VARICOSE VEINS.
Very often in pregnant women the veins in different parts, but particularly of the thighs and legs will swell out in knots, either singly or in bunches, sometimes like strings of beads, or like the links of a chain. These are called Varices, and occasionally they attain a large size, and extend to various other portions of the body, as the external lips, vagina, and mouth of the womb. Some women in fact have them over nearly the whole body. They are caused by the pressure of the womb on the large abdominal veins, preventing the return of the blood and disturbing the balance of circulation between the veins and arteries. In the majority of cases, unless very large, they cause but little inconvenience, and may be let alone, but sometimes they cause pain, or become so full that there is danger of their bursting, and then it is necessary to interfere.
The first thing to be done is to relieve the abdominal veins from the pressure of the womb, and this may be done by the patient keeping more or less the horizontal position, and carefully avoiding all violent exertion. The swelling is always worse during the latter part of the day, particularly if the woman has been much on her feet, she should therefore apply a cloth roller round the limbs before she rises in the morning. If this be carefully put on, just tight enough not to interfere with the motion of the limbs, nor totally obstruct the circulation, it will prevent the varices to a great extent, if not altogether. Brisk friction with the hand will disperse the swelling in many persons, or warm fomentations, but sometimes cold bathing answers better. It is advisable always to disperse them as soon as possible, for if they remain too long that part of the vein becomes permanently weakened by being overstretched, and will be always liable to swell again from any slight cause. It is particularly advisable in these cases to avoid constipation, and also to keep the skin in good action by bathing and frictions.
If at any time one of these varices should burst, it need occasion no alarm, unless it be seated on a large vein, and the bleeding becomes profuse. To stop it, bind on firmly over the rent any firm cold body, as a flat stone, or a large silver coin, passing the bandage several times round. In slight cases a simple cold compress will be sufficient, or a little powdered alum, or some vinegar and water. In short any of the usual remedies for stopping bleeding from wounds. The female must be quite still till it is stopped, and must be careful when she begins to move about again, because it is liable to break out afresh. Those of a very full habit must live low, and avoid all stimulants, so as not to increase the quantity of blood in the body more than is necessary. It is advisable to remove the varices, as much as possible, before labor comes on, particularly if they are situated on the lips, or in the vagina, because they may burst during delivery and cause considerable inconvenience, or even danger. It is rare that these swellings continue after delivery, but if they should do so, the same treatment must be persisted in as before.
HÆMORRHOIDS, OR PILES.
These are troublesome annoyances at any time, but particularly during pregnancy, and unfortunately they are very common at that time. They are, no doubt, chiefly caused in the same way as varicose veins, that is by the enlarged womb preventing the proper flow of the blood in the small veins, and so causing them to swell, and form tumors. They may in fact be called varices, as truly so as those on the limbs. In many persons however they are undoubtedly brought on merely by Constipation, which will undoubtedly either cause them or make them much worse when otherwise produced. In general they become worse as the pregnancy advances, because the womb becomes larger and the bowels are more apt to be confined.
As long as they only cause inconvenience, without any particular distress or urgent symptom, they may be let alone, or be slightly treated in the way of palliation, till after delivery, when they will disappear. Occasionally however, they grow to a large size, so as to hinder the passage of the bowels, and prevent the patient from sitting down or walking. They may then cause inflammation, and bring on falling of the intestine, or abortion, by the straining which they necessitate when the bowels are moved. And even if these extreme results do not follow, there may be serious derangements of the general health, indicated by difficulty of breathing, sleeplessness, headache, and fever. In short there are few of the derangements incident to pregnancy so annoying as this, and unfortunately, from its nature, the sufferer dislikes to speak of it and seek the necessary assistance. Many prefer undergoing the most excruciating agony for months, rather than complain, which shows the necessity for females knowing how to treat themselves, when possible.
The bleeding which sometimes takes place from Piles is more often beneficial than otherwise, unless it becomes excessive, from rupture of a large vessel, in which case, if the wound is external, it may be treated the same as the ruptured varicose vein; if it be internal, the remedies must be injected with a syringe, or a large roll of lint or cotton may be soaked in alum water and passed up the rectum. Frequently bathing the thighs and perineum with cold water will be sufficient.
To relieve the pain and swelling, the female should sit over the steam of hot water, and use the warm bath. If the piles are external, they should be bathed with hot milk and Laudanum, or rubbed with any soothing ointment, particularly the Cucumber Ointment, mentioned in my Diseases of Woman, or with Stramonium Ointment. If they are internal the milk and Laudanum should be injected if possible, or some thin starch and Laudanum, and a stiff roll of cloth may be smeared with the ointment and introduced. In general, ointments or other greasy matters are not so good as the milk or starch. In conjunction with this, the bowels must be kept free, either with enemas or castor oil, or by using a seidlitz powder in the morning. This is indispensable, for if constipation exists, no applications can render much service. The patient must also avoid fatigue, and not remain too long upon her feet, nor sit long, particularly on a hard seat, and if she be of a full habit she must live low, to avoid making too much blood. It is also important, at all times, to avoid using drastic purgatives, such as Aloes, Colocynth, or Gamboge, as they always make piles much worse, or even cause them.