This is one of the most common questions asked mostly by near relatives of patients who buy stockings from us. Adding from my existing knowledge, I’ve scrounged the internet and taken some options which seems may be helpful for many reading this blog.
To begin with, let’s be clear that there’s no fixed way to guarantee that you’ll be able to prevent varicose veins. However, that should not discourage you from trying out different options to reduce the chance of getting it.
There are many reasons why varicose veins occur. Not a long time ago, I had the privilege of meeting Prof. Dr. Waldemar Olszewski. We were discussing about why do we get so many leg problems ranging from Varicose veins, knee problems, to flat feet etc. His outlook on this matter was way outside the realm of current medical thinking, but still was interestingly logical. Humans first evolved in Africa, and much of human evolution occurred on that continent. The fossils of early humans who lived between 6 and 2 million years ago come entirely from Africa#1. Thats when the body weight distribution went from 4 limbs to 2. With more weight bearing, and balancing on hind limbs, evolution, in its slow pace, gave rise to long legs, adjustment of muscle mass for better balancing etc. Since this was a slow process, the first apes who started walking, the process must have taken many centuries and generations, if not less, for mother nature to adapt the ape’s body to be able to stand without problems. Now, fast forward to the 20th century. With the invention of antibiotics and sudden#2 technological advancements of medical therapies, the human life expectancy. The average lifespan was considerably less than 50 years. It began to rise markedly in the 19th century, hitting 49 in the United States in 1900, and then took off in the 20th century. “Life expectancy increased only very slowly for two millennia,” said Richard Suzman, director of the Social and Behavioral Research Program at the National Institute on Ageing, “and then almost doubled since 1800.” Today, the average baby born in this country (USA) will live to 78. The average 35 year old will live to about 80. And the average 65 year old will live past 83.#3
So this time around, mother nature OR evolutionary process didn’t get as much time to adapt the body mechanics to adjust to this long life. So, now we find these old age illnesses much more rampant than what was rarely found before 1900. I’m not saying that living a long healthy life a bad thing, rather pointing out that possibly human body wasn’t yet adapted to handle to longer life. I’m sure in a few centuries, we’l overcome some of the problems that we face now. Until then, we’ve to face that certain problems, need to be tackled or prevented by ourselves until our bodies evolve to take care of it by itself.
Varicose veins is one such problem which until the late 1900s was though to be problem of the old age. Varicose veins is a disease of the veins which are responsible for the blood flow. In this case, return of the blood from the periphery to the heart (from far to centre). Before the invention of vehicular transport, computers and internet, most work used to be physical labour based, barring a few like accountants etc. and even then we had to walk a lot due to unavailability of public transport systems, whether to reach our work place, or to go buy day to day groceries and other necessities. But with the advent of technologies, comes convenience and also comes problems like obesity, spine problems, varicose veins. It is found that now even young adults have started developing Varicose veins, swelling of the feet, heavy legs, DVT (deep vein thrombosis). Varicose veins is a problem which develops very slowly, it gives you mild dull aches in the legs, feet and/or calves especially in the second half of the day. Eventually the swelling or pain bothers your work and mental state. If you can imagine trying to give your 100% at work while dragging your heavy legs all day long everyday, you’ll understand how frustrating it can get for a hard working professional. Your productivity would go down drastically, your mood would be affected at home and work. This is why it might be important for you to be careful about such a problem, especially if your genetic family member has it.
To understand how to prevent varicose veins, first we must look at what all reasons are the culprits which increase your chance to get varicose veins:
- Genetic/ family history of varicose veins
- Sedentary lifestyle (inactive lifestyle)
- Pregnancy and related hormonal changes – like oestrogen
- Obesity – heavy weight
- Long standing or sitting hours job profile
- In rare cases some mass / tutor pressing in the veins obstructing blood flow
- Deep vein thrombosis
- Chronic (long term) fluid overload caused due to Heart failure or kidney failure or liver damage
- Birth / development defects (rare)
- Some drugs which can cause hormonal changes which affect the muscles in the veins
There maybe many more reasons, why they occur. For example, some people believe that varicose veins may be more prevalent in taller people than shorter ones. I do not know any science, except for gravity. to explain this theory. But it is not been proven, so I remain doubtful about such theories. So for now, let’s concentrate on the ones above, about which, we can do something.
Out of the above, Genetic pre-disposition, tumors, pregnancy, kidney / liver problems (after they’ve developed) are some things that we don’t have control over. Most doctors will tell you the following advice:
- Active lifestyle
- Reduce weight
- Dietary changes
- Avoid prolonged heat / sun exposure
- Wear support compression socks
- Watch out for drugs, foodstuff (like soy) which increase oestrogen content
- Take precautions during pregnancy
- Drink plenty water (expect in some medical conditions)
- Cool water while washing legs
- Elevate legs
- Regular deep breathing
- Avoid tight clothes
I’ll try to expand individual points to help explain in as much details as possible:
- Active lifestyle – This is the most important. As I explained above that in the 21st century, our sedentary lifestyle has caused sudden changes in the body activity levels and blood flow dynamics. Active lifestyle can include any of the physical activities that you may be interested in – like yoga, pilates, gym, jogging, running, etc. However, do not think that doing morning yoga / running is enough to prevent varicose veins all together. As I mentioned above in the causes, sitting or standing for long hours can lead to varicose veins. So if you do any exercise only in the morning or evening (even though it’s very helpful for a lot of reasons) and sit at your work desk for hours together, you’re still at risk of developing varicose veins. What I’m trying to say is to add mini-activity regimes within your day. For example, take a 2 min walk or foot and calf exercise every 2 hours. You’ll find plenty of online videos, of small exercises which you can do while sitting at your desk as well. On a holiday, instead of ordering everything online at home, if time & location permits, go out and walk to the store. The point is be physically active throughout the day.
