Varicose veins

You may have always associated varicose veins with your grandmother more than yourself. That is, until you've become pregnant. Even though you d prefer not to know, for most women pregnancy is a time when a whole new range of health related issues may become all too familiar.

But don t despair just yet. Varicose veins and spider veins in pregnancy are considered normal and although you may not be too keen, they are just part and parcel of the whole wonderful process known as pregnancy.

What are Varicose Veins?

Varicose veins are dilated veins found just under the surface of the skin. They form when the valves which are designed to encourage blood to flow in one direction are unable to cope so they become faulty and ineffective. They mostly occur in the legs but can also found around the anal region, where they are formally known as haemorrhoids, or piles .

During pregnancy, varicose veins are most common in the third and final trimester.

This is when the weight of the baby, the size of the uterus and the mother's increase in circulating blood volume is at its highest. And it is these contributing factors which are to blame for varicose veins occurring.

What do Varicose Veins Look Like?

Varicose veins have quite a distinctive appearance. If you are personally unfamiliar with them, you're bound to have seen them on other people.

Varicose veins are generally a bluish/purple colour, are lumpy or knobbly, and appear like clusters of dilated, engorged veins. They are not always evenly distributed. Many people, including pregnant women, find that their varicose veins appear more on one leg than the other; or they are more visible in one portion of their leg/s than another. Often, a portion of one large vein can be seen tracking down the leg.

Varicose veins can be almost invisible when lying or sitting down or when the legs are elevated, but on standing, they immediately appear. They are not always painful and the only negative aspect may be their unattractiveness. But most women find that the larger their varicose veins, the more uncomfortable they become.

There can be a sensation of heaviness, aching, throbbing and general pain from varicose veins.

Is There Any Risk in Having Varicose Veins?

Varicose veins can increase the likelihood of having skin rashes such as eczema. There can also be a brownish discolouration to the skin as a result of the capillaries rupturing. Skin ulcers can also form and take a long time to heal because of the reduction in blood flow to the lower limbs.

There is also a condition known as deep vein thrombosis (DVT) which is more common in women with severe varicose veins of the legs and/or vulva. For specific and more comprehensive information check deep vein thrombosis.

What Causes Varicose Veins?

Varicose veins are all about mechanics and are not under your direct control. No amount of wishing or hoping they will go away will have any effect.

During pregnancy the enlarging uterus presses down on the major blood vessels in a mother's pelvis. These veins are primary arteries which feed back to the heart and lungs and are vital for the mother's life. During pregnancy these blood vessels also need to cope with a significant increase in overall blood volume.

Because of the uterine weight and size, there is not a free return of blood to the major organs and a back log of blood forces blood to pool or gather in the smaller blood vessels of the mother's groin and legs.

Another contributing factor is that pregnancy hormones allow the blood vessels to become more dilated and less resistant to blood flow. This is to help deal with the extra blood volume, up to 30% more than when not pregnant, and also to maintain a mother's blood pressure at a safe level. But this relaxation of the vessels also means that the usual efficiencies and resistance of the veins and valves are not in place.

Varicose veins can also occur in and around the vulva. These are particularly uncomfortable especially at the end of a long day standing up or running around. They can also appear after intercourse. Cool washers, supportive underpants and lying down to rest can all help.

In the majority of women, vulval varicose veins resolve after their baby is born. If they are particularly bad during pregnancy, a mother may be advised by her healthcare provider to avoid having an episiotomy when the baby is born. This is because there can be an increased risk of bleeding if a vulval varicosity is severed.

Check: www.huggies.com.au/childbirth

The general consensus is that it is better for there to be a controlled delivery and a mother's perineum to tear, rather than be surgically cut.

What Can I Do to Prevent Varicose Veins in Pregnancy?

Pick your parents carefully! Genetics accounts for an increased risk of developing varicose veins. If your mother and/or father had them then unfortunately, you're more likely to as well.

But biology is not destiny there are a number of things you can do to reduce the likelihood that you will too.

• Avoid gaining too much weight. Ideally, pregnancy weight gain should be within the region of 10 -12 kgs, or based on a health Basal Metabolic Index. Check BMI pregnancy for specific information.
• Buy some good, supportive pantyhose. Price really is an indicator of quality when it comes to support hose so check the denier strength and ratio of Lycra to nylon. This will give you a clearer idea of support characteristics.
• Consider wearing support underpants. But be mindful that if they are too tight you'll be uncomfortable and importantly, they may create more compression in your groin area which has to be avoided.
• You may need to wear compression stockings which provide a higher degree of support. However, it's wise to check with your maternity care provider first to make sure these are right for you.
• Rest with your feet up. Where possible, elevate your legs and feet so they are off the ground. At the end of a long day lie flat on your bed or the floor and position your legs upright on the wall. This will help the blood to drain from your legs. Just don t get up too quickly; a temporary drop in blood pressure is common when going from a lying to standing position (postural hypotension).
• Sleep with your legs slightly elevated. You could try positioning a pillow or cushion underneath the bottom sheet. Just be careful not to put a pillow behind your knees.
• Avoid wearing high heeled shoes. These interfere with the correct movement of the calf muscles and functioning of the larger veins.
• Aim to exercise very day. Avoid hard, repetitive stepping type exercises, but instead look into pregnancy yoga, aqua aerobics and Pilates.
• When you are walking, try to up the pace and walk briskly. Doing this will activate the large muscles in your legs which will help to divert blood back up through your groin to your heart.
• Avoid crossing your legs when you are sitting. This interferes with blood flow especially behind the knees.
• Avoid standing in the one spot for long periods of time. Instead, shift your body weight around by distributing weight from one leg to the other. Do little marches on the spot, stand on one leg then the other and go for short, brisk walks. Look for reasons to move.
• Drink plenty of fluid and keep your circulating blood volume at a healthy level. Avoid becoming dehydrated. Thirst is a symptom of early dehydration so keep your water bottle handy.

