Leg Pain in Pregnancy : Cramps, Varicose Veins, and Thrombophlebitis

Leg cramps are a famous misery of pregnancy.  They range anywhere from a fleeting musclular pulling all the way to hopping around in agony.  There are many factors which may contribute to the increased tendency toward leg cramps in pregnancy, and there is no agreement among doctors as to which factors are the more important causes. Among them are:

• Pressure of the baby's head on the nerves of the pelvis can fire off the leg muscles.
• Alterations in calcium and magnesium, not only because of the altered physiology of pregnancy but also because of alterations in circulation due to swelling and changes in blood volume.
• Increased exertion on muscles due to changes in weight and center of gravity later in pregnancy.  In other words, leg muscles that do just fine when non-pregnant, but prove to be out of shape with the increased physical demands of pregnancy.

Remedies for leg cramps have been dismal failures.  Massaging the cramps is the most immediate remedy, but that can be like chasing your own tail. Taking extra calcium in supplements sounds like a good idea, but that is probably voodoo.  In my practice, these remedies have fallen short of relief.  What I have seen work the best is continued exercise to keep the leg muscles in shape, but this assumes good exercise and toned muscles before pregnancy, too.

As impotent as this information seems in trying to prevent or relieve this common misery, the good news is that the phenomenon is harmless, in spite of the severity.  Now you know everything I know about leg cramps in pregnancy, which is pretty sad.

But here's the most important thing: REPORT ALL LEG PAIN TO YOUR DOCTOR.

Thrombophlebitis

Leg cramps may be harmless, but it is crucial to differentiate this pain from the pain of thrombophlebitis, which is an inflammation of the deep veins of the legs. Thrombophlebitis is an emergency and a very big deal, because deep leg veins so inflamed can develop blood clots that can fling off toward your lungs and endanger your life suddenly.

Now before there is a flood of hysteria about leg cramps possibly being thrombophlebitis, please know that there is a
simple method of distinguishing between the two.  With sporadic leg cramps, the legs should not hurt when there is not a cramp.  Squeezing the calf muscles shouldn't be painful in between these episodes.  On the other hand, squeezing the calf muscles causing pain any time would be be very disturbing.

The treatment for thrombophlebitis involves anticoagulants ("blood thinners"), which are medicines that decrease the blood's ability to clot.  The management of the doses of the anticoagulants can be quite tricky, so it is necessary to hospitalize such patients for a while.

On the one hand we have leg cramps, which are an inconvenience at worst; on the other we have thrombophlebitis, which is extremely dangerous if not diagnosed and treated.  Thankfully, it's easy to tell the difference with a simple squeeze of the calf muscles.  And if there's any doubt, ultrasound can look at the deep leg veins to see if there are any clots.

What about varicose veins?

Varicose veins are not dangerous, and they are NOT thrombophlebitis. Varicose veins are a problem with gravity and the weight of the baby on the drainage of superficial veins back up toward the heart.  Varicose veins are mere engorgements of these structures and have nothing to do with clots in the deep veins of the legs.  Although they can hurt, they don't present as the danger that deep blood clots are.  Because they are a result of partial obstruction of their drainage, wearing those nasty grandma stockings can help keep them compressed.  There are other specialty girdles that are sold that can help all the way up to varicose veins of the vulva, too.