Reducing Leg Swelling and Varicose Veins in Pregnancy - Naturopathic Perspectives
With pregnancy comes major changes in circulation. It’s no wonder, with an increase in body weight from the fetus and surrounding fluid, extra pressure is added onto organs and other structures like the weaker-walled veins. The body’s blood volume also increases and these changes can result in swelling, varicose veins, and hemorrhoids.
About 40% of pregnant women are affected by one or all of these, and symptoms can show as early as the first trimester, but may be more prominent by the third trimester. [1] It’s common for women to experience lower leg cramping or pain with onset in the evening or as the day progresses; especially those who are standing or on their feet most of the day. Other symptoms include numbness, tingling, or heavy, achy legs.[1]
How is circulation affected by pregnancy?
First, it’s important to understand the structure and function of veins and the valves within them. Valves are present in veins to prevent blood from flowing backwards. When these valves weaken, the veins struggle to keep all of the contained blood moving forward and upward against gravity. This can lead to pooling of blood within the veins: The vein becomes distended as its walls stretch and sag. When volumes of blood pool in this way it leads to major issues in lower limb circulation.
The veins in the legs are most affected because they have to work harder against gravity. Though in pregnant women, it’s common to see the development of hemorrhoids and vulvar varicosities due to the increased pressure within the pelvis from the fetus.[1]
Of course the development of circulation issues in pregnancy is multifactorial. In addition to the extra weight of the uterus, increased blood volume puts veins under more pressure. Increased progesterone levels also play a role as progesterone acts as a muscle relaxer for blood vessel walls. [1]
Venous blood pressure can be affected whenever excess pressure is put on the inferior vena cava (IVC). The IVC receives blood from the lower limbs and brings it back to the heart. Therefore any compression here will further increase blood pressure in the veins of the lower extremities and increase the risk of developing varicosities. [1] This may be one reason women favour laying on their left side vs their right: the collapsibility of the right-sided IVC, which can be uncomfortable compared to the more compression-resistant left-sided aorta, a major artery with thicker and more muscular walls.
Because of this anatomical difference, symptoms are generally first noted on a woman’s right side. For example, women may notice that their right ankle or leg will swell first before it is noticed on both sides.[2]
These issues with circulation can then lead to what we call “venous insufficiency” and lower leg edema or oedema, where excess fluid collection leads to swelling of tissues: Blood that has pooled in the veins can be forced from the vein into the surrounding tissues of the ankles and lower legs.
Ways to prevent and treat leg swelling and varicose veins
Compression Stockings
These are tall socks, knee-length or mid-thigh-length, that have graduated pressure built in. The fabric is tightest at the ankles, becoming gradually looser as you move proximally up the leg. This type of graduated compression helps encourage blood flow back to the heart by adding counter pressure.
One study in Switzerland showed that women who wore compression stockings during their pregnancy experienced a significant decrease in the circulatory symptoms of the legs, despite not being able to fully eliminate superficial varicose veins. [3] However, researchers also noted a significant decrease in the incidence of reflux within the deep saphenous vein. [3]
Another study, this one out of Italy, reported that pregnant women who wore compression stockings regularly had less leg
pain and an increased quality of life, compared to those who did not wear them, or didn’t wear them often. [4]
Compression stockings have come a long way and are available in different fabrics, colours and styles, from sports socks to tights to pantyhose-style. This makes it easier for women to incorporate into their daily wear.
Walking
Walking can offer support for lower leg fatigue and swelling. In general, walking offers compression from skeletal muscles in the legs to help pump venous blood back in an upwards direction. Standing, by contrast increases the distance that blood has to travel against gravity, without the pumping action of the lower leg muscles. Walking is a great low-impact and gentle exercise for pregnant women. In addition to acting like a “cardio” workout, short-distance walking offers positive support for the lower legs, but also whole-body circulation in general. For women who are sitting for long periods of time, getting up and walking even a short distance (such as across the room) can offer enough support to help reduce swelling and lower leg heaviness.
Water Immersion
Historically, water and hydrotherapy has been used to promote healing. Water has the ability to both hold a temperature long enough for physical application whether it be as a cold compress to decrease swelling, or as a warm compress to relax tissues and increase blood flow. As an immersion however, it acts as a medium to provide relief from the force of gravity. In altering the environment with which the legs are submersed, water immersions hold a lot of potential as a treatment option.
This can be done in a variety of ways. First, by standing in waist-high or chest-deep water. This alone can alleviate the force of gravity. To add further support, walking in water with the legs submersed creates extra pressure from contracting the leg muscles. And even more so, participating in an “aqua-fit” class (tailored to the abilities of the individual) will use the whole body in the water and even more muscle groups to support circulation (in addition to being an excellent form of exercise throughout pregnancy). These are all safe options in pregnancy and applicable for individuals at varying physical fitness levels.
One study looked at women who stood or walked in water (immersing their legs) for 20 minutes. It was reported that women in the water immersion group had significantly reduced leg swelling.[1]
Two other studies have looked at water immersion: One showed that a 45-minute aqua fit class was able to significantly reduce leg volume,[5] while the second showed that leg immersion for 20 minutes in pregnant women in their third trimester was successful in reducing lower limb edema.[6]
Reflexology
A study that tested two different reflexology techniques found that relaxing and lymphatic reflexology conducted on pregnant women led to significant reductions in leg symptoms, specifically edema, compared to women who were given instructions to rest. As well, the women in the reflexology groups were more satisfied with the intervention as opposed to the rest only group.[1]
Rest
From the results above there are definitely options to help reduce leg symptoms and improve circulation despite the changes present in pregnancy. However, there is still benefit from altering standing/sitting behaviour. For example, symptoms are often worse, with increased venous insufficiency, when women stand for long periods of time. Breaks should be taken either with exercise, or by elevating the feet and legs. The study listed above that tested water immersion, also compared the results for women in their third trimester who instead elevated their legs for 20 minutes. The results were comparable between water immersion and leg elevation with a reduction in lower limb swelling.[6]
Conclusions
Although there are many other options available, including medications and surgery, these options may not be appropriate in pregnancy. Therefore, using practices such as water immersion, reflexology, leg elevation, and walking with compression stockings can offer a viable and safe option for reducing and treating circulation issues of the lower limbs in pregnancy. Rest, and breaks from standing in general, should also be encouraged.
References
- Smyth, R.M., et al. “Interventions for varicose veins and leg oedema in pregnancy” Cochrane Database Syst Rev. 10: CD001066 (2015)
- Benninger, B., and Delamarter, T. “Anatomical factors causing oedema of the lower limb during pregnancy” Folia Morphol (Warsz) Vol. 72 No.1 (2013): 67-71
- Thaler, E., et al “Compression stockings prophylaxis of emergent varicose veins in pregnancy: a prospective randomized controlled study” Swiss Med Wkly. Vol. 131 No.45-46 (2001): 659-62
- Allegra, C., et al. “Acceptance, compliance and effects of compression stockings on venous functional symptoms and quality of life of Italian pregnant women” Int Angiol. Vol. 33 No.4 (2014): 357-64
- Hartmann, S., and Huch, R. “Response of pregnancy leg edema to a single immersion exercise session” Acta Obstet Gynecol Scand. Vol. 84 No.12 (2005): 1150-3
- Khedr, N.F.H., and Hemida, R. “Effect of leg elevation versus water immersion on leg edema in third trimester of pregnancy” IOSR Journ Nurs Health Sci. Vol.5 No.6 (2016):1-9
