards the heart in one direction. Failure of one-way valves in the leg veins will allow blood to flow backward towards the feet, stretching the walls of the veins. Some pregnant women are especially prone to developing varicose veins when they have a family history of varicose veins, are overweight, or have a job that requires prolonged standing or sitting. Pregnancy can also exacerbate the symptoms of those who already have varicose veins.

Vein with normal working valve
Vein with normal working

There are various reasons that may account for the development of varicose veins during pregnancy:

  • An increase in pregnancy hormones (oestrogen and progesterone) will lead to dilatation of veins and failure of one-way valves in the veins to work properly
  • The enlarging uterus of a growing baby may result in compression of pelvic veins, which are responsible for returning blood from legs to the heart
  • An increase in total blood volume during pregnancy to support a growing baby will lead to stretching of the vein wall. An increase in the diameter of veins will prevent one-way valves from closing properly, leading to the pooling of blood in the legs.

Symptoms of varicose vein in the leg may include:

  • Swelling feet and ankles: Swelling tends to be more significant during the late stage of pregnancy and especially worse towards the end of the day. This is due to the pooling of blood in the leg because of gravity and vein valve failure.
  • Heaviness
  • Tiredness
  • Aches
  • Pain- may be burning, crampy, throbbing or shooting in nature
  • Muscle cramps at night
  • Itching

In addition, pregnant women are up to five times more likely to develop deep vein thrombosis (DVT) than when not pregnant. This is because:

  • Blood clots more easily during pregnancy
  • Blood flow in the leg veins is also slowed down by the compression of the pelvic veins from the increasing size of the uterus. This encourages the blood to clot.

Surgery or minimally invasive procedures to treat varicose veins should be avoided during pregnancy.  Regression of varicose veins is often observed within the first three months after delivery. There are, however, many conservative approaches that can manage varicose vein symptoms effectively during pregnancy:

  • Avoid prolonged standing and sitting
  • Engage in exercise regularly, such as walking and swimming
  • Wear graduated compression stockings. The pressure exerted by the stockings on the leg veins will help the vein valves work properly by promoting blood flow from the leg towards the heart
  • Elevate legs regularly to improve venous circulation of the legs
  • Try to keep body weight within recommended limits

Do not hesitate to consult a vascular surgeon about your varicose veins, especially when they become symptomatic as pregnancy progresses. It is important to exclude serious conditions, such as DVT.  Not uncommonly, varicose veins stay after pregnancy as the valves in the veins are irreversibly damaged. Medical intervention may be required to normalise the vein circulation.

Dr Tan Yih Kai, a Senior Consultant Vascular and Endovascular Surgeon at The Vascular Vascular Vein and Wound Centre is a leading specialist in the care of varicose veins. He has many years of experience treating patients with varicose veins and the associated complications, such as DVT.

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