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Compression stockings

Compression stockings help to maintain the flow of blood in your leg veins and reduce leg swelling. They are used to treat leg ulcers and varicose veins, and to help reduce the risk of blood clots forming in the veins of your legs (deep vein thrombosis, DVT).

Compression stockings (also called graduated compression stockings) can be used to prevent as well as treat a number of conditions that affect the circulation of blood in your legs.

  • DVT. This is a blood clot in a deep vein, usually in your leg. If the blood clot breaks loose, it can travel to your lungs and block a blood vessel there (this is known as a pulmonary embolism).
  • Varicose veins. These are swollen veins that lie under your skin (superficial veins) that look lumpy and dark blue or purple through your skin. They usually affect your legs, particularly your calf and sometimes your thigh, and are caused by damaged valves in your veins.
  • Venous leg ulcers. These are areas of broken skin usually near your ankle. They are often caused by problems with the valves in your leg veins.
  • Fluid build-up in your legs (oedema). This can be a result of problems with the veins in your legs, but can also occur during pregnancy or as a result of other medical conditions such as heart failure.

Compression stockings are available in several sizes, lengths and colours. They are also available with different strengths of compression from class I to III. Class I stockings apply the least amount of pressure and class III stockings apply a much higher pressure. Compression stockings may cover your whole foot or they may be open at the toes. Your GP will be able to advise you which type is appropriate for you.

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  • How do compression stockings work? How do compression stockings work?

    Compression stockings work by putting pressure on the veins in your leg to increase the speed at which blood moves through them. They are called graduated compression stockings because the pressure is greatest at your ankle and reduces further up your leg. When you walk or exercise your legs, compression stockings help the natural pump mechanism of the muscles in your legs. This improves the flow of blood back towards your heart.

  • Wearing compression stockings Wearing compression stockings

    For compression stockings to be effective, you need to wear them constantly during the day. Usually, you will be advised to take them off before you go to bed. If you can, wash your legs every day and check the condition of your skin. It’s a good idea to use a gentle moisturiser on the skin of your legs when you’re not wearing your stockings as it may become dry. Your GP can recommend creams that are suitable.

    When checking your legs you need to look out for:

    • sore marks on your skin at the top of your stockings or pinching of your skin
    • broken skin
    • your skin becoming purple in colour
    • numbness or tingling

    If you spot any of these signs or if you're worried, don't put your stockings back on and talk to your GP as soon as possible.

    Wearing compression stockings for surgery

    Hospitals often do a preoperative risk assessment for DVT, which takes into account your health and the type of treatment or surgery you're having. Your surgeon will recommend appropriate preventative measures for you.

    Your surgeon may ask you to wear low-pressure compression stockings (also called anti-embolism or thrombo-embolus deterrent – TED – stockings) before your surgery and to keep wearing them during your hospital stay. You may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing stockings.

    Your nurse will measure your legs and recommend the correct compression stockings for you. He or she will record your stocking size and length but may need to measure your legs again after surgery if this has caused them to swell.

    Your nurse will show you how to put the stockings on and may also give you advice about washing and taking care of your stockings once you're back at home. You may need to wear your stockings for several weeks or months afterwards depending on your health and the type of surgery you had.

    Wearing compression stockings for travelling

    If you need to make a long journey, you may be at a slightly increased risk of DVT, especially if you have other risk factors. It’s recommended that you wear knee-high compression stockings that have been properly fitted for you if you're travelling for more than three hours and you have:

    • cancer or are having cancer treatment
    • had a previous travel-related DVT
    • had a previous unprovoked DVT
    • recently had major surgery (within the last four weeks)

    Speak to your GP about whether or not you need to wear compression stockings if you’re going to be travelling for more than three hours and you:

    • have a blood condition called thrombophilia
    • have had DVT in the past, or a close family member has
    • recently had a baby
    • have a major condition that affects your heart or lungs, for example, you have recently had a heart attack
    • are taking the contraceptive pill
    • are taking hormone replacement therapy (HRT)
    • have varicose veins
    • are obese (your BMI is 30 or greater)
    • have a blood condition called polycythaemia
  • How to put on compression stockings? How to put on compression stockings?

