We all want to enjoy healthy and active lives but with all the tasks of work and family we may forget about maintaining the health of our legs.
Problems with the veins of the leg occur in both men and women of all ages but certain factors increase the risk of venous problems. Health conditions, lifestyle habits, heredity, injury, surgery, age, and pregnancy all play a role.
While you are unable to control heredity, age, surgery and changes during pregnancy, you can improve lifestyle factors through exercise, good posture, avoiding inactivity, choosing good fitting clothing and footwear, and wearing gradient compression hosiery that is right for you.
Three easy actions can help you maintain the health of your leg veins: exercise, elevation, and wearing gradient compression hosiery. Regular walking, swimming or cycling works the calf and thigh muscles. Contraction of these muscles helps the return of venous blood from the legs back to the heart.
Compression therapy alone is not enough. Exercise and periods of leg elevation are also necessary for effective management of edema, venous disease, and lymphatic disease.
- Elevate your feet above the level of your heart whenever possible.
- Draw letters of the alphabet with your toes once each hour when sitting for extended time.
- Avoid long periods of standing or sitting.
- Avoid crossing your legs, wearing high-heeled shoes or tight-fitting clothes.
- Lose excess weight.
Pregnancy is a special time to take care of your developing baby and yourself. While much of the focus is on your baby and bodily changes, changes are also affecting your veins. The normal hormonal changes that occur with pregnancy affect the walls of your veins causing the vein walls to relax or dilate. Relaxation of the veins occurs early in the pregnancy – during the first trimester. Total blood volume also increases in the first trimester and gradually rises with gestation. Your total blood volume may increase as much as 45% in comparison to the non-pregnant level. Relaxation of the vein walls, especially in areas of venous valves may cause the valve to become incompetent – thus allowing backward flow of the venous blood.
Vein relaxation, valve incompetence, and increased blood volume all contribute to reducing venous flow from your legs. The reduced flow results in congestion. Venous congestion in turn causes swelling and leg discomfort. Ankle swelling occurs with most pregnant women.
During the later months of pregnancy (third trimester) the weight of the baby and the uterus may impede return of blood through the veins of your legs. This is often dependent on your physical position.
Gradient compression stockings reduce venous congestion and support the superficial veins of your legs. This helps manage the increased blood volume and relaxed vein walls thus reducing the amount of swelling and the severity of varicose veins.
Talk with your obstetrician or OB nurse about the amount of compression and stocking style best suited for you during this pregnancy. Congratulations on your pregnancy! JOBST® extends our best wishes for a safe delivery and healthy baby.
Long distance travel, whether by automobile, train, or airline can be associated with leg discomforts and risks. Lack of leg movement gives way to swelling of the feet and legs. The swelling contributes to leg fatigue, discomfort and the sensation of leg heaviness.
Activity restriction in the confined seated position results in diminished flow of venous blood from the legs back to the heart. This combined with pre-existing risk factors may lead to a more serious danger – travel-related thrombus. You may have heard this reported in the media as economy class syndrome (ECS). A travel-related thrombus is a venous thrombosis (blood clot in a vein) associated with greater than 5 hours of travel in a seated position. The venous thrombosis may be limited to a deep vein (DVT) or a fragment could flow to the lungs and lodge causing a pulmonary embolism (PE).
The likelihood of a thrombus occurring can be reduced with appropriate preventive measures suited to an individual’s risk. Risk factors for long-distance travel related venous thrombosis include: age >40, malignancy, heart failure, severe varicose veins, chronic venous insufficiency (CVI), obesity, hormonal medication, previous DVT, family history of DVT, and recent surgery.
Consult with your physician to determine your risk category and seek advice on appropriate prophylactic measures, including the amount of compression to wear.
Recommendations for any extended travel:
- Drink plenty of non-alcoholic fluids, especially water
- Perform ankle movements often
- Stretch and exercise your legs at least once every hour
- Elevate legs when possible
- Avoid high-heeled footwear and restrictive clothing
- Wear gradient compression hosiery
- Seek medical advice if you have or are concerned about any risk factor
- Visit http://www.economyclasssyndrome.com/ for more information.
Gradient compression delivers a squeezing to the leg that is tightest at the ankle. The degree of squeezing or compression gradually decreases up the leg. This compression, generally expressed in mmHg (millimeters of mercury) provides two main benefits.
A complete understanding of precisely how compression works remains unknown. Two actions are generally accepted. Probably the most beneficial effects of compression are its effects on the capillaries and tissue spaces.
Compression is believed to increase the pressure in the tissues beneath the skin thus reducing excess leakage of fluid from the capillaries and increasing absorption of tissue fluid by the capillaries and lymphatic vessels. Compression therefore reduces and helps prevent swelling.
The physical presence of the stocking also helps control the size (diameter) of superficial veins beneath the stocking. The stocking does not allow these superficial veins to over expand with blood. This action helps prevent “pooling”. The venous blood then flows more quickly up the leg towards the heart.
Most of our blood volume is carried in the veins (64%). Veins can expand to hold large amounts of blood. Veins are blood vessels that carry blood from the body back to the heart. Blood return from the legs occurs mainly through the deep veins. Within the veins, especially those of the legs are valves. Venous valves are bicuspid (two) flap like structures made of elastic tissue. The valves function to keep blood moving in one direction.
The flow of blood in the venous system is complex for several reasons: the low pressure within the veins, flow rates that vary from high (during muscle contraction) to almost no flow during quiet standing or sitting positions, the effects of gravity, the collapsible nature of the venous wall, the presence of valves, and the large volume of blood carried in the veins.
Once the blood has passed from the arteries through the capillaries, it is flowing at a slower rate because little pressure remains to move the blood along. Blood flow in the veins below the heart is helped back up to the heart by the muscle pump. The walls of the veins are thin and somewhat floppy. To compensate for this many veins are located in the muscles. Movement of the leg squeezes the veins, which pushes the blood toward the heart. When the muscles contract the blood within the veins is squeezed up the vein and the valves open. When the muscle is at rest, the valves close helping to prevent the backward flow of blood. This is referred to as the muscle pump.
Spider veins are a common minor problem. These are small red or purplish dilated end vessels. While they may be unattractive they pose no harm. Other venous problems may cause leg discomfort, leg swelling, and in severe cases skin breakdown. Vein problems affect both men and women and are more likely to occur the older we age.
The walls of a vein may be weak and bulge and twist as with varicose veins. When veins continually over-expand the valves fail to close properly. Venous blood then falls backwards putting more pressure on the valves below. Eventually these valves may also weaken and pooling or venous congestion results while standing or sitting.
A blood clot in a deep vein (DVT) most often occurs near a venous valve. The DVT can permanently damage the vein wall and valve. Damage, scarring or fibrosis to the vein wall and valve cause them to become incompetent resulting in reflux (backward) flow of blood and venous congestion.
American Venous Forum
The AVF is an international consortium of venous and lymphatic specialists dedicated to improving patient care through education and information exchange.
American College of Phlebology
The ACP works to provide education related to venous disorders, such as the management of varicose veins, and strives to improve the standards of patient care.
National Lymphedema Network
Founded in 1988 the NLN is a non-profit organization dedicated to providing education and support to lymphedema patients and their families, and health care providers.
JOBST Vascular Center
Interdisciplinary Team Focus on the Treatment and Prevention of Vascular Disease. Through active clinical research and practice the JOBST Vascular Center, a Center of Excellence at the Toledo Hospital, Toledo, Ohio, U.S.A., is among the world leaders in Vascular Surgery.