All About Compression Stockings for Venous Diseases

How Compression Stockings Work?

Compression stockings are designed to provide external, consistent and graduated pressure in the legs, helping blood to flow back to the heart. They are able to improve varicose vein related symptoms such as pain, sensation of heaviness, swelling and night cramps. Compression stockings exert higher pressure at the ankle and lower pressure gradually towards the knee and thigh, to ensure blood in the veins is pushed upwards toward the heart.

Classes of Compression Stockings

Compression stockings are classified according to the compression pressure applied by the garment at the ankle level. There are four compression classes. The higher the class the stronger the compression.

Compression Class	Pressure in mmHg	Indications
I	18–21	Prevention of DVT Mild varicosities eg spider veins
II	23–32	Varicose veins Mild oedema
III	34–46	Ulcer treatment Post thrombotic syndrome
IV	> 49	Severe lymphaedema

Measurement for Compression Stockings

The sizes of compression stockings will be determined based on the measurement of ankle, calf and thigh circumferences. Good fit is essential to ensure pressure exerted by the compression stockings is evenly distributed. There is no universal accepted sizing method for compression stockings. Measurements need to be taken according to the sizing system of the respective brand of stockings.

Types of Compression Stockings

Knee length
Thigh length
Pantyhose

Why compression stockings need to be prescribed by doctor?

Compression stockings are generally safe to wear. However, all compression stockings with compression pressure greater than 20mmHg need to be prescribed by doctors. This is because if compression stockings are applied on legs with impaired arterial circulation, they will worsen the ischaemia which may lead to tissue necrosis or gangrene.

Furthermore, poorly fitted compression stockings can cause more discomfort and pain. Under sized stockings will leave marks on the skin, at worst, skin necrosis. Over-sized stockings will lead to the stockings continue sliding down from the top, resulting in ineffective compression.

When and How Long Should I Wear Compression Stockings?

Compression stockings should be worn during the day and removed before going to bed. The stockings should be put back on again first thing in the morning. This is when the leg swelling is minimal, allowing stockings to go up the legs easier. It is advisable to wear stockings for 4-6 weeks after varicose vein surgery.

How Long would a Pair of Compression Stockings last?

Medical grade compression stockings that are worn and washed daily should maintain their compression effect for about six months. It is advisable to change the stockings every 6 months. Remember that, a pair of worn-out and non-stretchy socks will lose their medical benefits in preventing deep vein thrombosis (DVT), leg swelling, leg ulcers, or venous insufficiency.

Compliance with Compression Stockings

The non-compliance rate for compression stockings has been reported to be 30%– 65%. The commonly reported reasons include worsening of pain and discomfort, difficulty in putting on the stockings, perceived ineffectiveness, too warm to wear, skin irritation, cost and appearance.

Should I also wear my medical compression stockings overnight in bed?

It is ok to wear compression stockings overnight but in generally not necessary. Please discuss with your doctor before doing so. In upright position, compression stockings provide a constant amount of pressure to the venous circulation system to fight gravity pull and pump the blood back to the heart. However, when laying down flat in horizontal position, veins do not subject to gravity pull and the blood will flow naturally back to the heart. Therefore, the benefit from the compression stockings is minimal. Furthermore, wearing compression stockings at night may apply unnecessary pressure to the ankle, reducing blood supply to the leg especially in those people already have poor arterial circulation.

What Are Some Tips to Help When Putting Compression Stockings On?

Putting compression stocking on and taking it off can be challenging, especially for elderly and those with arthritis. There are variety of tools available in the market to help putting on and taking off compression stockings. These include: