Varicose Veins During Pregnancy and its Treatment in Singapore

Why do pregnant women get varicose veins?

Up to 70% of pregnant women suffer from varicose veins in the legs during pregnancy. Varicose veins are enlarged veins which appear to be bulging, tortuous and bluish in colour, running just underneath the skin.  Veins in the legs have one-way valves which ensure blood flows from feet toward the heart in one direction. Failure of one-way valves in the leg veins will allow blood to flow backward toward the feet, stretching the walls of the veins. Some pregnant women are especially more prone to develop varicose veins when they have a family history of varicose veins, are overweight and have a job that requires prolonged standing or sitting.  Pregnancy can also exacerbate the symptoms of those who already have varicose veins. 

  Vein with normal working valve                 Vein with faulty valve

There are various reasons that may account for the development of varicose veins during pregnancy:

• Increased in pregnancy hormones (oestrogen and progesterone) will lead to dilatation of veins and failure of one-way valves in the veins to work properly
• Enlarging uterus from growing baby may result in compression of pelvic veins which are responsible for returning blood from legs to the heart
• Increased in total blood volume during pregnancy to support growing baby will lead to stretching of vein wall. Increased in diameter of veins will prevent one-way valves to close properly, leading to pooling of blood in the legs.

What are the symptoms?

Symptoms of varicose vein in the leg may include:

• Swelling feet and ankles- Swelling tends to be more significant during late stage of pregnancy and especially worse towards the end of the day. This is due to pooling of blood in the leg because of gravity and vein valve failure.
• Heaviness
• Tiredness
• Aches
• Pain- may be burning, crampy, throbbing and shooting in nature
• Muscle cramps at night
• Itching

In addition, pregnant women are up to 5 times more likely to develop deep vein thrombosis (DVT) than when not pregnant. This is because:

• Blood clots more easily during pregnancy
• Blood flow in the leg veins is also slowed down by compression of pelvic veins from the increasing size of uterus. This encourages the blood to clot.

What is the management of varicose veins during pregnancy?

Surgery or minimally invasive procedures to treat varicose veins should be avoided during pregnancy.  Regression of varicose veins is often observed within first three months after delivery. There are however many conservative approaches that can manage varicose vein symptoms effectively during pregnancy:

• Avoid prolonged standing and sitting
• Engage in exercise regularly such as walking and swimming
• Wear graduated compression stockings. The pressure exerted by the stockings on the leg veins will help the vein valves to work properly by promoting blood flow from the leg towards the heart
• Elevate legs regularly to improve venous circulation of the legs
• Try to keep body weight within recommended limits

Varicose Veins Treatment Singapore 

Do not hesitate to consult a vascular surgeon about your varicose veins especially when they become symptomatic as pregnancy progresses. It is important to exclude serious condition such as DVT.  Not uncommonly, varicose veins stay after pregnancy as the valves in the veins are irreversibly damaged. Medical intervention may be required to normalize the vein circulation.

Dr Tan Yih Kai, a Senior Consultant Vascular and Endovascular Surgeon, at the Farrer Vascular Vein and Wound Centre is a leading specialist in the care of varicose veins. He has many years of experience in treating patients with varicose veins and the associated complications such as DVT.