Vulvar varicosities are typically something you do not hear about until you have them. If they occur during pregnancy, as they do for about 20% of pregnant women around 18-20 weeks gestation, it’s often not a great morale boost physically or psychologically. However, there is plenty you can do to manage them well and alleviate some of the discomfort they might cause! 

Vulvar varicosities (or varicose veins in the vulvar/pelvic region) are essentially dilated or stretched veins. Veins, typically colored blue in anatomy pictures, pump blood back towards your heart from all over your body. In pregnancy, your body increases its blood flow by up to 50%, is managing increasing pressure on your pelvic area as your baby and belly grows, and experiences changes in hormones (progesterone and estrogen) that affect the pliability of anatomical structures. For 1 in 5 pregnant women, veins just need more help doing their job of circulation and decongestion efficiently. 

Vulvar varicosities result in the following changes in the look and feel of your labia and genital area (either on one side or both):

• areas of blueish discolouration
• small, soft bumps
• feelings of pressure, heaviness, swelling
• vulvar discomfort or pain
• and/or less ability to be upright or sit comfortably

Vulvar varicosities can also be alarming or discouraging for women who don’t know what they are.  What is nice to know is that given the special and particular circumstances of pregnancy, vulvar varicosities go away after delivery for the majority of women. In addition, they do not affect your mode of delivery. (*Note: if you have been diagnosed with vaginal varicosities it is worth discussing different delivery options with your obstetric provider(s)).

It’s also worth knowing that if you have vulvar varicosities with one pregnancy, they do not always occur with subsequent pregnancies, but the chance of reoccurrence is much higher. Whatever your experience is, knowledge is power, so let’s put more tools in your toolbox to help you have a better pregnancy experience.

For managing vulvar varicosities, keep in mind the words pressure and pump. The following is a list of suggestions from a pelvic health physiotherapy standpoint to help reduce pressure in and through the pelvic area and improve the blood pumping mechanism in your body:

• Gravity-minimized rest: As much as you are able, balance your upright activities (standing, walking, and especially sitting) with non-upright rest positions, such as lying on your side or lying on your back with your feet up (on a chair or the wall). (*Note: watch for symptoms of compression of the vena cava: light-headedness, dizziness, shortness of breath, and/or general malaise. If you experience these, change your position to off your back).

• Sitting breaks: If you spend a lot of time sitting at work, home, or in the car, give yourself plenty of breaks to walk around. This decreases the constant pressure on your pelvic region from the chair, couch, or seat you’re sitting on, and briefly activates muscles in your legs and pelvis that are part of the circulatory pumping mechanism.

• Constipation management: While constipation is very common during pregnancy, having persistent stool in the rectum and repetitively pushing to get it out both increase the amount of pelvic pressure you experience on a day-to-day basis. The position you are sitting in on the toilet, the ways you use your breathing, and your fluid and food intake can be very helpful treatments for constipation during pregnancy. A pelvic health physio can provide lots of useful information in this area.

• Exercise: Regular exercise (such as walking, swimming, stationary cycling, low impact aerobics) helps promote circulation in the lower legs as well as the pelvic region by activating important “pump” muscles. Routine movement also helps with constipation (it gets your bowels moving) and helps psychologically with energy and mood, so exercise is great bang for your buck. Thirty minutes is recommended, but keep in mind some is better than none.

• Posture: Certain positions your stand or sit in can increase pressure in and through your pelvic region. As you are able, you want to be sitting on your sitz bones (so that you are not on your tailbone) or standing with your pelvis in the center of your feet, stack your rib cage over your pelvis (so that your chest is not hunched or sticking out), and stack your head and neck over your rib cage (so that it is not forward). This posture gives the most space for the contents in your trunk and avoids pushing things downward, especially if you are adding weight on top of that (lifting a toddler, work bag, weights at the gym, etc). Some things that are helpful for posture are supportive shoes, a wedge cushion, lumbar support, and a good desk or work set up. A pelvic health physio can give you more guidance on this recommendation.

• Compression garments: If you can manage them, wear compression garments such as socks and/or pelvic support belts.  The compression they provide decreases the amount of work your muscles and veins have to do for circulation. Most products are made such that you can wear them under loose clothing, and some women find they actually feel good.

• Pelvic floor muscle activation: One of the functions of your pelvic floor muscles (the muscles you typically use to hold pee or stop gas) is to help with circulation. By intentionally activating them through their full range of motion – squeezing and lifting, as well as relaxing them fully – you can encourage circulation in the pelvic area, as well as work on muscular strength and coordination. Most if not all women benefit greatly from guidance for this activation, so an assessment with a pelvic health physio is highly recommended.

Overall, small to moderate changes in your day-to-day routines and habits can make significant differences on your comfort and function. We at The Mama’s Physio hope this information encourages and empowers you, and would love to help you in your pregnancy journey.

By Sophia McLean – PT, DPT

Sources:

Dufour, Sinead. “Pelvic Health Solutions: Pregnancy, Pelvic Girdle Pain, & The Pelvic Floor.” Abbotsford, BC, January 2019.

Gavrilov, Sergey G. “Vulvar Varicosities: Diagnosis, Treatment, and Prevention.” International Journal of Women’s Health 9 (2017): 463–75.

Weatherspoon, Deborah, Jeanne Morrison, and Christopher A. Weatherspoon. “Not So Sexy Legs: The Varicosities of Pregnancy.” International Journal of Childbirth Education 32, no. 1 (2017): 39–42.