Why varicose veins appear and worsen in pregnancy
Varicose veins appear for the first time in 30–40% of women during pregnancy, and worsen in those who already had them. This is not “bad luck” or “laziness” – there are three physiological reasons.
Progesterone relaxes vein walls. The hormone of pregnancy, which prepares the uterus for carrying a baby, also relaxes smooth muscle throughout the body – including in vein walls. Venous return slows, blood pools in the legs.
The growing uterus presses on the pelvic veins. Especially in the second and third trimester. The return flow of blood from the legs meets an obstacle – the uterus – and part of it pools below.
Blood volume rises by 30–40%. The body produces more blood for the placenta and the foetus. Veins have to handle a bigger volume with weakened walls.
Add daily factors: sedentary work, long standing, weight gain, and for some women genetic predisposition to weak vein walls. The result: evening heaviness in the legs, oedema, spider veins, dilated veins on the calves or thighs, sometimes pain and cramps.
The good news: movement is one of the main remedies against varicose veins in pregnancy. Not rest, but the right activity. Let me go through what works and what does not.
What helps: exercises and habits
Calf muscle pump work
When the calf muscles contract, they squeeze venous blood upward. This is a natural “pump”, and it needs to be switched on regularly – especially with sedentary or standing work.
- Walking 30–40 minutes a day at a moderate pace. Better with breaks of 5–10 minutes through the day than one long session.
- Foot flexion and extension while lying down – feet on a wall or pillow, toes pulled towards you – away, 20–30 reps. Can be done during work breaks.
- Walking on tiptoes 1–2 minutes a day – a simple but effective exercise for the calf muscles.
- “Bicycle” in the air lying down – soft smooth circles, not fast. 1–2 minutes.
Exercises with legs elevated
When the legs are above heart level, venous return is helped by gravity. This is a fast measure worth doing daily.
- Lying with legs against the wall – 5–10 minutes morning and/or evening. You can place a pillow under the pelvis for a greater angle.
- “Light shoulder stand” – lying on the back, legs up at 90°, can be supported with feet on the wall. 1–2 minutes. After 16 weeks do not hold longer than 1–2 minutes (inferior vena cava).
- Side-lying savasana with a pillow under the upper leg – a relaxed pose with support.
Safe strength work
Strength training with varicose veins in pregnancy is fine, but with rules:
- Breathing on effort – exhale on the hardest part of the movement. No breath-holding (Valsalva).
- Walk between sets, do not sit. 30–60 seconds of easy walking between sets – keeps venous return active.
- Many reps with light weight beats few reps with heavy weight.
- No more than 20–30 seconds of static standing positions. If warrior or plank – alternate with movement.
Swimming
One of the ideal loads for varicose veins in pregnancy. Horizontal position, hydrostatic pressure of water improves venous return, no impact load. Breaststroke or backstroke are the most suitable styles. Front crawl is fine if your technique is comfortable. Butterfly is not.
More – in the post “Swimming during pregnancy”.
What we do not do with varicose veins in pregnancy
Prolonged static standing. Long warrior pose without movement, long planks, holding weights standing for more than 30 seconds – all of these work against venous return.
Jumping and impact cardio. Running on asphalt, jumping exercises, aerobics with jumps. Relaxin has already softened ligaments, and impact load raises venous pressure.
Strength work with Valsalva. Breath-holding under load (typical powerlifting technique) sharply raises intra-abdominal and venous pressure. For a pregnant woman with varicose veins – categorically no.
Deep squats with extra weight. A deep squat already creates high venous pressure. With a barbell or dumbbells on the shoulders – the risk is higher.
Long sitting with crossed legs. Compresses superficial veins and worsens pooling. With sedentary work – legs parallel, feet on the floor or footrest.
Very hot showers, banya, sauna. Heat dilates veins, which makes already dilated ones worse.
Compression garments
With pronounced varicose veins in pregnancy – class 1–2 compression socks or stockings. They are prescribed by a phlebologist, not “I’ll buy something for myself based on a description online”.
When to wear:
- During training, if varicose veins are clinically pronounced.
- Long standing loads (a full day in a shop, on your feet with children).
- Long flights and journeys.
- In the third trimester – often recommended regularly.
When to remove:
- At night.
- At rest lying down with legs elevated.
- In the pool (use special compression garments if needed).
When varicose veins are urgent
Most cases of varicose veins in pregnancy are unpleasant but not acute. There are symptoms, though, that call for urgent medical attention:
- Sudden sharp swelling of one leg (especially with redness and pain).
- Calf pain when flexing the foot upward (Homans’ sign).
- A firm cord along the vein with pain and redness.
- Fever and general malaise alongside leg pain.
These may be signs of deep vein thrombosis – a rare but serious pregnancy complication. Do not “wait it out” – go urgently to a phlebologist or an emergency department.
What to do after birth
After birth the hormonal balance evens out, pressure from the uterus disappears, and vein state improves in 60–70% of women within 3–6 months. A full return to the pre-pregnancy state often does not happen – dilated veins remain, but symptoms pass.
If varicose veins still bother you significantly a year after birth – see a phlebologist. Possible options: sclerotherapy, laser correction, in rare cases surgery. This is no longer a trainer’s area but a phlebologist’s.
In the first months after birth: continue moderate activity, compression garments (if recommended), do not jump back into impact cardio. Veins gradually strengthen.
If you want to go through your situation in detail
Varicose veins in pregnancy can be trained for and managed, but the programme is individual. Everything matters: which trimester, how pronounced the varicose veins are, how previous pregnancies went (if it is not the first), what your lifestyle is (sedentary or active), whether there is concurrent oedema or symphysis pain.
At the first session I go through your specific situation, build a programme that combines work against varicose veins with the general pregnancy programme, plus recommendations on daily activity (how to sit, how often to change position, what to wear). Online or in the studio in Samara. If a phlebologist is already involved – we work alongside their recommendations.
More on fitness during pregnancy by trimester – in “Fitness during pregnancy by trimester”. On oedema – in “Oedema during pregnancy”.