    There are various lengths of compression stockings that fit your leg differently.

    • Knee-length stockings – these should sit below your knee.
    • Thigh-length stockings – the top of the stocking rests below your buttocks.

    The type of compression stockings that you’re advised to wear will depend on your condition, but most people have knee-length ones. You may need to wear thigh-length compression stockings if you have severe varicose veins or you have swelling that stretches above your knee. However, there is some evidence to suggest that these are no more effective than knee-length stockings in preventing DVT. They are also more uncomfortable and more difficult to put on.

    Compression stockings are tighter at the foot than higher up the leg. They can be difficult to put on and take off so you may need someone to help you with this.

    • Insert your hand into the stocking as far as the heel pocket and turn the stocking inside out.
    • Carefully slip your foot into the foot portion and ease the stocking over your heel – make sure your heel is centred in the heel pocket.
    • Bring the rest of the stocking over your heel and up over your ankle and calf. Don't pull the stocking but instead use the palms of your hands to gently massage it up your leg.
    • Smooth out any creases and check that the top of the stocking is neither too tight nor too loose.
    • Never roll down your stockings while wearing them. This can affect how well they work and may restrict blood flow through your legs.
    • Don’t use oils or creams on your skin before you put on your stockings as this can damage the elastic in them.

    If you’re still having trouble putting on your compression stockings, ask your GP about application aids, which can make this easier.

    To help improve blood flow in your legs, don't sit or stand still or lie in bed for long periods. Take regular walks around the house and do gentle foot and ankle exercises when sitting down.

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  • Caring for your compression stockings Caring for your compression stockings

    You may need to wear your stockings for several weeks or months so it's important that you take care of them and wash them regularly. Make sure you have a spare set to wear while the others are being washed.

    Always ask your GP or nurse for advice and follow the manufacturer's instructions that come with your compression stockings. Typical care instructions are described here.

    • Machine or hand-wash your stockings every two to three days. Check the manufacturer’s guidelines for the maximum temperature of water you can use.
    • Don’t wring out your stockings as this may damage them.
    • Leave them to dry naturally as the heat from a tumble dryer may damage the elastic.
  • FAQs FAQs

    How can I reduce my risk of deep vein thrombosis (DVT) when flying?

    Answer

    If you're at risk of developing DVT, a flight of more than three hours can increase this further. You can help prevent DVT by doing exercises and, if necessary, wearing compression stockings while you fly.

    Explanation

    There is some evidence to suggest that if you're already at risk of developing DVT – for example, if you’re having treatment for cancer or recently had surgery – a flight of more than three hours can add to this risk.

    There are steps you can take to help prevent a blood clot from forming when you're travelling.

    • Wear compression stockings if you're travelling for three hours or more and you're at an increased risk of DVT. These help to prevent DVT and the build-up of fluid in your legs (oedema). Speak to your GP for advice about whether you need to wear compression stockings.
    • Walk around the cabin – if this isn't possible, flex and stretch your ankles regularly to contract your calf muscles.
    • Drink enough water to stop you becoming dehydrated.
    • Don't drink too much alcohol.
    • Don't take sleeping tablets – if you’re asleep, you won’t be able to move around.
    • If you have had DVT in the past or recently had surgery, speak to your GP before you travel. He or she may recommend that you have an injection of heparin before the flight to help prevent DVT.

    I have varicose veins – will compression stockings stop them from getting worse?

    Answer

    It’s not known if compression stockings can stop your varicose veins from getting worse but they will help to control your symptoms. It’s important that you also take other measures to prevent your varicose veins from worsening, such as losing excess weight.

    Explanation

    It’s likely that if you have varicose veins, you won’t have any symptoms other than a swollen vein on your leg. However, sometimes varicose veins can cause other problems such as those listed here.

