The increase of venous volume and the relaxation of the venous walls causes or exacerbates the varicose dilation of the venous system in diverse territories, especially in the lower limbs and anorectal region. On the other hand, the hormonal stimulation on superficial capillaries will give rise to other vascular structures frequently confused as varicose veins: spider veins or telangiectasias.

Varicose veins and telangiectasias

Because there are no changes without costs, very often conditions that appear or accelerate as a result of the changes referred to above are observed, and although it would seem that they are a disgrace that looms over the woman, in reality manifest, indirectly , that the modifications of pregnancy are evolving properly. One of these “side effects” of pregnancy are varicose veins.

Despite the obvious that varices can become during pregnancy, the scarce information that exists about this problem is striking. To start developing this topic, which is so important from the aesthetic point of view and the health of women, I am going to define the most frequent conditions:

Venous congestion: during pregnancy the veins can become more visible under the skin (especially white skin) due to increased venous flow and some vasodilatation of their walls, scarcely muscular, without becoming varicose or behave like them, the case More representative is the venous network that is clearly visible in the breasts, especially towards the end of pregnancy and when breastfeeding begins.

Varices : they are dilatations, usually tortuous, of the veins of some organ or system due to circulatory disorders, alterations in the structure and function of the veins and genetic susceptibility for this problem. Thus, we can have varicose veins in any part of our body although the most frequent, famous and annoying are those located in the legs; I take the opportunity to mention that hemorrhoids are also varicose veins and that they can become quite annoying during pregnancy and after delivery.

Vascular spiders : medically called “Telangiectasias”, they are characterized by the presence of a central vessel (capillary of small caliber) from which fine branches emerge in the form of sun rays or spider legs. They are flat, painless, small, red, that whiten when they are tight and that appear preferably on the face, chest and back. We must make the exception that there are small varicose veins that are very similar to these spider veins: they are the varicose veins in “rocket burst”, very frequent and especially located in the ankles and behind the knees. The trained medical eye can make the differential diagnosis easily.

Hemangiomas : small, round, red, elevated arterial malformations that do not bleach when pressed and have no branches. They have a predilection for the thorax, head and neck. Many people call them “blood spots”.

How are these alterations generated?

Venous congestion is due to the direct effect of venous vasodilatation and increased local blood flow in various vascular beds.

The varicose veins are produced basically by pressure increases, dilation and blood stagnation within the veins of susceptible people, in whom the structural mechanisms and the venous circulatory physiology fail. The legs are the favorite site because on their venous system the gravitational effect is maximum, these veins must raise the blood from the legs to the heart facing a large column of blood against gravity. So that the blood is not returned to the legs there are small valves that close the retrograde passage but if these valves become incompetent the blood flow is altered, the blood is returned to the legs, the venous pressure increases and the veins dilate and the They make tortuous and insufficient. This is what explains the great varicose veins of cooks, chefs and photographers, to name a few professions closely related to varicose disease.

Telangiectasias and Hemangiomas are lesions mainly associated with female hormones (estrogens) present at very high levels during pregnancy, are mistakenly mistaken for varicose veins. These are produced by the stimulation that female hormones have on the growth of new arterial vessels, a process that is called “angiogenesis”.

Which are the risk factors?

Family Tendency and Personal Susceptibility: heredity dictates the quality of venous tissues of people, there are those who have more delicate and more likely to generate varicose veins.

Pregnancy: the progressive increase of the pressure exerted by the growing uterus on the venous drainage of the legs, combined with the circulatory changes of pregnancy and weight gain, are the ideal ingredients. It is possible that the hormonal component of pregnancy plays a less important role than the obstructive effect of the uterus.

Occupational Risk: works that condition fixed postures for a long time, sitting or standing for a long time, without changes of position (cooks, photographers, surgeons, secretaries, vehicle drivers, etc).

Age: the older the age, the more frequently the varices are observed. In fact, older pregnant women have more varicose veins than younger women.

Obesity and Excess of Weight: the excessive increase of weight conditions, by diverse mechanisms, the appearance of circulatory upheavals.

How does it feel to have varicose veins?

