Varicose Veins during Pregnancy – causes, treatment and prevention

by Dr. Alison Gault

Varicose veins during pregnancy are a condition in which veins become enlarged and tortuous. Symptoms include tired aching legs, swelling or edema. This most commonly affects the lower leg but can occur anywhere else in the body. In pregnancy, other areas that are commonly affected are the:

  • rectal area with haemorrhoids (piles)
  • perineum- area between the anus and vagina
  • Vulval- in the vagina (4%)
  • Labial- external parts of the vagina Inner thigh

Symptoms of varicose veins during pregnancy

Primary Symptoms

  • Enlarged and twisted blue coloured blood vessels that are usually clearly visible. The varicose veins may appear as bulges under the skin and are tender to touch.

Secondary Symptoms

  • Small superficial blood vessels called starburst veins, spider veins or burst capillaries may form secondary to the varicose veins during pregnancy.
  • Swelling of the lower limb especially around the feet and ankles associated with fluid accumulation.
  • Bruising easily.
  • Aching, heaviness, itching, throbbing or burning feelings in the legs or groin which tend to be worse at the end of the day.
  • Muscle cramps at night.
  • Symptoms are aggravated by long periods of standing still.
  • Haemorrhoids are varicose veins in the rectum or anus. These can protrude out of the anal canal. Symptoms include pain with defecation, bleeding, itching and burning. There can be a sensation of bulging within the anus and a visible/ palpable lump.
  • Sex can be painful for some women with vulval, peritoneal and labial varicosities. Other women have no discomfort at all or discomfort only after intercourse due to increased blood flow to the pelvis.

What is happening and why?

Veins are the blood vessels that return blood from the limbs back to the heart and lungs to get more oxygen. Unlike arteries, veins have no muscle in the vessel walls. Return of blood to the heart results from muscle contraction from limb movement such as walking. Blood is prevented from flowing backwards in the veins by one way valves. Varicose veins during pregnancy occur when the valves stop working properly causing the blood to pool and the vein walls to stretch. Varicose veins tend to worsen over time. When a valve fails, the valves below it have more pressure on them and become more likely to fail. The most common valves to fail are those at the groin and behind the knee.

Causes and contributing factors of varicose veins during pregnancy

  • You may inherit weakness in the valves of vessel walls from your family
  • Previous episode of a deep vein thrombosis
  • Obesity
  • An increase in blood volume of on average 45-50% occurs with pregnancy and puts an increased strain of the whole cardiovascular system
  • Pregnancy causes an increase in the hormone progesterone that relaxes the vein walls making them more susceptible to being stretched. This relaxation is necessary to compensate for the increased blood volume
  • The growing uterus and baby puts pressure on the inferior vena cava and other pelvic veins making it harder for the blood to exit the lower limb. This contributes to pooling.
  • Pregnancy may initiate the first appearance of varicose veins or may worsen an existing condition. Veins tend to worsen with each successive pregnancy especially with multiples. Varicose veins tend to improve after birth so wait at least 3 months post partum before determining if you need surgical intervention. Treatment can be performed between pregnancies. The pelvic varicosities are much more likely to ease significantly than those of the leg.

Complications of varicose veins during pregnancy

Complications of varicose veins are rare and generally occur after a long period of time. These are:

  • Damage to the skin and subcutaneous fat causing scarring and tissue hardening
  • Ulcer formation
  • Bleeding
  • Discoloration of the skin
  • Superficial thrombophleblitis- small blood clots within the superficial veins. The vein may feel hard with the surrounding skin hot and tender. Contact your Obstetrician, Midwife or GP if you are concerned
  • Pulmonary embolism

Having varicose veins does not lead to an increased change of developing deep vein thrombosis.[block id=”love-stuff-share”]

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