The Way to a Man’s Heart is Through…
The body’s circulation has two transport systems: the delivery system (arteries) and the return system (veins and lymph vessels).
The venous (not Venus) system is the way blood returns to the heart. It is the 5-lane I-70 that runs through downtown Indy. On the other hand, the lymphatic system is the alleyways and side streets that also get you downtown.
The vessels in the lymphatic system rarely get any credit. They are truly the Rodney Dangerfield of the body. Let’s call them “lymphettes.” Their job is to sponge up and transport all fluid that surrounds all the organs, tissues and cells of the body. Both the veins and the lymph vessels work together to ferry fluid away. But like a sink, if more fluid goes in than can be drained, we’ll have an overflow.
What Goes Down Must Come Up
As I mentioned, the blood and fluid pumped away from the heart has to make its way back up. That means it has to beat Sir Isaac’s gravity. This is one of the best magic tricks that the body performs. It is accomplished by pumping, squeezing, and blocking, using muscles and valves inside the vessels.
The valves in your heart keep blood flowing forward when it pumps. There is a lot of pressure in the heart and these valves are large and robust. A smaller and delicate version of these valves are in the veins and “lymphettes.”
If you have ever owned a house that had a sump pump in the basement, you may know about stop valves. This pump pushes water out of the basement when water collects in the overflow well. When the pump stops, you do not see a flood of water coming back in the basement. This is because a one way valve lets fluid move up but not down.
When either the pumping actions of the circulatory system or the “stop valves” do not do their job well, more fluid accumulates in the “basement” of your feet. This is when swelling becomes noticeable. Fortunately, there are multiple veins/drains in the leg. But if one vein goes bad, the others veins have to do more work. This leads to further vein failure like a row of dominos. The valves will eventually become “incompetent” and allow fluid to flow downward. Gravity is now an enemy.
Who is at Higher Risk for Swelling in the Feet?
People that are not active are prone for swelling. Examples are people that travel a lot, couch potatoes, post-op patients, and paraplegics.
Another category would include pregnant women. Their growing bundle of joy sits on the large veins and blocks returning venous flow. This is like bending a garden hose to stop the water.
People that stand without movement are also prone to swelling. This is why a military guard can lose consciousness and collapse. There is not enough blood that returns to the heart because leg muscles are not pumping fluid. This can also happen when standing in line for Black Friday sales, standing up to quickly, or in hot weather. This is known as a “head rush” and is a result of diminished blood flow to the brain.
Other instigating factors are obesity, medications, oral birth control, bleeding disorders, and trauma.
Boring trivia: My surgery patients wear a knee-high compressive sock. But on the opposite side of surgery. The chances of a blood clot/phlebitis is greater on the nonsurgical side following lower extremity surgery. After 2-3 weeks, they will switch to the side of surgery to control any lingering swelling.
What Makes Bad Veins Bad
If blood pressure is too great or if there is too much fluid in the body, there will be valve damage.
Your kidneys play a critical role in condoling the body’s fluid level and blood pressure. Both of these problems can lead to fluid accumulation/swelling. Anything that impedes return flow will cause damage. Over a long period of time, the valves get damaged and cannot repair themselves. Unfortunately we cannot repair or replace valves in these small vessels like we can with heart valves.