- The clinical severity of venous disease is worse in the obese patient. The effect of obesity is increased venous reflux and venous pressure in the lower limb probably due to the raised intra-abdominal pressure. The venous calf muscle pump is more effective but because of decreased activity is not well used and does not compensate for the greater reflux. These findings are consistent with the view that obesity worsens the clinical manifestations of varicose veins rather than the initiation of them#4. Reducing weight has so many benefit apart from only preventing varicose veins, but also many heart conditions, atherosclerosis, etc. Losing weight has also shown to psychologically beneficial also#5.
- Dietary changes include avoiding constipating food stuffs, include more fibre in your diet.
- Avoid heat exposure to legs for prolonged periods at a time, including sun bathing, hot water baths or keeping your legs dipped in hot water.
- Wearing support socks can help a lot during the day. It keeps the pressure in the vein to a minimum, enhances blood flow all day. Many hair dressers, policemen, IT professionals, other professionals who have to stand or sit for hours together, are greatly benefitted with the use of such compression support socks. If you do regular exercise or gym, it is important to wear some kind of compression on your legs. There are a lot of pressure changes occurring in your body when you’re doing heavy exercises, which may lead to back pressure in your leg veins. Wearing compression during sports or strenuous activities like gym, avoids the harmful effects of such intra body pressure changes, and also improves the blood flow from your legs upwards. It helps in taking away the waste products developed by the body quickly to be filtered away thereby improving your performance. Hence it is beneficial in many ways
- Some hormonal pills containing oestrogen help relax the muscles, though necessary for some patients, can also cause varicose veins. For those who need to be on that therapy, one should wear compression stockings and ask their doctor on what more steps to take to avoid developing varicose veins. Some foods like Soy contains isoflavones, which act like oestrogen in the body can be avoided.
- Pregnancy is the most beautiful time in a couple’s life. However, pregnancy causes a lot of changes in the female body. American pregnancy association#6 lists the following ways to prevent varicose veins during pregnancy:
- Avoid sitting or standing in the same position for long periods of time. Make sure to take breaks to change your position
- Avoid wearing high heels. It is better to wear lower-heel or flat shoes as this works your calf muscles, fostering healthy circulation
- Get regular exercise. Talk with your doctor to confirm if it is safe for you to exercise during pregnancy
- Wear maternity support hosiery. These put pressure on the legs, stimulating blood flow up the leg towards the heart. However, avoid wearing tight hose that cut off circulation
- Avoid crossing your legs while sitting
- Elevate your legs periodically to improve circulation
- Sleep on your left side. This will help relieve pressure on the inferior vena cava (main vein transporting blood to the heart)
- Reduce sodium intake to minimise swelling of the veins
- Drink plenty of water and eat enough fibre to prevent constipation
- Apart from these, wearing compression stockings during pregnancy helps reduce and prevent swelling and varicose veins.Water helps maintain integrity of the veins, takes away waste products quicker, thereby reducing potential damage being caused to tissues.
8. Cool water jets on the legs from below upwards is very helpful. Due to cold temperature, the veins contract and streaming these jets of cool water from below upwards creates like a squeezing effect inside the veins causing the blood flow upwards and also helps the muscles in the vein wall.
9. Elevating legs whenever possible drastically takes away the gravitational and abdominal pressures exerted on the leg veins during sitting and standing postures. Of course, this cannot be used as an excuse to be lazy.
10. Deep breathing helps create negative pressures in the chest and abdominal cavity, which results in better blood flow of the legs.
11. Clothing worn should be comfortable. Avoid tight clothes that create constriction or obstructions at the waist or abdomen or even on the thighs. This obstructs the blood flowing upwards and thereby creating higher blood pressure inside the veins in the lower leg, which is very harmful.
As more & more data becomes available, we’ll have many more options how we take care of our veins. The first step is to recognize and start somewhere, anywhere.
Acknowledgment: Prof. Dr. Waldemar Olszewski
#2 – here sudden is in relativity to the speed of evolution. Antibiotics were discovered by Alexander Fleming in 1928
#4 – Obesity and Impaired Venous Function. By – A.M.van RijC.S.De AlwisP.JiangR.A.ChristieG.B.HillS.J.DuttonI.A.Thomson (https://doi.org/10.1016/j.ejvs.2008.01.006)
#5 – Lasikiewicz N, Myrissa K, Hoyland A, Lawton CL. Psychological benefits of weight loss following behavioural and/or dietary weight loss interventions. A systematic research review. Appetite 2014; 72: 123-137. [PubMed] (https://www.ncbi.nlm.nih.gov/books/NBK179815/)