Pregnancy can do funny things to your body. Just about everyone has heard of the more common unpleasant side effects, things like: “morning” sickness, fluid retention and swelling, joint pain, and heart burn.
But there is a condition that may be the most painful side effect of pregnancy which is not talked about as often: vaginal and vulval varicose veins. In hindsight, I know that I devloped this condition during the last few weeks of my second pregnancy. I didn’t realize it at the time and never got a mirror to check, but near the end I felt a lot of pressure down low in my groin and was particularly uncomfortable sitting for long periods of time.
With my third pregnancy I began to notice that uncomfortable feeling of too much pressure down low at 25 weeks. That seemed strange, the baby was not big enough to be causing that much pressure. I had trouble sitting for more than 15 minutes at a time and at first I thought it was just hip pain. Changing position seemed to help. The pain quickly became severe enough that I had to check out what in the world was going on down there.
I held a small mirror in position and when I saw my groin I almost dropped the mirror in shock. The entire external private area was swollen to about three times its normal size and grotesquely large veins bulged out over the labia, looking as if they’d been stuffed with walnut halves. I had never heard of anything like this happening with pregnancy. I called two physicians whom I knew (my father and the father of my neighbor) and soon had an explanation:
Vaginal or vulval varicose veins were caused by the expanding uterus interfering with the blood return from the legs. They were more common with “multips” (people who had experienced more than one pregnancy) and might be associated with inactivity or poor muscle tone. (I had experienced 2 months of almost complete inactivity earlier in the pregnancy, courtesy of the swine flu and a bad bought of nausea and fatigue).
Would they cause any problems with delivery? No.
Would they go away after I delivered? Yes. Immediately.
Would they continue to get worse as the uterus grew in size? Most likely.
Could they be this painful? Yes. They were VERY painful.
Was there anything I could do about it? Any treatment? No. I could spend more time lying down.
After this explanation from the physicians and a rather non-helpful visit to my own OBGYN where he confirmed what I already knew and said “wow. That’s a really big one. So is that one over there. Boy, that one’s really large. You’ve got a bad case.”, I began to probe the reservoir of womenly knowledge contained in my friends and acquaintances.
This condition was not as uncommon as I would have thought. I found a dozen or so people who I knew directly or indirectly who had experienced these “varicosities.” Those who had experienced it found it so painful that they crawled on their hands and knees around their house rather that walk. One said she got an epidural when she was in labor just to have relief from the varicose veins; her contractions were nothing compared to them. And with every single women I talked to, the pregnancy where the varicies developed was her last pregnancy.
The good news was that everyone I talked to recovered. Very soon after delivery they said they felt fine and could stand without pain. In the mean time, it seemed that the only thing I could do was to spend more time laying down.
When the pain got to be too much I was able to get complete relief if I positioned myself so that my heart was lower than my pelvis. In the beginning weeks I reverted to this position several times a day:Despite what I had heard, I was hopeful I wouldn’t have to lay down all day every day. We ordered a prenatal cradle with V-brace support and tried it out:It would have helped if the varicose veins had not been quite as severe and if I did not have internal swelling as well (puffy painful area in the lower left quadrant of my abdomen). If I had been 36 weeks instead of 26 weeks pregnant, perhaps I would have worn it all day every day and been able to be upright more. But as my belly grew so did the swelling and accompanying pain. Within a few weeks it was ineffective.
By 30 weeks I gave up and decided I had to be on almost complete bed rest. I had about 5 minutes of “up” time for every 5 hours laying down. If I was up more than that I developed referred pain in my back and abdomen and was in constant pain for at least a day. If I respected my limits then at least I wasn’t in pain while laying down.
Each time I stood up there was a half second pause as the tissue swelled and then the pain hit. It was a strong enough pain that I had to breathe through it to keep from gasping or crying out. That level of pain continued until I returned to a horizontal position.
There was one thing that did help: exercise. I could tell from one day to the next that my pain was more tolerable if I exercised. And when my heart rate was sufficiently elevated I could be moving around without the swelling. It was such a positive thing for me mentally to be upright without that pain. Here’s a picture of my son doing “side crunches” with me: As the weeks went by I had to modify my exercise routines with more and more “downward facing dog” poses or other “hip above heart” positions to relieve the swelling and pain, and then I developed trouble breathing and had to stop exercising completely (different story). Three days after I stopped exercising I noticed the eruption of 6 additional large varicose veins. There is no question in my mind that exercise helps tremendously to prevent this condition and if you develop it then exercise helps to moderate the pain and swelling.
The last 5 weeks of the pregnancy I was pretty miserable. I only got out of bed to go to the bathroom and take a super-fast shower or visit the doctor’s office or my weekly massage appointment with a massage therapist who lived 2 miles away from home.The massages helped and it was a nice thing to look forward to each week.
I was never upright for more than 5 minutes at a time. I crawled to the bathroom rather than walk. I wondered if I had developed some strange psychological hyper-sensitivity to pain. This was incredible. It seemed to me that there was no other physical condition in the modern world where I could be in this much pain. Anything else would entitle me to some powerful pain killers, but being pregnant I was told I could try ibuprofen. It was like blowing in the wind; acetaminophen couldn’t touch this.
