We all know that during pregnancy, a woman’s body undergoes many changes, including varicose veins. As the fetus grows into a baby, the uterus enlarges to accommodate this growth. Along with hormonal changes and the obvious enlargement of the mother’s “belly”, there are internal adjustments being made as well. As a result, many women discover new unwanted varicose veins in their legs and other areas.
The leg veins return blood to the heart in a passive flow mechanism. This is enhanced by the calf muscle pumping the blood back up through the veins. In the pelvic area, the leg veins carry the blood into the iliac veins, which then come together to form the inferior vena cava which then drains into the right side of the heart. As the uterus expands, it can compress the iliac veins, forming an “hourglass” effect. So, what then happens, blood flow going up is under higher pressure due to the tightness of the vein at that bottleneck area, and this back pressure causes the leg veins to bulge. Think of a 6 lane highway where 4 of the lanes close down, and all the traffic suddenly has to merge into 2 lanes. Not only is there back up on the highway, but the exit ramps back up as people try to avoid the slowdown.
In addition, women normally gain weight during pregnancy. This added weight and fluid retention, often due to hormonal changes of pregnancy, causes swelling in the soft tissues of the legs. It also adds stress to the veins as gravity exerts more pressure downwards and it is more difficult to pump the blood up to the heart.
Once a vein is dilated, it can rarely regain its original size. (Think of a sweater that stretches out with use over the years, then when you lose weight, the sweater is too big.) As veins get larger, the valves inside the veins stretch apart and become more incompetent, so the reflux (reversal of blood flow in the vein) also gets worse. This is why it is very common for second or third time pregnancies to cause more vein problems than the first pregnancy. In addition, more distal veins get involved, and more spider veins become obvious.
Other areas where pregnancy can cause vein problems are the breasts, the anal and the labial areas. Usually breast veins regress after pregnancy and after a woman stops breast feeding. However, they may persist as blue-green veins traveling to the nipple area. In the genital region, it is the same pelvic pressure changes that can cause hemorrhoids to form and bulging swollen vulvar abnormalities. These abnormalities often remain long after the pregnancy is over, and can cause significant pain and deformity.
The good news is that all of the changes that occur and are discussed above can be treated very effectively. Office based management includes laser closures, micro-excision procedures and chemical injections (Sclerotherapy). There are no big incisions or general anesthesia necessary. We take a comprehensive approach to treating vein problems, and do not limit our patients to any single option (hemorrhoid treatment is usually referred to a general surgeon and may require outpatient hospital care). Many of the treatments are covered by insurance, too! So if you or someone you know has a problem similar to what was discussed above, call The Kimmel Institute so that we can help get you on track for a happier, healthier life!
Dr. Richard Kimmel is a Board Certified Cardiothoracic and Vascular (CTV) Surgeon who has been in private practice in South Florida since 1991. He is a Fellow of the American College of Chest Physicians, a Fellow of the American College of Osteopathic Surgeons, a Clinical Investigator with the NIH, an Affiliate Member of the H. Lee Moffitt Cancer Center of the University of South Florida, and an Assistant Clinical Instructor in Surgery at the Nova-Southeastern University College of Osteopathic Medicine in Davie, Florida.
