Compression Garments

19th April 2023 | Dr Boon Lim

Introduction

Compression garments have gained recognition as an effective non-pharmacological intervention for managing symptoms associated with vasovagal syncope and orthostatic intolerance. These garments apply pressure to specific areas of the body, improving blood flow, reducing pooling of blood in the lower extremities, and enhancing cardiovascular stability. 

Importantly, compression stockings should only be worn in the daytime, ideally after waking up, and can be taken off in the evening before bed. Do not wear them whilst sleeping in bed.

This article and video focuses on the benefits of grade II graded compression garments and abdominal binders in alleviating symptoms and provides guidance on where to source them.

 

Grade II Graded Compression Garments

Sourcing Compression Garments

Grade II (RALS standard) or Grade III (British Standard) compression garments provide moderate pressure, typically ranging from 23 to 32mm Hg, and are commonly recommended for individuals with vasovagal syncope and orthostatic intolerance. These compressions garments should ideally be waist high – ie fully height leggings from the toes/angles to the waist.  There are different standards for compression generally,  most commonly RALS (European Standard), British Standard or AFNOR (Association Francaise de Normalisatio). But do not be too concerned or confused. If in doubt, look at the actual mm Hg compression – something between 23-32mm Hg should be fine, whatever the classification is.  

Consider the following key points:

– Improved Blood Flow: Compression garments facilitate venous return by applying pressure to the lower extremities, promoting better blood flow towards the heart and reducing blood pooling in the legs.

– Enhanced Blood Pressure Regulation: By reducing venous pooling and enhancing blood flow, compression garments can help stabilize blood pressure, minimizing the risk of orthostatic hypotension and associated symptoms.

– Increased Circulation: Compression garments support the movement of lymphatic fluid, reducing swelling and aiding in overall circulation.

When seeking grade II (23-32mm Hg) graded compression garments, consider the following options:

– Medical Supply Stores: Local medical supply stores often carry a range of compression garments, including stockings, socks, and sleeves. They can provide guidance on sizing and fitting based on individual needs.

– Online Retailers: Several online retailers specialize in compression garments, offering a wide variety of styles, sizes, and brands. Ensure reputable sources and consult size charts to ensure a proper fit. Some online retailers who make medical compression incude: Gardamed, Sigvaris, Medi-UK, daylong, but there are several other brands on-line which have not been listed.  

– Healthcare Professionals: Healthcare professionals, such as physicians or physiotherapists, may provide recommendations for specific compression garments and direct individuals to trusted sources.

One of our recommended compression garment manufacturers is Sigvaris: click to download a sizing information leaflet and an ordering form which does provide some discount to you (full disclosure – a small donation will also be made the Imperial Health Charity – who support the maintenance and upkeep of this free-to-use website resource)

Abdominal Binders

Abdominal binders can be particularly helpful for individuals with orthostatic intolerance, as they provide support to the abdominal region. Key considerations include:

– Improved Venous Return: Abdominal binders compress the abdominal area, assisting in venous return from the lower extremities and minimizing blood pooling.

– Enhanced Postural Stability: By providing support to the core muscles and abdomen, abdominal binders can improve postural stability, reducing the risk of postural changes triggering symptoms.

– Comfort and Adjustability: Look for abdominal binders that offer adjustable straps or closures to ensure a comfortable and customized fit.

Practically, we have found that our patients have found shapewear (worn along the hip /waist) such as the brands Spanx, Rago, and some online retailers like Amazon also sell compression garments (i.e. everday medical “umbilical hernia belt” on Amazon). Practically, these abdominal binders/shapewear help symptoms by promoting abdominal compression, “squeezing” the blood which may be pooling in your gut vessels, back into the central circulation (heart and brain)

Top Tips

Wearing compression garment leggings can be beneficial for individuals with various conditions or those seeking enhanced circulation and support during physical activities. Here are some top tips for wearing compression garment leggings:

Proper Sizing: Ensure you choose the right size of compression garment leggings for a snug yet comfortable fit. Refer to the sizing charts provided by the manufacturer to determine the appropriate size based on your measurements. Ill-fitting leggings may not provide the desired benefits and can be uncomfortable to wear.

Put Them On Properly: To wear compression garment leggings effectively, roll them down to the heel, then gently roll them up, making sure the fabric is evenly distributed. Avoid bunching or folding the fabric, as this may create pressure points or affect the overall effectiveness of the compression.

Gradual Application: Apply the leggings gradually, ensuring even pressure distribution throughout the legs. Start at the ankle and work your way up, smoothing the fabric as you go. This gradual application helps in achieving optimal compression and prevents discomfort.

Don’t Pull Too Hard: While wearing compression garment leggings, avoid pulling too hard or tugging aggressively on the fabric. Gentle handling is key to prevent damaging the garment and maintaining its integrity over time.

Pay Attention to Seams: Check the seams of the leggings to ensure they are flat and not causing any discomfort or irritation against the skin. If necessary, adjust the leggings to ensure the seams are positioned comfortably.

Moisturize Your Skin: Applying a moisturizer or lotion to your legs before wearing compression leggings can make the process smoother and more comfortable. However, be cautious not to use oily or greasy products that could affect the fabric’s grip or compromise its compression capabilities.

Gradual Adaptation: If you are new to wearing compression garment leggings, allow your body to adapt gradually. Start by wearing them for shorter durations, and gradually increase the wearing time as your body gets accustomed to the compression. If you experience any discomfort or adverse reactions, consult a healthcare professional.

Heat intolerance: Some patients will find it challenging to keep the compression stockings on during hot humid weather, for example in the summertime. In these circumstances it may be better to take a break from the compression stockings during hotter weather or seasons and return to using them in when the weather cools down particularly if “heating up” is more detrimental to your symptoms than the benefit of “compression”. 

Follow Manufacturer’s Guidelines: Always refer to the specific instructions provided by the manufacturer regarding the appropriate wearing duration and care instructions for your compression garment leggings. This ensures you maximize their effectiveness and maintain their quality over time

Conclusion

Compression garments, including grade II graded compression garments and abdominal binders, offer a non-pharmacological approach to managing symptoms of vasovagal syncope and orthostatic intolerance. By promoting blood flow, reducing blood pooling, and providing support, these garments can enhance cardiovascular stability and alleviate associated symptoms. Individuals can source compression garments from medical supply stores, reputable online retailers, or with guidance from healthcare professionals. Abdominal binders can offer additional support to the abdominal region, improving venous return and postural stability. Embracing compression garments and abdominal binders as part of a comprehensive treatment approach can significantly enhance the quality of life for individuals with vasovagal syncope and orthostatic intolerance.

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