I tried my best to appreciate the quiet time being on full bed rest provided. I read lots of books to my two young kids:We put a mattress downstairs and once a day I got up and had a change of scenery. The kids enjoyed more cuddle time and mom attention. I was always available now and never busy doing laundry or cooking dinner. Church members came in shifts and took care of us while Serge was away from home, and my mom came 3 weeks before the baby was born to help full time.When I went into labor my husband Serge joked that labor would be nothing compared to what I’d been through already just being pregnant. That might have been true if I had not also been pregnant while experiencing labor. The varicies were still there, and I could only tolerate being upright for 5 to 10 minutes at a time.Here we are checking into labor and delivery. This was my standard “out in public” pose. For doctor’s visits the last couple months of the pregnancy I would walk where I needed to, and then find a chair and lean forward like this for relief from the pain. Or I would lay on the floor. I didn’t care at all what other people thought about this behavior; it was too painful to stand or sit.
A lot of my labor was spent leaning over the birth ball and laying on my side in bed. Labor this third time was long: 25 hours, with most of it spent stalled at 8 to 9 cm dilation. I didn’t have an epidural, partly because of personal quirky prejudice (thought of a needle in my back creeps me out), partly because I felt it would be better for us medically to be unmedicated (my blood pressure was low during the pregnancy (80/40) and the strange breathing issues I’d had made me a little nervous to introduce any additional risks), and partly because I felt the need for some assurance that I still had a decent pain tolerance. Our baby was born healthy and beautiful and it was such a relief to be holding her in my arms! I was weak and exhausted, but now very hopeful that sometime soon I would be able to stand up without feeling like I’d been smacked in the groin with a baseball bat.
The two days postpartum that I was in the hospital the nurses came every four hours to do vital signs and check out my bottom. This is standard practice to make sure that any stitches are healing well and to also look at bleeding. Every nurse that looked at me gave a little gasp of surprise and exclaimed “Wow. You’re really swollen.”
I checked the view with my handy little mirror and it was the same picture I’d seen the last couple months. Why wasn’t it getting better? Was the interruption of venous flow so severe that I would be permanently handicapped and never able to stand or sit without pain? I could only wait and see.
Three days postpartum: situation unchanged. Very swollen and huge onslaught of pain every time I stood up (which was not often, I only got out of bed to pee a couple of times a day).
Four days postpartum: the varicose veins and swelling are still there. I’m starting to wonder if I’ll ever recover.
Five days postpartum: it’s significantly better. Still painful, but not as bad.
Six days postpartum: The magic moment came. I stood up in the morning to pee, and there was no pain. I could hardly believe it. No swelling, no pain. I was standing, and I was not in pain! It seemed miraculous, and completely amazing.
Since then I’ve been fine and have had no discomfort or problems associated with my groin, but I’ve known some women who have had perpetual troubles after a bad bought of vulval or vaginal varicose veins. The two women I know who had remaining difficulties didn’t go on bed”rest.” They continued to be upright and “toughed it out.” I think it’s better to listen to your body. If the pain is that severe, then lie down. You might be able to get by pretty well by spacing your “up time.” For example: four 5-minute intervals of standing would be much better tolerated than 20 minutes of continuous standing.
Two years ago when I was pregnant the only information I found online were occasional notes on midwifery forums and a few odd references. There was not much to glean from the internet. I did some more searching tonight and found a lot more references, including a few groups that offer treatment by inserting catheters and then injecting foam sclerotherapy to kill the offending veins.
I’m hoping that this post will reach someone who has just learned that they’ve developed this condition. I would have loved to have read this when I was first searching for help and information two years ago. I would have wanted to hear this reassurance:
Yes, it is VERY painful. But you’ll be OK! Hang in there and figure out a way to spend more time in bed. Ask for help from neighbors and family. Ignore what you read about varicose veins in the legs unless you also have varicose veins there.
The pain is all positional: if your heart is above your pelvis then you will be hurting, if it’s even or below then you should feel fine (as long as you respect your body’s limits and lay down often). Exercise will help. I recommend DVDs over walking because it’s easier to modify them with downward dog or stop and rest as needed. If your heart rate is increased and the muscles in your legs are contracting then they push the blood though the veins and keep them from distending as greatly. This is why exercise provides pain relief (to a point). If you have access to a pool swimming is ideal because you are in a supine position but also have the benefit of increased circulation.
Massage also helps, quite a bit. I went for weekly massages the last two months of the pregnancy and asked my massage therapist to work the entire hour on my hips, upper legs, and lower back. When I stood up after the massage it was like I’d been moved back in time a few weeks. The pain was much less! This relief only lasted a couple of hours, but it was still very nice.
A V-brace type of support to provide counter pressure to the groin might help, but if you have internal swelling too then this will not be a solution. Often internal swelling in deeper veins accompanies a bad case of external varicose veins. You will know you have this as well if the pain is severe and pressing your hand (or a special support) against the external veins doesn’t completely relieve the pain. Listen to your body and lie down. You don’t want to have issues for years to come. Bed rest for a couple of months is better than chronic pain following the pregnancy. The chance of perpetual issues is very slight but it can happen.
This condition will not affect your delivery (apart from making upright laboring positions more painful) but you should not have an episiotomy (potential risk of increased bleeding if a varicose vein is cut before the head comes through and deflates it.). If your varicose veins are on the mild side (still can be very painful) you might be pain free while standing the day after delivery. If they are more severe it will take longer. Be patient and rest. It will heal.
And lastly, you’re not alone. More people have experienced this than you would think, but it’s not talked about as openly as heart burn or vomiting, simply because of its location.