As my POTS progresses, I’ve been trialling various interventions to reduce the effect it has on my quality of life, and sharing my findings with you along the way. You can read about my attempts to increase fluid and salt in my electrolyte drink mega-review. This time I’m looking at compression stockings, one of the most commonly recommended lifestyle interventions for dysautonomia.
Which do I wear?
Typically, POTS patients are advised to use medical grade compression stockings (not anti-embolism stockings)* of 30-40mmHg which reach waist heigh. This is an ideal level of compression, but many patients have to make compromises for wearability.
For instance, 30-40mmHg stockings may be too difficult to don (or walk in!) for weak or hypermobile patients, who may find 20-30mmHg easier to manage. Thigh and knee highs suit those who can’t tolerate abdominal compression, and can be teamed with shapewear for lighter belly/thigh support.
There really is a world of choice out there and ultimately it’s about what is comfortable for you and best reduces symptoms. But the general rule of thumb is, the higher compression you can tolerate and the more body area covered, the better.
Medical disclaimer: always check with your GP before wearing compression stockings, as there are medical conditions which can make wearing them extremely dangerous (as can wrinkles/bunches in the fabric and improperly fitted hose). And if you find stockings leave deep blue indents, make your legs/toes numb/dark or cause ulcers, FOR GOD’S SAKE TAKE THEM OFF & GO TO ED.
But they’re so ugly!
It’s easy to associate compression garments with the elderly and bedbound, and I must admit that support stockings aren’t exactly the height of fashion.
Luckily, compression garments are becoming more mainstream with the advent of compression activewear such as 2XU’s and Skins reaching the casual wear market. There are also companies making more fashion-forward compression garments and doing their best to introduce disability wear to the mainstream fashion world, which are too often separated. Fellow Antipodeans may have to order from the US to access fashionable choices, as the local market is sorely limited.
Michelle has written at length about compression garments and disability fashion if you’d like to read more.
So what do you wear?
Here’s what I tried:
Sports compression tights
These did not work for me AT ALL. Some find sports compression garments the perfect compromise between fashion and function, but the 2XU Mid-Rise Compression Tights (17-20mmHg) were helpless to stop the blood pooling in my feet, which quickly turned into puffy purple blobs after I donned them.
Footless tights/leggings can be a bit of gamble for those with poor venous return, as without compression over the ankle and foot, the blood can’t make it back up into the compressed leg section. I guess my dreams of being (or looking like) an athlete are over.
Thigh high stockings
Thigh high stockings are a popular choice in the dysautonomia community, as they compress most of the leg without the downsides of full pantyhose (tummy discomfort, yeast infections, feeling like you are using the Thigh Blaster every time you go to the loo!). Most thigh high stockings start at $150AUD, so you can imagine my delight (and suspicion!) to find an Australian company making inexpensive compression garments.
My fears were unfounded, and the Jinni MD Thigh High Medical Compression Stockings (20-30mmHg)** quickly became my workhorse stocking. They stay up well with their silicone-dotted band, and although the colours are basic, it doesn’t matter when worn under pants. I also lashed out and bought the Rolls Royce of compression stockings: Juzo Soft Thigh Highs (20-30mmHg).
Juzos are known for their dazzling array of colours, which alter on a seasonal basis. They are so lovely and soft, I can see why they are popular. And if you buy carefully, their price is comparable to (if not better than) some of the less-flash brands.
Now for the downsides: it is not uncommon to experience contact dermatitis from the silicone band, especially in warmer weather. Garter belts or stockings with a waist attachment are an alternative if this becomes a problem.
Thigh highs also have the tendency to create a charming “butt verandah” (thanks Michelle for the phrase!) where the tightly compressed stockings end. For some, it’s a fair trade off for avoiding the discomfort waist-high pantyhose cause.
Full pantyhose (waist high)
Waist high pantyhose have all the benefits of full compression, but can be extremely uncomfortable and leave you feeling like a sausage in a casing. Due to the gradient compression, my Jinni MD Waist High Pantyhose (20-30mmHg) are less constrictive at the waist than at the ankle, but some days I’ve just too damn weak to wrestle with them.
Enter: maternity pantyhose. (No, really!) A popular alternative for those who find regular waist-high hose too uncomfortable, maternity pantyhose have compression through the legs but are much more comfortable around the waist thanks to an added belly panel and adjustable elastic waistband. (I bought Jinni MD Maternity Compression Stockings / Pantyhose (20-30mmHg) and removed the elastic waist for greater comfort.)
My other concern with waist high hose is that on taller folks, they aren’t actually that “waist high”! So I’ve ordered some tall pantyhose (Therafirm Ease) to address this problem.
Shit, they’re expensive!
Yup! And they need to be washed daily to prevent fibre breakdown, and they don’t last – you get about six months of daily wear from one garment. Being sick sucks in a multitude of ways, and the cost of existing is one of them.
If you have lymphoedema, you may be eligible for a full or partial rebate through your state’s compression garment scheme. Shopping online (provided you know what you’re looking for) is another way to keep costs down, but beware of cheap imitation or non-medical grade compression garments which could come with dangerous health risks.
But do they work?
On me? Yes! They make a great difference in my quality of life*** (that is, the difference between getting up and making a start on my day vs lying flat on my back after a shower). I’m still experimenting with different styles and brands, and will update with further posts as I go.
Abed, H., Ball, P. A., & Wang, L.-X. (2012). Diagnosis and management of postural orthostatic tachycardia syndrome: A brief review. Journal of Geriatric Cardiology : JGC, 9(1), 61–67.
Dysautonomia International. 2016. The Skinny On Compression Stockings. Available at: http://www.dysautonomiainternational.org/blog/wordpress/the-skinny-on-compression-stockings/. [Accessed 27 October 2017].
Figueroa, J. J., Basford, J. R., & Low, P. A. (2010). Preventing and treating orthostatic hypotension: As easy as A, B, C. Cleveland Clinic Journal of Medicine, 77(5), 298–306.
Grubb, B. (2008). Postural Tachycardia Syndrome. Circulation, 117(21), 2814-2817.
Raj, S. R. (2006). The Postural Tachycardia Syndrome (POTS): Pathophysiology, Diagnosis & Management. Indian Pacing and Electrophysiology Journal, 6(2), 84–99.
Smit, A.A.J., Wieling, W., Fujimura, J. et al. (2004). Use of lower abdominal compression to combat orthostatic hypotension in patients with autonomic dysfunction. Clinical Autonomic Research, 14(3), 167-175.
“UnPayWall” extension for Chrome is a handy tool for accessing free journal articles.
*Anti-embolism stockings (as opposed to compression hose) aren’t suitable for ambulatory patients. This is due to the lower compression which works fine when a patient is bedbound, but isn’t enough to fight the force of gravity in upright patients. TED hose also have a much shorter lifespan than compression hose (about 3 weeks). And knee-length socks (which seem to be the more commonly used TED hose) don’t often help those with dysautonomia due to the relatively low venous capacity of the calves and the risk of edema above the knee.
**I’ve heard bad stories about WallCann’s customer service from others, in regards to refusing to refund faulty merchandise. Proceed with caution!
***And bank balance.