Phlebitis

Phlebitis

Women Are Most at Risk

The late Richard Nixon may have been best known for the Watergate scandal, but during his presidency he also brought global attention to a disease called deep-vein thrombosis, the severe form of phlebitis, which periodically laid him low.

Nixon's form of phlebitis was indeed quite serious. More often, though, phlebitis attacks a relatively small vein close to the skin. This is called superficial phlebitis, and it is much more painful than it is life-threatening. The symptoms usually include inflammation, swelling and tenderness. You can actually feel the clot, a painful, tender lump right under the skin, and the skin surrounding the clot often feels hot and looks pink or red.

Treatment of this most common and benign form of the disease is surprisingly simple. Even if you don't do anything, most superficial vein clots will dissolve within about two to four weeks. In the meantime, your doctor will recommend applying cold packs and prescribe anti-inflammatory drugs to ease discomfort.

Frequently less painful but far more dangerous is the formation of a blood clot in a large vein deep in the muscles, called deep-vein thrombosis. Two things can happen to these clots: They can adhere to the vein wall or break off and go into a lung. In the first scenario, scar tissue may damage vulnerable valves, causing swelling and an accumulation of fluid, known as edema.

But the real threat is the latter possibility. If the clot detaches and travels to a lung, it can cause sudden death from a blockage of the lung, or pulmonary embolism. Such an occurrence is extremely rare, but it's frightening. "With horrors in mind, people often panic" when they receive a diagnosis of phlebitis, says Brian McDonagh, M.D., a phlebologist and founder of the Vein Clinics of America in Schaumburg, Illinois.

Their fears are almost always groundless, he says. In most cases when superficial veins are involved, there's no need to worry about dire consequences, he explains. But if you have any doubts, or if a fever accompanies a bout with phlebitis, see a doctor immediately. A physical examination can determine just what veins are affected. New diagnostic techniques, such as ultrasound scanning to detect blood flow patterns, can precisely and painlessly locate a clot and help doctors determine treatment.

The Female Phlebitis Factor

Although Nixon may have been the most famous person to have phlebitis, he was not really typical. The vast majority of people who experience this painful circulatory problem are women--up to 80 or 90 percent, according to Dr. McDonagh.

Doctors don't understand exactly how or why women get phlebitis so much more often than men do, but studies suggest that female hormones make the difference. Pregnant women face a particularly high risk for phlebitis--about 1 in 100 newly delivered moms develops it--because pregnancy releases "a tide of hormones that may affect the walls of the veins," says Eugene Strandness, M.D., professor of surgery at the University of Washington School of Medicine in Seattle.

Pregnancy is also the time when many women first notice varicose veins, and people with varicose veins, whether they're pregnant or not, are far and away the most likely to get phlebitis. Dr. McDonagh estimates that 80 percent of the phlebitis patients he sees are women who started out with varicose veins.

Varicose veins are most vulnerable to the kind of minor trauma that can cause a blood clot to form, according to Dr. McDonagh. "Even a slap on the knee or bumping into a coffee table can cause a clot in a superficial vein," he says.

While anybody with varicose veins is at increased risk for phlebitis, the risk rises gradually with age. Older people who are physically inactive for long periods of time are prime candidates. And prolonged bed rest slows down circulation, causing blood to pool in the veins. "One of the most common situations in which phlebitis develops is during hospitalization, particularly after major surgery," says Dr. Strandness.

Effects of the Pill

Until recently, researchers believed that women who took birth control pills were four to six times more likely to get phlebitis. But these figures are now being re-evaluated, since the oral contraceptives currently in use contain much less estrogen than the pills women took only a decade ago.

What about menopausal women on hormone replacement therapy (HRT)? "In most cases, the advantages far outweigh the disadvantages," says Dr. Strandness. There's no conclusive evidence that HRT significantly increases the dangers of developing phlebitis, he says, and the body of evidence that HRT reduces postmenopausal women's risks for heart disease and osteoporosis is growing.

The best advice is to consult your own physician if you have a problem or believe you're at risk because of your medical history or that of your family.

What You Can Do

Phlebitis doesn't have to happen. Here's how to prevent it.

Stay on your toes. People who have varicose veins can help prevent blood clots from forming by keeping active. A regular exercise program--a brisk 20-minute walk three or four times a week, for instance--does nicely, says Dr. McDonagh.

Relax with your legs up. Rest your legs on the couch or on a footstool while you read or watch TV. You deserve the extra comfort, and keeping your legs elevated relieves pressure on your veins.

Support yourself. Compression stockings, available over the counter or by doctor's prescription, give varicose veins the extra support they need and keep blood flowing through your legs smoothly and steadily.