By Jill Buterbaugh, RN, MSN, CRNP, FNP-BC
Venous insufficiency is not just a disease of the legs. Some women experience pelvic congestion syndrome where they may have varicose veins in the groin or labial areas and incompetent veins supplying the ovaries, uterus, vagina, bladder, and rectum. Symptoms may include chronic pelvic pain or discomfort, painful menses, bladder irritability, rectal pain and hemorrhoids. While pregnancy may make venous insufficiency in the pelvis and legs worse, in most cases with obtaining a careful history we find that women usually had some symptoms before the pregnancy occurred. But some women do not have any symptoms prior to pregnancy and the culprit is most likely a hormone called progesterone.
Both women and men have progesterone in their bodies but women tend to have higher levels most of the time. In both men and women, progesterone helps with the normal function of muscles, lungs and the immune system. In women, progesterone is second primary a sex hormone and levels rise and fall to control normal menstrual cycles. During pregnancy there are high levels of progesterone that are sustained throughout the pregnancy that helps to maintain the thickness of uterine walls and causes relaxation of the smooth muscle of the uterine wall allowing it to expand and prevent premature contractions. Unfortunately, progesterone not only effects the uterine wall, vein walls have smooth muscle layers and during pregnancy the vein walls become more elastic and are prone to dilating. According to the National Institute of Health, pregnant women have just under 50% more circulating blood volume than when in a non-pregnant state. This means the veins have to work even harder to return the blood to the heart.
Another contributing factor to vein disease during pregnancy is the increased abdominal pressures and compression of major veins in the abdomen. When abdominal pressures increase, the venous system meets resistance to blood return to the heart resulting in increased congestion in the lower extremities. Most women are instructed to lay on their left side when sleeping or resting to shift the weight of the uterus off the vena cava, which is the main vein running from the abdomen to the heart. Arteries are under higher pressure and have stronger walls than veins and sometimes the arteries that lay over veins can actually compress the veins preventing easy flow.
After pregnancy, the veins will decrease in size but the damage done to the walls from being over-stretched may be permanent. Then, with each subsequent pregnancy, the vein walls become more and more diseased. We know that the more pregnancies a woman experiences, the higher the risk for developing vein disease. There is also a genetic predisposition in some people to develop varicose veins so those women who are genetically inclined to develop venous insufficiency will be more effected.
Pregnancy is a contraindication to treatment of venous insufficiency. We recommend that after delivery, allow about 6 months for the body to recover to a pre-pregnancy state. We also do not recommend treatment while breast feeding. The evaluation for venous insufficiency involves ultrasound and can still be done in the immediate post-partum period or while breast feeding so if you feel your veins need evaluated please call for more information.