Jun 29, 2012

Compression Stockings: The Good, The Bad, The Ugly

Many POTS patients have been advised by their doctors to try wearing medical compression stockings to help their orthostatic symptoms.  For some reason, many patients are reluctant to try them.  I know I was at first too.  All I could imagine was some old granny with thick beige colored itchy knee highs  rolled halfway down her jiggly calves, only held up by cankle fat.  I may have been sick, but I was still vein enough to not want to look like that.

My first attempt at compression stockings was while I was admitted to a large hospital in NYC in 2010.  My doctor really pushed me to try them.  I tried the ones the hospital had on hand.  They were hospital white, thick, itchy and worst of all, they had latex in the rubber that wrapped around the leg band (they were thighs highs).  Not exactly a good experience.

My wonderful husband wanted to help me anyway he could, so he walked a few blocks down to a drugstore and bought me three pairs of compression stockings - thigh highs, pantyhose, black, nude and all in different sizes.  I think he just bought the first three pairs he saw on the shelf.  They were very expensive, so I only kept one pair that I thought fit me.  I later learned they were the wrong size to work effectively, but at least they were comfy.

Then I started to do a little research and talk to other patients about compression stockings.  I learned some great tips:

Knee highs aren't going to do anything for a POTSy.  Most of us have blood pooling in our upper legs and stomach area too.  If you put knee high compression stockings on the average POTSy, they get fluid retention or blood pooling just above the top of the stocking at the knee.  Not helpful, and not a good look.

Thigh highs are better than knee highs, but only really look good on skinny girls and marathon runners.
Thigh highs are better than knee highs for POTSies, but if you have a healthy layer of thigh fat as most women do, medical compression thigh highs will leave a weird dent in your thigh at the top of the stocking.  If any of you vixens have worn some sexy Victoria's Secret thigh highs and though you looked great in them, keep in mind that this is not the same thing.  Medical compression stockings are REALLY tight and tend to make you feel and look like a stuffed sausage.   If you have normal female thigh jiggle, this dent looks weird under pants or skirts.  If you are skinny or have rock hard quads, this won't be a problem for you.

Full length pantyhose are the most effective for POTS.  Since they provide compression to the whole lower body, including the belly area, they work better than the thigh highs and knee highs.  Some POTSies are worried that compression on their belly area could worsen nausea, reflux or further impair gastric motility.  One way to deal with this is to roll them down to below the belly.  I have done this many times after eating, since I have some motility problems too.

Open toe is the way to go!  I love wearing flip flops and you can't wear them with regular pantyhose.  Most compression stocking brands, and definitely the Juzo Soft brand, comes with an option for closed toe or open toe.  Even the thigh highs come in open toe now.  Besides flip flops, open toe stockings are easier to put on and take off that closed toe stockings.  They usually give you a slip to put over your foot, which makes the stocking slide on much easier.  Once you have the stocking on, you simply slide the slip out of the toe opening.

Not all brands or all lines within a brand are equal.  Most people dread the thought of itchy, scratchy, sweaty compression stockings.  Me too.  I tried many different brands and different lines within each brand.  My favorite line is the Juzo Soft line, sometimes called Juzo Soft 2000.  Second best is Jobst Opaque.  I also like the stockings from Rejuvahealth.com.  The Juzo Soft stockings are very soft, and they seem to breathe pretty good.  I have worn them for 2 years though the summer heat without a problem.

They come in colors and fun prints now!  You'll probably want your first few pairs to be a skin-toned color, but after you have a few of those, why not have some fun and get a pair of paisley or tie-dyed stockings, or ballerina pink.  The Juzo Soft line comes in a bunch of solid colors like blueberry, plum, pink, green, red, yellow, etc.  They also have seasonal prints like tie-dye.  Rejuvahealth.com comes in paisley, colored animal prints, and a few other fun prints.

Cut out the crotch of you brand new $100 stockings. What? Yes, that's what I said. OK, I know this is gross.  You don't want to think about this.  But any of you ladies who has ever had a yeast infection (um, probably all of you at one point or another) would do ANYTHING to avoid dealing with that awfulness again, wouldn't you?  So just trust me on this one.  Cut out the crotch of you brand new $100 stockings and let your lady parts breathe so you don't end up brewing any funky stuff down there.    Compression stockings are made from various synthetic fibers.  They don't breathe very much and they are very tight.  This creates ideal growing conditions for candida (yeast) overgrowth.  Add to that, that many medications can cause yeast overgrowth, and people with various medical conditions are more prone to yeast infections, particularly people with weakened immune systems.  So just cut the crotch out.  Make the cut when you are NOT wearing the stockings.  Cut out the crotch area inside of the seams, leaving the seams intact, and at least a half inch of fabric between the cut and the crotch seam.  This will help deter any runs in the stockings.  I have done this to 12 pairs of stockings and have not had one run in my stockings caused by this.  I have had runs start at the heel from walking barefoot outside with my stockings on - oops!

Compression stockings are for men too.  Most companies that make medical compression stockings offer a few styles meant for men, with a little extra room in "the region."