What Can I Do to Treat Varicose Veins in Pregnancy?

There is very little you can do in terms of permanent treatment. The best advice is to avoid getting varicose veins in the first place; by being careful of not gaining too much weight and avoiding standing for long periods.

Symptoms of varicose veins generally improve in the first few weeks after the baby is born; however, for some women, varicose veins which develop during their pregnancy are permanent. Similarly spider veins can remain.

There is no point in having them treated if you have not finished having your family. Varicose veins tend to become worse with each subsequent pregnancy and appear earlier in each gestation. Even if between your pregnancies you don t have them, once those pregnancy hormones start up again, you may find those old friends reappear.

If you do decide to have your varicose veins treated there are a number of options open to you. You will need to see a doctor who specialises in veins known as a vascular surgeon. They will be able to advise you on the best treatment options. You may need to have them stripped which require a general anaesthetic or, injected with a sclerosing (chemical) agent which closes the veins. Alternately, laser therapy may be an option for you. This is only done on smaller surface type veins which do not carry such a large blood flow.

What Are Spider Veins?

Spider veins look like little red spider webs just underneath the surface of the skin. They are the red or purple capillaries which supply blood to the skin and surrounding networks of tissue. Spider veins don t have the large dilated heavy vein look of varicose veins but instead, are generally very small and flat. They tend to spread out with little fingers or networks and can either be quite small and contained or can spread.

Spider veins are commonly seen on the face of pregnant women and tend to be more visible in fair, Caucasian women. Across the cheeks, on the nose, on the chin and across the forehead are common areas for spider veins to appear. They can also appear in the sclera-the white portion of the eye and on the legs, upper chest, neck, arms and torso.

Spider veins are common both during pregnancy and after delivery. The intense force of pushing out her baby can cause a mother to develop spider veins in her face and neck. These tend to settle within a week or so. If they don t then a check with a dermatologist may be helpful to discuss treatment options.

What Causes Spider Veins?

There are a few influencing factors when it comes to spider veins developing. Pregnancy hormones, (in particular oestrogen) certainly contribute but they're not totally to blame. The increased blood volume associated with pregnancy places pressure on the capillaries. These are more sensitive and fragile during pregnancy. This means that instead of the fine network of blood vessels containing the blood flow they become more transparent and less strong.

See more information about pregnancy changes

What Can I Do to Prevent Spider Veins in Pregnancy?

• Try to avoid extremes of hot and cold.
• Aim for showers which are comfortably warm, not too hot.
• When washing your face use a gentle, indirect shower spray rather than a forceful jet.
• Avoid using facial scrubs, exfoliants and steaming your face.
• If you are having a facial, let the beautician know you are pregnant. You skin may be more sensitive to the usual products they use.
• After showering, use a soft towel to dry your face. Line/sun dried towels can be too abrasive and coarse, so consider using a dryer for some of the drying time.
• Avoid exposure to direct sunlight. Wear a hat; use a broad spectrum and low allergenic sun screen.
• Drink plenty of water and ensure your skin is well hydrated.
• Try not to ingest too much caffeine. This is found in tea and coffee, chocolate and energy drinks.
• Be kind to your skin. Avoid using harsh washes, brushes and abrasive cloths.
• Increase your dietary intake of Vitamin C. This is an excellent nutrient for cellular recovery and repair. It will also help to strengthen your veins and capillaries.
• Avoid eating spicy or hot food. Some women find that chilli, paprika and/or garlic exacerbate the appearance of their spider veins. Coffee and caffeine will do the same thing.
• If you are developing spider veins in your legs, consider wearing support hose.

Treatment for Spider Veins

There is no treatment for spider veins during pregnancy. The best option is to use a covering cream or concealer which will cause the spider veins to not be so noticeable. However, if you are particularly concerned about their appearance after your baby is born you may want to investigate treatment options with a doctor.

Dermatologists specialise in skin assessment and treatments. If you are breastfeeding you may want to wait until after you have stopped as breastfeeding hormones can exacerbate some skin conditions. Laser therapy can be very effective for spider veins and there are a range of different laser treatments now available.