Causes
Varicose veins are superficial veins, meaning just under the skin, that become large and noticeable on the thighs and legs. These purple, blue or dark-colored crooked veins can also appear around the vulva or vagina during pregnancy, as well as in the rectal area in the form of hemorrhoids. The appearance of varicose veins is associated with increased pressure, which results from the added weight and volume of a pregnancy stressing the lower body. An increase in female sex hormones during pregnancy also weakens vein walls and allows them to grow larger. Valves in the veins that normally prevent blood from flowing back into the legs no longer function correctly, and veins swell when the blood flows backward and pools.
The risk of developing varicose veins during pregnancy increases with a family history of their appearance, multiple pregnancies, being overweight or gaining an unhealthy amount of weight during gestation, or standing or sitting for excessive amounts of time. Varicose veins are generally painless, but they can cause leg and foot swelling, itching, pigmentation changes and ulcers around the ankles, and blood clots and infection in the veins in extreme cases.
Prevention
Although the appearance of varicose veins cannot be completely prevented, early precautions can minimize the severity. The most important step is to walk often and complete other exercise if possible. This will prevent excess weight gain, improve blood circulation and decrease the risk of venous blood pooling. Avoid sitting or standing for long periods of time and crossing legs when seated, which increases leg pressure and reduces blood circulation.
Elastic support stockings with graduated compression help to prevent blood pooling in the legs, reduce swelling and improve circulation. Sleeping on the side with a pillow under the legs can reduce the risk of developing varicose veins by preventing the fetus from pressing on leg veins. Other precautions include avoiding clothing that is tight across the waist or groin and following a low-salt diet to prevent water retention.
Treatment
Varicose veins often subside after delivering the baby, and no other treatment is required. Veins that do not return to normal after pregnancy can cause discomfort and place the woman at higher risk for developing blood clots. Continue being monitored by a doctor in case the blood clots develop and need to be treated. One option for treatment is surgical ligation and stripping, which should only be performed if varicose veins are large and create a cosmetic nuisance. Anesthesia and up to 1 week of recovery are required for this type of treatment. Another procedure is ligation and stabs, which is the process of tying off superficial veins in the groin, creating 1-cm stabs under the skin and removing the largest portions of varicose veins. Some bruising may result, but the recovery time is only 2 to 3 days.
The newest treatment is ultrasound guided laser therapy, which is accomplished by using ultrasound to guide a laser probe in the burning of large veins. This outpatient procedure requires only local anesthesia and an incision at the knee. Any treatment of varicose veins should be performed after the last pregnancy because reappearance during a subsequent pregnancy is probable.