Try out different compression strengths before you decide they are not for you.  I have heard some patients say "compression stockings did nothing for me," but they only tried the 10-15mmHg compression, which is very minimal.  I have heard other patients say "oh they were so tight my legs went numb and cold," but those people had bought a size too small and had the 30-40 strength compression, which is really, really tight.  I would encourage people to get fitted properly for compression stockings (take the measurements in the morning when you first get out of bed).  I would also encourage you to try the 20-30mmHg first.  If they feel way too tight, then try either a larger size or a lesser compression strength.  If they feel like they are not helping at all because they are too lose, try a smaller size, and if that doesn't help, then try a stronger compression.

Insurance will often pay for them.  Before ordering them, check with your insurance company.  Sometimes they will cover medical compression stockings if you have a script from your doctor.  For POTSies, it may be easier to get your doctor to write Orthostatic Intolerance or Hypotension as the diagnosis on your script, since the compression stocking company and the insurance company probably have no clue what POTS is.  Since stockings can be well over $100 a pair, it is worth it to make a few phone calls to see if they will cover them.  If they are covered, find out how many pairs per year you are entitled to.  My insurer had no limit; they said it just had to be within reason.  So I order a new 6 pairs every 6 months.  The insurance company probably has a list of approved durable medical good providers that you will have to use if you want them to pay for the stockings.  Just ask that company to order the stockings you want.  Most of them have large catalogs they order from, so you shouldn't have to be limited to only what they advertise online or have in their store.

Comparison shop online.  If insurance won't pay for them, search around and comparison shop online.  I have found the same pair of stockings on one website for $160 and then on another website for $95.  Also keep in mind tax and shipping costs when comparing prices.

Buy one pair at a time until you find the perfect stocking for you.  Don't order 6 pairs of a size or brand you have never tried before.  You could end up wasting a ton of money if they are not comfortable or don't fit you.

Wash them everyday.  I originally thought that I should wear them for 2 days before I washed them, but  then I read the washing instructions and it said to wash them after every wear.  Your skin has natural oils that break down the elastic fibers in the stockings if they are not washed every time you wear them.  I wash them in a pillow case on the gentle cycle with my regular laundry.

Compression stokcings are most effective when you put them on just as you first get out of bed in the morning.  The longer you are sitting or standing upright before putting on your stockings, the more time your blood has to pool in your lower legs.  Blood pooling can actually cause a shift of fluid out of your veins and into the surrounding tissues, which can worsen low blood volume or low blood pressure if you are already dealing with that.  Putting your stockings on first thing in the morning avoids this.


  1. love this post, very helpful. I'd also like to mention that I love ames walker stockings and they're about $30 a pair, much cheaper than any other brand!

  2. I am getting some knee high compression stockings this week to help with the blood pooling. My legs are visibly purple from the knee down, but not above, so I don't think I have pooling above the knees. If I do, I can't see it or feel it.
    I got mine at a medical supply store and my insurance will cover them. I was told, though, that I should NEVER under ANY circumstances put them in the washer or dryer. Hand wash and hang to dry. Were you told differently?

  3. Sarah Mae,

    I wear Juzo compression stockings, and the instructions that came with them say to wash them in the regular wash on gentle cycle after each use. Other brands may have different instructions for how to care for the stockings. I would do whatever the manufacturer says to do.


  4. Great post! Thanks for the tip re compression stockings and summer heat. Good to know there is a brand out there that can be comfortable.

  5. Thank you for this post. I could definitely relate to the thigh high dilemma. Do you know if compression leggings are just as effective?

  6. Thank you for the insight. Definitely true that the full length pantyhose are most effective. I have edema from knee replacenent surgery. I am a male. So I was not too thrilled about compression hose, but definitely know the benefits for my health.

  7. Thank you for this information. I am so dejected at having to wear these now. I haven't gotten them yet and your post and suggestions are so appreciated! How can they fit under dress pants? I'm not a skinny girl, and I was hoping the knee highs would work but full length? Full length wearing anything would be a chore but under pants? That's if you can get them up. I know people who have tried to wear them but can't pull them up. I can't believe this is the only treatment available for so many diagnosed edema and circulatory problems.

  8. Love your post. It should be required reading for anyone who is ordered to "Hose Jail". It's the worst part of all my vein treatments. I'm not suffering the same condition as you are but after a few months of dealing with these things I learned 3 things. 1) YES! wash them everyday. 2) Utilize the roll on glue ('It Stays!' is the one I use) for thigh highs. and 3) Get a hose buddy, especially if you're older or you will need a chiropractor.
    Once I got used to them I liked the way my legs feel all day wearing them, "they are my magic legs". The hardest part was like you said the rubber part at the top of the thigh-highs since I'm a heavy person, it wasn't easy.

  9. Thanks for all of the great info Potsgrrl, I feel lucky to have found your site. My doctor didn't know what to recommend and googling the various products was so overwhelming that it was impossible.

    After reading your post I contacted my insurance company and found they will cover some of the expense, but more importantly, they gave me the number of a medical supply company so I could get personal help with sizing and some first-hand experience.

    I'm grateful there is a great site like yours that introduced me to "younger" options; I'm loving the Juzo soft leggings and actually can't wait to get some tie-dye versions. Many Thanks!!

  10. So far the thigh high using a garter belt is what is going to work for me. Any ideas how to convert the interesting colors to to be used with a garter belt. Hate just beige! Thanks for the the good tips!