Expert / 20 July, 2021 / Professor Mark Whiteley
Professor Mark Whiteley, Consultant Venous Surgeon and Founder of The Whiteley Clinic gives us the low-down on pregnancy and veins.
Varicose veins occur when the valves in our veins stop working. This valve failure means that blood falls down the veins when standing up rather than flowing upwards towards the heart. In their simplest form, varicose veins appear as bulging veins that protrude from the legs. However, shockingly, up to half of all varicose vein sufferers will show no overt signs of the condition, as the problematic veins remain hidden under the skin.
Pregnancy can worsen the symptoms of varicose veins because pregnant women need more blood circulating than usual to help their baby grow, filling the veins and stretching them. In addition, the pregnant uterus can presses on some of the veins in the pelvis in certain positions, impeding blood flow from the legs to the heart. This pressure is often thought of as a contributory cause of leg swelling, although it is probably not a significant cause in most women.
As well as this, an increase in progesterone, the pregnancy hormone, relaxes the blood vessel walls, making it harder for veins to work correctly. The hormonal changes that occur during pregnancy mean expecting women often notice that their varicose veins have become more prominent. Before the publication of research in 1999, many people thought that pregnancy causes varicose veins. However, this link has now been disproven. Venous changes are progressive, and so women with hidden varicose veins will often see varicose veins “develop” during subsequent pregnancies.
The most common place for pregnant women to get varicose veins is their legs; however, it is possible to develop varicose and thread veins in other parts of your body. Such places can include the vagina and vulva, anus (haemorrhoids), buttocks and perineum. However, women will also notice veins appearing elsewhere due to the increased volume and relaxed vein walls, such as on the breasts and hands.
The most frequently occurring symptoms of varicose veins/hidden varicose veins are tired/heavy/aching legs (worse on standing and in hot weather). Painful lumps under the skin on the legs, sometimes red and hot, can indicate “phlebitis” – venous blood clotting in the varicose veins. Itching of the lower legs can be a sign of venous eczema. Tender/painful discoloured skin on the inner part of the lower leg can indicate that a venous leg ulcer might be forming.
It’s important to note that not all sufferers will experience every symptom. However, there is a helpful mnemonic with some key indicators to be aware of:
V – Veins which are visible on the surface of the skin, or just under
E – Enlarged veins that are blue or dark purple
I – Itchy, sore or dry skin over your veins
N – Nodular, bulging or twisted veins
S – Swollen, achy or heavy legs and ankles
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During pregnancy, especially early pregnancy, breast veins may also appear more prominent. These appear because the blood volume increases by approximately 20-40% during late pregnancy, filling the veins more than normal. Obvious or bulging blue or green veins on, or in the cleavage between, the breasts, can be very upsetting. As a result, many woman become very self-conscious.
These should not be assessed for treatment until three months after breastfeeding has completed. However, if they are still prominent at that time, treatment can be considered. Each patient needs an individual assessment to choose the optimal treatment. Treatment is usually by removing the vein under local anaesthetic, or by an injection of foam sclerotherapy. In some cases, both treatments are used in combination. Some patients with widespread veins may need a series of treatments to get the optimal result.
Haemorrhoids are also quite common during pregnancy and postpartum recovery. Haemorrhoids are thought to occur because the growing uterus puts pressure on the pelvic floor and inferior vena cava – a large vein on the right side of the body which receives blood from the lower limbs. This in turn increases the pressure on the veins below the uterus, causing them to swell. In addition, when standing or sitting, the uterus presses directly downwards on the veins draining the lower rectum. In addition, the increase in blood volume and the increase in the hormone, progesterone, contribute significantly to the swelling of these veins.
In many cases, postpartum haemorrhoids will shrink away on their own not long after birth, as the pressure on the lower rectum is eased. However, in some cases, they can persist for up to six months after birth and often longer.
If people are concerned that they are suffering from varicose veins, haemorrhoids, or any other venous issue after pregnancy, then my advice would be to go and see a venous specialist who will arrange for them to have a venous duplex scan. Nowadays, these scans should be performed by specialist technologist trained in not only scanning leg veins but also pelvic veins. This scan will tell the consultant whether there are any hidden problems and from here, they will be able to decide upon the best course of action.
There are also some simple, at-home lifestyle changes people can make when they are pregnant to help prevent varicose vein symptoms from worsening. These include:
Gentle exercise – While it can be harder to move around when pregnant, gentle exercise helps the leg muscles to pump blood out of the legs. When you sit for extended periods, your blood flow becomes compromised as it slows down and pools – causing an elevated risk of blood clots, otherwise known as DVT. A simple 20- minute stroll will help to boost circulation and keep your veins healthier.
Elevate your legs – It’s essential that as well as taking regular breaks to go outdoors and ‘get moving’, you are sitting in the correct position to maximise blood circulation. It may sound simple but try placing pillows or a footstall underneath your legs to keep them elevated whilst at home as this will improve venous circulation. By raising your legs whilst you are sitting still, you are encouraging blood to flow back to the heart and avoiding the risk of blood clots and swelling. In addition, I recommend you try this helpful exercise to increase blood flow in the leg muscles – every half an hour stand up and pump your calves by rising onto your toes repeatedly for 60 seconds.
Wear Maternity Hose – Supportive compression stockings work by applying pressure to the outside of the legs. This helps to counteract the pressure within the veins and prevents the leg veins from swelling and bulging. You can wear compression stockings throughout the day, but make sure to remove them before going to bed each night.
If you are concerned that you are still suffering from varicose veins six months after pregnancy, several different techniques are available for treating them effectively. Some of the most cutting-edge techniques we use at The Whiteley Clinic include:
• SONOVEIN: (also called HIFU Echotherapy) is the latest innovation in treatment for varicose veins, which uses high precision Echotherapy to treat patients 100% non-invasively. Unlike traditional varicose vein treatments, no catheters, chemical injections, or incisions are required with SONOVEIN®, meaning patients are left with no scars or risk of infection and can return immediately to their normal daily activities.
• EVLA (ENDOVENOUS LASER ABLATION): This technique destroys the veins at the root of the problem, under local anaesthetic, as a walk-in, walk-out procedure.
A needle is placed into the vein near the knee under ultrasound control. Then, a wire is passed through the needle and into the vein. The wire guides a dilator and sheath into the vein, allowing venous access through a tiny hole. Next, the laser device is passed through the sheath and into the vein. We use ultrasound to ensure the laser device is passed up the vein to the very top and positioned precisely. We inject local anaesthetic around the laser device and we switch the laser on. We pull back the laser device at an exact rate, ensuring complete treatment of the target vein without damaging the surrounding tissues.
• MICROWAVE ABLATION: the advantage of this technique is that it produces reliable heat at exactly the point needed to destroy the varicose vein permanently. Microwave targets water, and so does not require contact with the vein wall – offering the same advantages as Laser Ablation. However, because there is no laser light involved, surgeons do not require special rooms, regulations, or eye protection to carry it out.
The Whiteley Clinic is now running a Covid-secure service in Guildford, London and Bristol, as well as virtual consultations, for those who might need urgent care for their veins. For more information about treatments offered by The Whiteley Clinic please visit: The Whiteley Clinic.
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