While this is a less common occurrence than morning sickness, back pain, or the constant urge to pee, vulvar varicosities can happen during pregnancy and can be a significant source of discomfort for women, especially in the last trimester.
What is a vulvar varicosity?
Varicose veins are enlarged veins that can occur anywhere in the body and are often the result of increased pressure to the area involved. In this case, the vulva or perineum. Vulvar varicosities typically occur due to increased pressure on the genitals and lower extremities during pregnancy. Roughly 4% of women will experience vulvar varicosities. The risk increases when the woman already has varicosities in areas near the pelvic region or has a family history of varicosities. Once a woman has vulvar varicosities, she is more likely to get them with each subsequent pregnancy. While these varicosities are not always problematic, they can often be painful and leave women feeling extremely self-conscious.
What are the symptoms?
Some of the symptoms of vulvar varicosities include pressure or heaviness in the genitals, swelling in and around the genitals, vulvar pain or pressure that is worse with prolonged standing, or sexual and physical activity. Despite the discomfort they cause during pregnancy, there has been no evidence to suggest they cause delivery complications. So, there is no reason to worry these veins will make a vaginal birth challenging or impossible. Although there is no way to eliminate them completely during pregnancy, there are strategies that can be used to reduce the discomfort and prevent them from worsening.
Strategies for helping heal vulvar veriscosities
Avoid prolonged standing or sitting.
These positions put a lot of downward pressure and stress on your pelvis and vulvar tissues, and can make it more difficult for your veins to function. Over time, this can lead to weakening and enlarging of the veins. So, sit down and put your feet up, momma!
Wear supportive compression garments.
Wearing garments that support the vulvar tissues and provide compression to the area can reduce the discomfort associated with vulvar varicosities and prevent them from worsening. Such garments include the Prenatal Cradle, Pelvic Floor Press, and Baobei maternity and postpartum bloomers. Knee-high compression socks can also be beneficial for vulvar varicosities.
Elevate your pelvis and legs for a few minutes at the end of each day.
Lie on your back with a few pillows or a pelvic wedge under your bottom, which will help reduce swelling and improve circulation. You can include an extra pillow under your right hip so you are slightly tilted to your left. You can also perform kegels in this position to help facilitate blood flow and circulation. This will be especially beneficial if you have a job where you are on your feet most of the day.
Ice your vag.
An ice pack to your vulvar tissues for a few minutes several times a day can help ease the pain and reduce swelling in the area. There are several pelvic support garments that have slots for ice packs to make it easier or you can just put a bag of frozen peas in a pillowcase as you lie in the position recommended above. Leave on for 20 minutes several times a day.
Try sleeping on your left side.
This will reduce pressure on the vena cava and improve blood flow to the lower extremities and pelvis.
Try to reduce the amount of lifting you are doing throughout the day.
This may mean that you will have to modify your exercise routine for a while. Or it can mean that you may need to be placed on light duty at work. This is also important for our pregnant mommas with toddlers that they are still picking up and carrying.
Exhale on exertion.
The better pressure management you have throughout your daily activities, the less stress you will be putting on your vulvar tissues. One way to do this is to use a slow, controlled exhale as you lift. This will reduce the pressure in your abdomen, and the negative stress on your vulvar tissues.
Get you a squatty potty, girl!
That’s right, modifying the way you poop can help reduce negative pressure and stress on the pelvic floor and vulvar tissues. You also want to remember to use a slow, controlled exhale as you void.
See a pelvic floor PT!
Pelvic floor physical therapists can help educate patients on how to better manage their pressure throughout the day and with exercise, teach modifications for activities that may cause worsening of varicosities, and screen the patient for pelvic floor muscle weakness or tightness (both of which can make varicosities worse).
While these strategies can help prevent varicosities from worsening throughout pregnancy, it is important to note that they typically do not resolve during pregnancy. However, most vulvar varicosities will completely resolve following delivery. If your varicosities do not resolve within a few months of giving birth, there are surgical/medical treatment options available. These options are not recommended during pregnancy, and should only be considered if your varicosities do not resolve on their own. These surgical interventions include:
This is a procedure where a catheter is used to close the weakened vein with a coil.
This is an injection into the vein with a solution that blocks blood flow. The goal of this treatment is to reduce the pain and swelling associated with varicose veins.
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Emily McElrath PT, DPT, MTC, CIDN is an orthopedic and pelvic health physical therapist with a passion for helping women achieve optimal sports performance. She is an avid runner and Crossfitter and has personal experience modifying these activities during pregnancy and postpartum. She is certified in manual therapy and dry needling. When not working, Emily enjoys time with her husband and two kids.
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