    • You may develop a condition called thrombophlebitis in which superficial veins (veins near the skin) can become painful and red because of inflammation or a blockage in your veins.
    • Your varicose veins can bleed if you cut or bump them. If this happens, raise your leg above the level of your heart and apply pressure to the area to help stop the bleeding.
    • The skin near your varicose veins can be damaged over time. This may lead to brown or purple discolouration of the skin that often becomes permanent.
    • You may also develop varicose eczema – this is red, scaly skin that may become ulcerated.
    • You can get venous ulcers if you have varicose veins in your leg

    If you have any of these symptoms, see your GP.

    If you have varicose veins and don't have any other symptoms, there are a number of things you can do to help prevent them from getting worse.

    • Wearing compression stockings will improve the blood flow in your legs.
    • Don't stand still for long periods of time. Walk around regularly as this works the muscles in your calves, which act as a pump to improve the blood flow in your legs.
    • If you're overweight, try to lose any excess weight.

    I have had leg ulcers before – can compression stockings help prevent them coming back?

    Answer

    Yes, wearing compression stockings can help to prevent the reoccurrence of leg ulcers. If your leg ulcers are caused by varicose veins, you may be able to have surgery to treat your varicose veins.

    Explanation

    Leg ulcers are painful areas of broken skin, usually on your lower leg (below your knee), which often take a long time to heal. They are usually caused by a problem in your veins. This type affects between one and three in every 1,000 adults in the UK. They are more common as you get older.

    Most leg ulcers are caused by problems with the valves in your leg veins. These are called venous leg ulcers. You're more likely to get venous leg ulcers if you're overweight, you can't move around easily or you injure your leg. If you have diabetes, you may also be more at risk of venous ulcers.

    If you have had venous leg ulcers caused by vein problems, your GP may refer you for surgery on your veins. This may reduce your risk of further leg ulcers in future.

    Up to seven out of 10 people who have a venous leg ulcer will get another one within a year. You can help to reduce your risk of this by:

    • wearing compression stockings
    • losing excess weight
    • stopping smoking
    • exercising – try to walk around for at least an hour a day, or if this is difficult, bend and straighten your ankles regularly to keep your calf muscles moving
    • keeping your legs raised when resting
    • using a moisturiser on the skin on your legs
  • Resources Resources

    Further information

    Sources

    • Compression stockings. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published October 2008
    • Dilks A, Green J. The use and benefits of compression stocking aids. Nurs Times 2005; 101(21):32. www.nursingtimes.net
    • Chronic venous insufficiency and postphlebitic syndrome. The Merck Manuals. www.merckmanuals.com, published November 2012
    • Walker L, Lamont S. Use and application of graduated elastic compression stockings. Nurs Stand 2007; 21(42):41–45. www.nursingstandard.rcnpublishing.co.uk
    • Compression stockings. HeartHealthyWomen.org. www.hearthealthywomen.org, accessed 27 February 2013
    • Deep vein thrombosis – prevention for travellers. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published May 2009
    • Watson HG, Baglin TP. Guidelines on travel-related venous thrombosis. Br J Haematol 2011; 152(1):31–34. doi:10.1111/j.1365-2141.2010.08408.x
    • Agu O, Hamilton G, Baker D. Graduated compression stockings in the prevention of venous thromboembolism. Br J Surg 1999; 86(8):992–1004. doi: 10.1046/j.1365-2168.1999.01195.x
    • Varicose veins. BMJ Best Practice. www.bestpractice.bmj.com, published November 2012
    • Varicose veins. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published October 2008
    • Veins. The Circulation Foundation. www.circulationfoundation.org.uk, accessed 28 February 2013
    • Leg ulcers. The Circulation Foundation. www.circulationfoundation.org.uk, accessed 28 February 2013
    • Chronic venous insufficiency. BMJ Best Practice. www.bestpractice.bmj.com, published December 2012
    • Leg ulcer – venous. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published February 2008
    • Venous leg ulcers. The British Association of Dermatology. www.bad.org.uk, published May 2010
    • Leg ulcers. DermNet NZ. www.dermnetnz.org, published December 2012
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  • Author information Author information

    Produced by Polly Kerr, Bupa Health Information Team, April 2013.

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