Varicose veins are quite common and are considered the most common pathology in pregnant women. This is due to an increase in body weight, compression of the pelvic veins by the uterus, which leads to impaired blood flow, and increased loads on the lower extremities. Varicose veins in pregnant women appear in the second trimester and have several stages of development.
The mechanism for the development of varicose veins in pregnant women is as follows: blood is directed through the arterial bed to the lower extremities, from where, due to compression of the vessels and impaired venous outflow, it does not immediately return to the heart. As a result, blood stagnation occurs in the veins of the lower extremities, which increases the pressure in the venous vessels and leads to their gradual deformation. Another factor in the development of varicose veins is a decrease in the production of vasopressin, which results in a decrease in tone and weakening of the walls of the coronary vessels. Because of this, they change their shape and become thicker and less elastic. The expansion of veins also occurs due to an increase in the volume of circulating blood of a pregnant woman, since not only the body of the expectant mother, but also her fetus is supplied with blood. During pregnancy, blood tends to change its usual properties, including rheological ones, which leads to an increase in its viscosity , and, as a result, a decrease in blood flow speed and stagnation in the veins.
Varicose veins can develop both during pregnancy and long before its onset. The onset of the disease is quite difficult to determine, since it develops asymptomatically. However, there are a number of symptoms that indicate the development of varicose veins in pregnant women. At the initial stage of the disease, no disturbances are observed, only towards the end of the pregnancy the swelling of the extremities appears, which disappear by the morning at rest. Swelling may be accompanied by heaviness in the legs, fatigue and a feeling of fullness. Later, a slight deformation of the veins may be observed, to which the woman does not pay attention. Varicose veins during pregnancy are accompanied by the following symptoms:
At the first manifestation of symptoms, doctors recommend immediately contacting a phlebologist for advice. Doctors distinguish between functional and false varicose veins in pregnant women. After delivery, the symptoms and signs of the disease may disappear without a trace, or, on the contrary, they may progress, aggravating the woman’s condition. This is possible if there is a hereditary predisposition to this disease. During pregnancy, women may experience varicose veins of the vulva, labia, and anus. The latter is known as hemorrhoids. Delayed treatment or lack thereof can lead to rupture of the coronary vessels and extensive bleeding, leading to fatal consequences.
If a woman develops varicose veins even before pregnancy, and during the examination a hereditary predisposition is revealed, then there is a possibility of developing complications, including:
The difficulty of treating varicose veins in pregnant women lies in selecting a gentle method of therapy that is safe for both the mother and the unborn baby. As a rule, the doctor prescribes wearing compression garments and performing a complex of physical therapy. Women are recommended to walk daily and go up and down stairs.
These recommendations are complemented by the local use of various ointments and gels, which are the safest in composition during pregnancy. The most famous and popular gels are Venoruton, Lyoton, Essaven-gel, Diclofenac-gel, Fastum-gel. From the second trimester of pregnancy, the drug Venoruton can be used, and Detralex is often prescribed throughout the entire period.
In extreme cases, when the disease progresses rapidly, the doctor prescribes surgical treatment, which is allowed to be performed in the first and second trimesters of pregnancy. In some cases, women undergo vascular sclerosis.
Varicose veins mean an increase in the size of the veins, which appear on the surface of the skin of the legs in the form of an unsightly network with intertwined and wriggling nodes.
These veins are divided into two groups:
Both groups are treated with different methods.
Varicose veins of the great and small saphenous veins, enlarged lateral and perforating veins (= associated with deep veins) are mainly treated surgically. Previous operations on them are not an obstacle to surgical intervention. For small or moderate varicose veins, surgery is possible with local anesthesia. If a major operation is necessary, the anesthetist Mrs. Baldi will advise the patient in detail about the appropriate anesthesia for him.
Only in exceptional cases is it necessary to carry out a rather unpleasant venography procedure with the injection of a contrast agent into the veins. Almost always it can be replaced by other more subtle and gentle research methods: ultrasound Doppler sonography of the vessels of the lower extremities, duplex sonography, etc.
Rapidly developing technologies of medical instruments, as well as the use of surgical lasers, allow the doctor to remove dilated veins in a gentle way (incisions of only about 0.3 - 0.4 cm). They heal within a year and with proper care there are no scars left. The only large incision - 3-4 cm, required for such an operation, also heals with virtually no traces.
