Compression stockings
Support stockings
Ordinary 'support stockings (or tights)' can be bought in chemists and many other shops. They give some degree of support all the way up the leg and a lot of people find that they help to reduce the discomfort caused by varicose veins. Graduated compression stockings. These stockings are specially made to give more compression on the lower part of the leg than higher up - the compressions 'graduated', increasing from the ankle upwards. They provide more effective compression than ordinary support stockings and tights, and are the kind that doctors prescribe (although they can be bought at chemists and surgical appliance shops). Graduated compression stockings are made in different strengths and different lengths.
There are three strengths of compression.
• Class 1 : The least amount of compression - sufficient to relieve the symptoms of varicose veins in many people.
• Class 2: Stronger. Very good support for symptoms from varicose veins, and also sufficient strength for helping to prevent progression of skin changes and recurrence of ulcers.
• Class 3: The strongest. Advised for people with skin changes, a tendency to ulcers, or leg swelling that has not been adequately controlled by Class 2 stockings.
The two lengths of graduated compression stockings are below-knee and above- knee stockings.
• Below knee stockings: Like long socks. Usually quite sufficient for people with skin trouble, ankle swelling and symptoms below the knee only. This includes most people with varicose veins. Generally more comfortable than above knee stockings.
• Above-knee stockings: Need to be held up by suspenders or a special belt. Very seldom necessary, but still often advised and prescribed by doctors. Most people find them less comfortable and less acceptable than below-knee stockings, and I only ever advise them for people who really do have symptoms above the knees.
There are a lot of different makes of graduated compression stockings, only some of which are available on prescription. Stockings are available with open toes or closed toes (like normal socks). They are normally supplied in a brownish 'skin' colour, but some types are made in black and other colours.
These stockings come in a variety of sizes, and the circumference of the leg needs to be measured at a number of levels to select the right one. It is important to get stockings that are really comfortable if they are to be worn day after day. For a few people whose legs are an unusual size or shape, custom-made stockings may be necessary: these can be ordered as required.
After several weeks of daily wear and regular washing, graduated compression stockings need to be replaced, because they lose their stretch, and become less effective. New stockings are usually necessary every three to four months.
FOUR-LAYERBANDAGING
Various types of compression bandage have been used in the treatment of venous problems. Over the last few years a special 'four-layer bandage' system has been convincingly shown to get most venous ulcers healed. Four-layer bandaging is done by nurses who have been specially trained - usually in clinics devoted to the treatment of venous ulcers. It is particularly important for patients to have their leg arteries checked before putting on a four-layer bandage. If the blood flow is restricted by blocked arteries, then the pressure of a four-layer bandage can occasionally damage the skin.
OTHER HELPFUL THINGS TO DO
Intermittent Compression
Being overweight makes the symptoms of varicose veins worse. The box shows approximate ideal body weight, depending on height. Getting down to an ideal body weight is likely to help with any symptoms of varicose veins. Surgeons are particularly keen for obese patients to lose weight if they want an operation for varicose veins. Operating on obese people is rather more difficult; the risk of problems such as wound infection and deep vein thrombosis is increased, and the chance of recurrent varicose veins and further symptoms may be higher. Having said this, surgery can usually be done relatively safely even on very obese people if there is serious need (for example, ulcers that are failing to heal). Change occupation People who work standing up all the time may find that changing to different work relieves their symptoms. Of course this may not be an easy or practical thing to do.