Counseling Sheet

Agatha M. Thrash, M.D.

Preventive Medicine

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Varicose veins are caused by thinning of the walls of the veins due to an increase in the pressure on the blood inside the veins. They may have a poor cosmetic appearance. They may cause pain, especially at the time of the menstrual period or on long standing. They occasionally become injured or inflamed, producing phlebitis and thrombosis.

‍Treatment

• Relieve pressure on the blood to the lower extremities by reducing intraabdominal pressure and by reducing the amount of time spent standing.
• Reduce intraabdominal pressure by reducing gas. Intestinal gas is caused by too much food, too many concentrated foods, too much fat, poor chewing, nervousness at mealtimes, using too many varieties of food, drinking liquids at the mealtimes, rapid eating, and swallowing air.

• Avoid constipation. Straining to pass a bowel movement will markedly elevate intraabdominal pressure, causing or aggravating varicose veins, hemorrhoids, and colon diverticula. See counseling sheet on "Constipation."
• Avoid overeating or overdrinking.
• Avoid overweight in the abdomen.
• Do not allow any bands or belts across the abdomen that are tight enough to leave even a faint mark.
• Use the following techniques for sitting in a chair:
• Do not allow the chair seat to press against the back of the thighs, as this increases the pressure of the blood in the veins.
• Do not cross legs.
• Keep one or both feet propped up to relieve tension and fatigue of the back (a substitute for crossing the legs).
• Reduce the size of the legs, if there is any excess fat. Fat is not firm tissue and does not give the support for veins that muscle, skin, and fibrous tissue give. Also, there is invariably fatty infiltration of muscle, skin, and fibrous tissue. The fat weakens the tissues, causing them to become less firm.

Clothing

• Keep the extremities warm at all times to keep the tissues healthy.
• Have good circulation, which makes all tissues, including the tissues of the vein walls, healthy.
• Do not wear constricting bands around the legs.
• Deep breathing encourages the return of the blood from the lower extremities. With deep inspiration, there is a strong negative pressure developed in the chest, which pulls blood into the chest, allowing decongestion of the veins of the legs.

Exercise

• Walk enough or work at outdoor labor sufficiently each day to keep the leg muscles firm and the circulation good in the legs.
• Work up a sweat each day, as sweating removes toxins that may weaken the tissues.
• Exercise encourages deep breathing, which causes a decongestion of the legs.
• Edema. Swelling of the legs is caused by an accumulation of fluid in the tissues. To reduce the swelling, it is necessary to reduce the pressure, which may be either hydrostatic or osmotic in type. Hydrostatic pressure is relieved by elevating the feet. Osmotic pressure is relieved by drinking water to promote a diuresis, reducing one's salt intake, and maintaining a proper protein level in the blood.
• Treatment of painful varicose veins may be done by wrapping with ace bandages, use of elastic stockings, hot and cold leg baths, and by elevation of the feet.
• Occasionally, varicose ulcers develop. The unna boot is the best treatment for the chronic varicose ulcer. Rarely surgery is necessary for such late and chronic complications.