During preparation for the operation, the doctor informs the patient whether it will be performed on an outpatient basis or in a hospital. Staying in the clinic for more than two days is extremely rare. A thorough medical examination is performed the day after surgery (or on the day of discharge). The patient is explained in detail how he should behave in the postoperative period. On the 3rd day after the operation, additional fixation of the compression material is carried out, on the 8th day - the first replacement of the bandage and removal of the sutures. Dr. is responsible for this stage of postoperative care. Taucher, who is always reachable by phone. Further follow-up visits to the doctor occur every 8 days. The recovery period therefore lasts about 3-4 weeks. Inoperability occurs only in the case of major operations and, as a rule, lasts no more than 3 weeks. Sports activities can be fully resumed after four weeks.
These are the classic areas for which drug and laser sclerotherapy (= literally “devastation”) are “responsible”. The main point of this therapy includes aesthetic aspects, although we must not forget that the presence of a pronounced venous network (like the tip of an iceberg) may indicate the presence of deep problems in the venous system of the legs. A Munich clinic specializing in leg diseases has in recent years developed a special treatment method based on laser technology, which in most cases allows one to get rid of unsightly protruding veins on the surface of the skin.
To achieve a good result after the procedure and prevent the appearance of pigmentation or small skin defects, compression therapy is recommended for 12-14 days. The bandage is changed once every few days. There are no restrictions on work, sports or gymnastics.
Main topics: venous mesh, laser/laser for veins, gentle vein surgery, varicose veins
Varicose veins of the legs are one of those diseases that often first appear during pregnancy. Let's talk about the symptoms that may precede the development of this disease, and about the measures that need to be taken to combat varicose veins.
If the expectant mother's legs and ankles swell, a feeling of numbness appears, goosebumps appear on the skin and all this is accompanied by heaviness in the legs, especially in hot weather, mainly in the afternoon, there is reason to be wary. Varicose veins are their irreversible dilatation and lengthening , which occurs as a result of gross pathological changes in the venous walls and valve apparatus of the veins. Similar symptoms most often occur with the development of venous insufficiency (blood stagnates in the veins, its outflow is slowed down), which is a precursor to varicose veins. Find out the dangers of varicose veins during pregnancy and swelling in the article on the topic “Varicose veins during pregnancy, swelling.”
Varicose veins of the legs are observed in 20-40% of pregnant women, and in more than half of them this disease occurred during pregnancy, and not before it. Varicose veins most often appear in the 5-6th month of pregnancy. Each subsequent pregnancy increases the likelihood and severity of varicose veins.
Manifestations of varicose veins
At the initial stages they do not cause any concern, except for aesthetic ones, and after childbirth they gradually disappear. Reticulate enlargement of the small saphenous veins of the legs may persist after childbirth, although these veins become less noticeable. At the beginning of the disease, patients are concerned only with a cosmetic defect, then complaints appear about a feeling of heaviness, fatigue, fullness, bloating in the legs and their swelling after physical activity (prolonged standing) or in the afternoon, especially in the hot season. Subsequent progression of the disease leads not only to an increase in the number and size of dilated veins, but also to the occurrence of trophic disorders: pigmentation, skin thickening. Heaviness in the legs is often accompanied by a feeling of discomfort; sometimes a woman is bothered by a dull and aching pain, which occurs mainly in the feet and legs and has no clear localization.
Causes of varicose veins during pregnancy
One of the main reasons for the development of varicose veins is hereditary disorders of the elasticity of the venous wall. The risk of developing varicose veins increases with a family predisposition, the number of pregnancies and the age of the woman. During pregnancy, the venous system of the legs experiences maximum stress. The leading factors during this period are changes in hormonal levels, an increase in the volume of fluid circulating in the body, compression of the veins by the uterus, and weight gain.
External signs of varicose veins at the onset of the disease are telangiectasias - dilation of small superficial veins of the skin with a diameter of up to 1.5 mm, noticeable upon examination. They appear in pregnant women on the skin of the legs, less often the face, neck, upper half of the body, and arms. Telangiectasias look like dilated or burst small vessels: “cobwebs”, “stars”, “meshes”, “arches” on the thighs, under the knees or on the calves. Mostly, women notice telangiectasias on their legs. Sometimes in the evening, the legs - feet and legs - swell due to increased blood pressure in the veins. Often, swelling can be almost imperceptible, and the only sign of fluid retention is marks on the skin from socks or shoes. You can use your fingertips to press on the shin in the place where the bone is felt. If it is swelling, there should be traces of depressed fingers. Heaviness in the legs is often accompanied by cramps (often also at night), difficult-to-relieve tension in the leg muscles, and a feeling of “pins and needles.”