• Nothing in most of the early cases
• Feeling tired and tired in the legs
• Swelling in the ankles
• Pain over dilated and inflamed varices
• Itching around the varicose veins
• Muscle contractions in the calves.

I do not have varicose veins, will I have them in my pregnancy?

During pregnancy, almost all women will notice, for the first time, varicose veins on their legs and, as they advance, they will become more evident; however, on rare occasions they come to cause a severe problem. Usually we see the smallest ones (rocket burst) and the occasional varicose, short and little dilated leg in the calves and behind the knees. It is more common to find them in white people, perhaps because they are more noticeable. Do not worry, three months after the birth almost all will have disappeared.

I have them, will they get worse?

In patients who already suffer from varicose veins the tendency is invariably towards progression, the varicose veins will become larger and could disturb. The bad news is that in each pregnancy the varicose veins will be more evident, the disease will progress, but once the pregnancy is over, these varicose veins will also improve. Acute complications such as varicose burst (hemorrhage), venous thrombosis (clotting of the blood in the legs), thrombophlebitis (coagulation and infection) and varicose ulcers in the lower limbs will rarely occur. This usually occurs in very severe cases (rarely present in young women), in people who have neglected their circulatory hygiene.

Can they be prevented or treated during pregnancy?

Prevention is always the most intelligent and economic, the measures are:

• Raise your legs above the level of the heart whenever you have the chance.
• Rest regularly and change positions frequently.
• You can put pillows under your feet when you sleep.
• Use anti-varicose-sized stockings and appropriate material. Do not use tight stockings and do not allow them to roll up producing a choke ring.
• Exercise regularly to promote venous circulation; Swimming is perfect, walking is very good.
• Do not overdo the weight. Comply with the weight increase planned by your doctor.
• Avoid constipation (to control hemorrhoids)

Because varicose disease during pregnancy is rarely severe (most of my patients have small varicose veins and their main concern is aesthetics) I support the guidelines of the American Academy of Dermatology: No invasive treatment should be applied ( surgery or sclerotherapy) on them while you are pregnant. It is demonstrated that conservative measures are sufficient to control their progression, reduce discomfort and avoid complications.

The truth of the matter is that during pregnancy there is a high frequency of varicose veins but it is also true that most will improve and even some will disappear during postpartum: after three months there is almost no or at least the condition has stabilized as to decide which varices are justified to treat surgically.

Hemorrhoids

This is a particular type, and very annoying, of varicose veins. Hemorrhoids are the varicose dilation of the veins of the anus and rectum that can produce rectal masses that protrude through the anus (external hemorrhoids) or manifest by bright red rectal bleeding and painless at the time of evacuation (internal hemorrhoids). Mixed hemorrhoids have both components and manifest themselves in both ways in varying ways.

The most common complications of hemorrhoids are rectal prolapse (there is a large protrusion of the rectal mucosa through the anus accompanying the hemorrhoids) and hemorrhoidal thrombosis (the blood coagulates inside the hemorrhoids, generating intense local pain. cases it is impossible to return the hemorrhoids to their site (pushing them with your finger, which should be done to relieve the discomfort: reduction of hemorrhoids) and the only way to correct the problem is by operating the patient

Hemorrhoids are produced by increased pressure on the hemorrhoidal veins of the anorectal region in the presence of personal susceptibility of the local venous system. Constipation, obesity and pregnancy are frequent causes in the origin of hemorrhoids in susceptible patients.

Pregnancy causes hemorrhoids in almost all pregnant patients because the growing uterus obstructs the venous drainage pathways of the pelvis and the anorectal region (the same cause of varicose veins in the legs). Any additional increase in abdominal pressure (eg, during evacuation) can produce acute venous dilation that causes hemorrhoidal veins to protrude or internal hemorrhoids to bleed. Fortunately, most of the patients have very discrete and / or slightly symptomatic hemorrhoidal conditions.

In cases of complicated, severe or very symptomatic hemorrhoids, vaginal delivery can be contraindicated because the process generates such an increase in venous pressure that there is a risk of generating hemorrhoids that require emergency surgery.