Important Lifestyle Changes: Compression

Compression garments are sometimes recommended in PoTS, vaso-vagal syncope or orthostatic hypotension. Compression of the lower limbs helps to move blood from the legs and abdominal cavity back into the general circulation, returning more blood to the heart.

A small study in 2021 demonstrated that compression clothing reduced patients’ symptoms and lessened the increase in heart rate when patients were upright. This study found that compressing both legs and abdomen was more effective than compressing only the legs, and therefore the addition of abdominal binders may be more effective than using stockings alone.

Obtaining and using compression tights

Patients can buy compression tights from their pharmacist or order them from the internet. Some brands are available on prescription.

Before ordering the more heavy duty and expensive ones that are recommended in PoTS, you could consider trying lighter support tights which are available from some department stores. If you cannot tolerate the lighter ones, you are unlikely to manage to wear the stronger tights that are recommended for PoTS.

For the fashion conscious, manufacturers have worked hard to improve compression garments over the last few years. They are available from many companies in the UK. They now offer a wide range of sizes, colours and compression classes, but they are not all available on prescription.

Black or navy compression garments are available on prescription and can be worn as leggings or with boots. Some can be found by searching on the websites listed below.

It may be helpful to put compression tights on in the morning before rising from bed. They should be removed at bed-time. Ideally, they should be replaced with new ones every 3-6 months.

Strength of compression tights

Compression tights for PoTS should be waist high for maximum benefit.

There are different ways of describing the strength of compression which is measured in millimetres of mercury (mmHg).

European standard (also called RAL) is the most commonly used classification in the UK. RAL class 2 tights provide the recommended pressure for use in PoTS which is 23-32 mmHg at the ankle.

Rarely the following are also available and can be used in PoTS:

British Standard (BS) – class 3 (which provides 25-35 mmHg)

French Standard – class 3 (which provides 21-36 mmHg)

Compression Tights Available On Prescription

Below are some examples of suitable compression tights for PoTS. Some companies have helpful tips, internet links and downloadable apps to assist.

Size charts are available on the manufacturer’s website.

Asking your GP to prescribe compression tights

Previously GPs were only permitted to prescribe stockings (not tights) and some GPs do not know that regulations have changed and that some tights can now be prescribed.  

It is probably best to make an appointment to discuss only this one issue i.e. the prescription of compression tights. This is because it can take the doctor a very long time (i.e. a whole appointment) to find the correct size on their computer and issue the prescription.

Before the appointment, consider looking on the websites suggested above, choose a style and make your own measurements at home to take to the consultation.  If possible, try to find a unique code for the tights that you require. Not all websites offer this, but it can help the prescriber to identify the correct tights.

Prescribing guidance for your GP

Compression tights are difficult to find on a GP computer on the medication screen; the range is enormous. In general the GP will need to search on:

• the company name e.g. Haddenham, Jobst, Sigvaris etc.
• then look for the type e.g. opaque, veni
• look for tights, pantyhose or waist high
• class
• colour
• size
• length

Take a printout of our leaflet to assist your GP.

Many of the companies now have Apps to assist with measuring and prescribing codes.  

When Compression Tights Should Not Be Used

Compression garments can be harmful for people who have conditions which reduce the blood supply to the legs (e.g. peripheral vascular disease, diabetes, lower limb trauma or infection). Their doctor should request a doppler ultrasound test, which measures the blood flow in their legs, before prescribing them. If skin is very fragile, compression garments can cause damage.

Alternative to Compression Tights

Compression garments such as “Skins” are commonly used by athletes and can be purchased from a number of running or sports shops.  They are available as leggings, shorts, and upper body compression garments.  Although the level of compression is likely to be lower than suggested for PoTS and inconsistent, they provide an alternative to compression tights and may be more appealing to some. To find examples, follow the link below: https://www.skinscompression.com/uk/