• Changes in hormonal levels. The appearance of varicose veins in the legs in early pregnancy is associated with hormonal influences, in particular with progesterone. The amount of this hormone increases during pregnancy. Progesterone leads to a decrease in the tone of the venous wall and increases its distensibility to 150% of normal, returning to it only 2 months after birth. This is physiologically necessary, since a gradually increasing blood volume requires an increase in the capacity of the vascular bed, and veins, which are thinner-walled than arteries, stretch to a greater extent.
• Increase in circulating blood volume. During pregnancy, the amount of blood circulating through the vessels increases significantly. It begins in the first trimester of pregnancy, peaking at 36 weeks. These changes lead to a significant increase in the load on the walls of the veins of the lower extremities; it becomes much more difficult for them to push blood to the heart. And varicose veins develop.
• Compression by the uterus. In the development of varicose veins, the enlarged uterus plays a role only in the third trimester of pregnancy, putting pressure on the iliac and inferior vena cava, which causes a slowdown in blood flow through the femoral veins by up to 50%.
• Weight gain. During a normal pregnancy, the expectant mother gains 10-12 kg in weight. With a more significant weight gain (some pregnant women gain 20-30 kg), varicose veins occur more often. This is due to the fact that with obesity, venous blood pressure slightly increases due to the slow outflow of blood from the large veins and the right side of the heart. As a result, dilated veins develop with a tendency to form varicose veins.
Diagnosis of varicose veins
Diagnosis often does not require the use of any special methods - the diagnosis is made based on an analysis of complaints and examination of a pregnant woman. Additionally, Doppler ultrasound examination of the main veins of the lower extremities is performed. The ultrasound method allows the doctor to see the structure and evaluate the function of the veins of the lower extremities, their valves, and also identify venous blood clots.
To relieve tired legs, it is useful to do self-massage of the legs with any cream that prevents the flow of blood. Do it at home before bed. While rubbing the cream, massage your ankles, legs, and thighs from bottom to top: this improves blood flow. If you suffer from uncomplicated forms of varicose veins (without vein thrombosis, thrombophlebitis, skin ulcers), a light foot massage is also allowed and useful for you. It consists of lightly stroking the entire leg with the palm of your hand in the direction from bottom to top - from the foot to the groin. The procedure is best performed not only in the evening, but also in the morning, within 5-7 minutes after physical therapy. This measure will be more effective if in parallel courses of massage are carried out in the lumbar-sacral region of the spine, since the neuro-reflex effects on this area have a beneficial effect on the state of vascular tone of the veins of the legs. Massage is contraindicated in case of inflammatory changes in the veins: phlebitis (inflammation of the vein wall) and thrombophlebitis (inflammation of the vein wall in combination with a blood clot that closes its lumen), with signs of wet eczema (inflammatory skin disease of a neuro-allergic nature). Water procedures are useful: contrast shower for feet - alternating tight streams of warm and cool water (5-10 minutes for each leg). Walking (hiking in comfortable shoes) and swimming also have a positive effect on veins. If you begin to notice heaviness in your legs, you need to consult a phlebologist. Only a specialist can prescribe the correct treatment and prevention, and prevent the development of such a serious illness as varicose veins.
You cannot use knitwear only occasionally or only in winter, as many patients do - it must be worn constantly. Elastic compression of veins is indicated for all patients with chronic venous insufficiency, regardless of its cause. Wearing medical knitwear is the only means of preventing the occurrence and progression of varicose veins and at the same time preventing thrombosis (the formation of blood clots in the veins). If the phlebologist recommends, you should wear special compression stockings, tights or knee socks (compression medical knitwear). The doctor prescribes these products individually, selecting them according to the degree of compression. They evenly compress the leg, preventing the veins from expanding and... thereby increasing the speed of blood circulation and preventing the development of varicose veins. Knitwear is put on in a lying position before getting out of bed and worn during the day, since when lowering the legs, their veins fill with blood, and no knitwear will change this situation. The key to the success of compression treatment is its regularity.
An effective means of influencing the tone of the veins are the so-called phlebotonics. They should be prescribed by a doctor based on the results of examination and examinations. Pregnant women at risk of developing varicose veins are recommended to take Troxevasin capsules to prevent venous insufficiency of the lower extremities or relieve symptoms of varicose veins. In this case, you should apply Troxevasingel 2 times (morning and evening) to the calves, in the popliteal area, and then lie down for 10-15 minutes, raising your legs. Troxevasin eliminates swelling, pain, trophic disorders and various pathological phenomena associated with venous insufficiency. Troxevasin is approved for use in the second and third trimester of pregnancy.
