Varicose Veins in Pregnancy

The symptom that is not varicose veins

Leg symptoms in pregnancy need sorting before anything else, because one of them is urgent.

The NHS red-flag page for pregnancy says a sudden increase in swelling in your face, hands, legs or feet "can be a sign of pre-eclampsia or a type of blood clot called deep vein thrombosis (DVT) and needs to be checked immediately". The HSE lists "one of your calves is red, swollen and hot" among the symptoms that mean contacting your midwife, GP or obstetrician immediately.

The NHS DVT page describes the pattern: throbbing or cramping pain, usually in one leg, in the calf or thigh; swelling in one leg; warm skin around the painful area; and red or darkened skin around the painful area, which may be harder to see on brown or black skin.

The distinction that matters: varicose veins are usually in both legs, come on gradually, are worse by the end of the day, and improve when you put your legs up. A DVT is usually one leg, comes on over hours to days, and does not improve with elevation. RCOG's patient information on venous thrombosis in pregnancy exists because pregnancy raises clotting risk throughout, and for six weeks after birth.

ACOG adds one specific instruction to its varicose vein advice: "If a tender, red spot appears on your leg, it should be checked by your health care professional."

What varicose veins are, and why pregnancy causes them

The NHS defines them simply as "veins that have become swollen", and states the reassuring part directly: "They can be uncomfortable but aren't harmful." It also gives the location range that most articles omit: "Varicose veins most commonly affect the legs, but you can also get them in the vaginal opening (vulva). They usually get better after the birth."

ACOG explains the mechanism: "The weight and pressure of your uterus can decrease blood flow from your lower body and cause the veins in your legs to become swollen, sore, and blue." It notes they can also appear on the vulva, in the vagina and in the rectum — where they are usually called haemorrhoids — and that "you are more likely to have varicose veins if someone else in your family has had them."

Its outlook is the same as the NHS's: "In most cases, varicose veins are a cosmetic problem that will go away after delivery."

Vulval varicose veins

These are common, rarely mentioned, and often distressing precisely because nobody warns about them. They produce a heavy, dragging, aching or bulging sensation at the vulva that is worse when standing, worse at the end of the day, and eased by lying down. They are named explicitly by both the NHS and ACOG. They usually settle after birth and are not a reason on their own to change how you give birth, though they are worth mentioning to your midwife so that it is written down.

What the guidance says helps

The NHS list is specific:

• Avoid standing for long periods.
• Try not to sit with your legs crossed.
• Sit with your legs up as often as you can, to ease the discomfort.
• Try compression stockings, available at most pharmacies — the NHS is honest that "they won't prevent varicose veins but can ease the symptoms".
• Try sleeping with your legs higher than the rest of your body, using pillows under your ankles or books under the foot of the bed.
• Do foot and antenatal exercises, such as walking and swimming, to help circulation.

Its foot exercise is: bend and stretch your foot up and down 30 times, rotate your foot 8 times one way and 8 times the other, and repeat with the other foot.

ACOG's list overlaps and adds one more: move around from time to time if you must sit or stand for long periods; do not sit with your legs crossed for long periods; prop your legs up as often as you can; exercise regularly — walk, swim, or ride an exercise bike; wear support hose; and avoid constipation by eating high-fibre foods and drinking plenty of liquids.

ACOG is also clear about prevention: "You cannot prevent them, but there are some things you can do to ease the swelling and soreness and prevent varicose veins from getting worse."

On weight

The NHS advises trying not to put on too much weight, as this increases the pressure. That is worth reading in context: it is not advice to restrict eating in pregnancy, which the NHS specifically warns against elsewhere.

Compression stockings, practically

These are the intervention with the most evidence behind symptom relief and the one people abandon fastest, usually because they are put on wrongly. They work best applied before you get out of bed in the morning, when the legs are at their least swollen, and they are close to useless if you pull them on at lunchtime over legs that have already filled. Getting measured at a pharmacy rather than guessing a size matters, because a stocking that rolls or digs in at the top does the opposite of what it is for. The NHS is honest that they ease symptoms rather than preventing veins.

What is not offered during pregnancy

NICE's guidance on varicose veins covers referral and interventional treatments for the general population, but the practical position in pregnancy is that active treatment is deferred. Veins usually improve substantially in the months after birth, and treating something that is going to resolve makes little sense. Management during pregnancy is compression, elevation, movement and time.

If veins remain a significant problem some months after birth, that is the point to raise treatment with your GP.

What to expect afterwards

Both the NHS and ACOG say varicose veins usually get better after the birth. Improvement is gradual over weeks to months rather than immediate, and veins may not return entirely to how they looked before. Vulval varicosities generally settle faster than leg ones. Spider veins, which ACOG attributes to hormonal changes and the higher blood volume of pregnancy, should also fade — it says "the redness should fade after the baby is born".