If you feel heaviness in your legs, pain, or “crawling” in your legs before going to bed, you can use Ginkor Fort capsules in the morning and evening. With systematic (constant) use, the drug reduces the severity of clinical manifestations of chronic venous insufficiency of the lower extremities. It is prescribed for venous insufficiency of the lower extremities: a feeling of heaviness in the legs, pain, cramps, trophic disorders (brown pigmentation of the skin, ulcerations). Take the drug in tablets (day and evening with meals). The use of the drug is possible from the second trimester of pregnancy.
Treatment of varicose veins of the legs during pregnancy does not allow the use of all methods used outside pregnancy. Surgical treatment (operation) is indicated only in cases where varicose veins are accompanied by chronic venous insufficiency in combination with complications of varicose veins. The use of sclerotherapy is contraindicated for pregnant women (a sclerosant substance is injected into a vein and glues its walls, the flow of venous blood through it stops). During pregnancy and the first year after childbirth, preference is given to conservative (medicinal) treatment methods. Delivery of pregnant women with chronic venous insufficiency should be carried out in elastic bandages with the obligatory continuation of their use in the postpartum period for 4 months.
The drug increases venous tone, reduces vascular permeability to water, and has an analgesic effect. It can be used in the second and third trimesters of pregnancy. Another acceptable product during pregnancy is Lyoton 1000 Gel. The drug is safe when used in pregnant women in all trimesters. It is rapidly absorbed, which provides a high concentration of heparin in tissues compared to other local agents, creams and ointments. A feature that distinguishes this drug from other similar drugs used is a pronounced anticoagulant (reducing blood clotting), anti-edematous, anti-inflammatory, analgesic and phlebotonic (increasing the tone of the veins) effect.
The drug Detralex is also used. It has a venotonic effect: it reduces the distensibility of veins, increases their tone and reduces venous stagnation of blood.
Slowing blood flow in varicose veins of the legs, pelvis, uterus, and vagina, combined with damage to the vascular wall, creates optimal conditions for thrombus formation. To this should be added a violation of the blood coagulation system. The risk of thromboembolic complications in chronic venous insufficiency reaches 10%. Vein thrombosis (or phlebothrombosis) is the formation of blood clots - thrombi - in the lumen of a vein. When the lumen of the vein is completely blocked, sharp pain appears in the entire limb, with an increase in body temperature and chills, with a decrease in the skin temperature of the affected leg. The limb turns pale and cyanotic. Swelling of the entire leg appears, spreading to the abdomen and lumbar region. However, sometimes the only clinical manifestation of thrombosis may be pain when walking. Treatment of phlebothrombosis is usually successful and rarely leads to complications. Venous thrombosis can be complicated by pulmonary embolism. Thrombophlebitis is an inflammation of the venous wall with the formation of blood clots in the lumen of the vein. Thrombophlebitis tends to migrate and spread up and down the vein, sometimes penetrating from the superficial veins into the deep ones. With this complication, acute pain suddenly appears along the thrombosed varicose vein. The temperature may rise to 38°C. The skin around such a vein becomes red and swollen, the vein is palpable in the form of a dense, painful cord. Thrombophlebitis is a dangerous disease and without proper treatment it often leads to complications that threaten a woman’s life: pulmonary embolism, sepsis (entry of pathogenic microbes and their toxins into the blood and tissues), deep vein thrombosis, and gangrene of the leg.
Pulmonary embolism is a very serious complication. Most often, it is caused by blood clots that arise in the deep veins of the lower extremities. The most dangerous are blood clots that are attached at one end to the wall of the vessel, and the other, free, floats in the lumen of the vein. With a little effort: coughing, sudden movement, straining, the clot breaks off and enters the pulmonary artery with the blood flow. Acute heart failure or myocardial infarction develops. The patient suddenly develops shortness of breath, chest pain, and hemoptysis may occur. The skin of the nose, lips, and ears becomes bluish or turns pale. Wheezing is heard in the lungs. An echocardiogram reveals blood clots in the right heart and pulmonary arteries, signs of dysfunction of the right ventricle of the heart. The sudden onset of a serious condition can lead to death if immediate surgery is not performed. Timely prevention and treatment of chronic venous insufficiency can prevent the development of varicose veins and more serious diseases in pregnant women, such as thrombophlebitis, venous thrombosis and thromboembolism. Now we know the dangers of varicose veins during pregnancy and swelling.