Varicocele and Valsalva

[Ortnit]

Hey everyone, I am a 23 years old guy and am currently working towards the end of the advanced novice phase, transitioning to intermediate. Today I got diagnosed with a varicocele, a swollen blood vessel in the scrotum which can not keep up with the circulation, so that it essentially becomes a varicose vein.

It seems that a lot of young men are affected by it and you read of numbers ranging from 8% to 25%, but unfortunately its hard to find much serious discussion on its effects on heavy weight lifting. In some cases varicoceles can apparently lead to pain and problems with fertility and generally the vein does not seem able to recover on its own. The only treatment seems to be surgery or embolization, which are not (yet) necessary for me as I have no pain or other symptoms.

The urologist made it sound like a relatively small issue, but responded to my question about the use of the valsalva technique during heavy squats that it might indeed ontribute to the problem.

All in all I am left wondering how other serious lifters deal with it, as the urologist did not seem too familiar with weight lifting in general. Based on how common this condition seems to be I would think that quite a few people would have experiences with it, but so far it was hard to find much helpful material.

[Charlie Davies]

I was diagnosed with this many years ago, long before I took up lifting (and before my youngest 3 kids were conceived). Lifting hasn't made it worse.

Wear comfortable underwear and loose pants all the time, not just in the gym. Big swollen balls do not belong in tight jeans.

[iamsmuts]

I had surgery for this when I was 17 or 18, 20+ years ago. I'm not sure that it was the best thing to do, but it was recommended and my mother thought I should do it. . . . They worried that I might be infertile otherwise. I had no pain, just a big left testicle, bigger than a big left nut should be.

I think the surgery is better now days. Back then they cut through my lower abdomen to tie off the vein. I have a three inch, diagonal (almost vertical) scar on the edge of my lower abdominal muscles. They might have gone in at the edge of my external oblique or they might have cut through it. It's hard to tell.

I still have some pain there from time to time, but it's very rare. The pain is so close to where you'd get an inguinal hernia, that I thought I had one a while back. Last summer when they were looking for cancer in my testicles, I ask the ultra sound tech to check for a hernia. She didn't see anything.

I now think that I just have some irritation from the surgical scar, though it comes out mainly when doing RDLs. Three years ago when I started working out, I hurt the area trying to do pullups. I guess I must have been using my legs a bit.

Overall I'm not sure that the surgery was a success. I don't want children, so I don't know if my sperm count is high or not. I do know that my left testicle isn't a swollen coil of worms. That's something.

[hollismb]

You need worry no more about a varicocele and weightlifting/valsalva than you would about a varicose vein anywhere else, which is not at all. The main thing that's going to irritate it is gravity or bumping/rubbing against stuff, so wear comfortable and supportive underwear, a jock strap, or shorts with lining built in, and only worry about it if you go to have kids and you have a sperm count problem because your balls are too hot, are especially concerned about fertility problems before that happens, or if it starts to really bother you on a regular basis. The urologist just said, 'Eh? Huh? Maybe." to play it safe, and because he doesn't know.

Here's a related thread that specifically about varicose veins with information you can apply to your particular situation: Weightlifting & Varicose Veins.

[Ortnit]

I was diagnosed with this many years ago, long before I took up lifting (and before my youngest 3 kids were conceived). Lifting hasn't made it worse.

Wear comfortable underwear and loose pants all the time, not just in the gym. Big swollen balls do not belong in tight jeans.

Thats an encouraging thing to hear, especially if lifting didn't aggravate it. In terms of comfort I quite notice the increasing size of my thighs, which already require a few changes in posture. In regards to 'serious lifting' my definition is rather broad too, as I am far behind the ambitious schedules of the program as written. Just in this regard doing heavy squats probably puts a very different strain on the affected vein than doing some calf raises or light dumbell flyes once a month.

I think the surgery is better now days. Back then they cut through my lower abdomen to tie off the vein. I have a three inch, diagonal (almost vertical) scar on the edge of my lower abdominal muscles. They might have gone in at the edge of my external oblique or they might have cut through it. It's hard to tell.

I still have some pain there from time to time, but it's very rare.

As far as I understood one newer option for it is minimally invasive embolization. I was told that such treatments would not be reasonable at the current stage though, and in terms of fertility it would rather be indicated if one were actually trying to conceive without success over a longer period of time. Despite the nasty side-effects, a good thing is that you make it sound as if the problem didn't reappear regardless of weight lifting, as the article on wikipedia mentions that sometimes multiple treatments may be necessary.

The urologist just said, 'Eh? Huh? Maybe." to play it safe, and because he doesn't know.

This was definitely my impression as well, and there seems to be no consensus in this regard unfortunately. What you write about supportive underwear seems like the best bet probably, as I think it might be better to compress the vein rather than to let it stretch and dilate much further in more loose clothing as it struggles against gravity.

Here's a related thread that specifically about varicose veins with information you can apply to your particular situation: Weightlifting & Varicose Veins.

Thanks for the link! As far as I see the main argument there seems to be that the muscle contractions in the legs would counter any swelling caused by the blood pressure. Unfortunately there is not really much muscle around the affected vein in this case though. Instead the valsalva maneuver itself is actually used in the diagnosis, and I got to witness the affected vein light up very clearly in the colour coded ultra sonic image when asked to do it by the urologist. When squatting I definitely produce much more pressure yet.

[hollismb]

Thanks for the link! As far as I see the main argument there seems to be that the muscle contractions in the legs would counter any swelling caused by the blood pressure. Unfortunately there is not really much muscle around the affected vein in this case though. Instead the valsalva maneuver itself is actually used in the diagnosis, and I got to witness the affected vein light up very clearly in the colour coded ultra sonic image when asked to do it by the urologist. When squatting I definitely produce much more pressure yet.

Normally they just feel around your sack (if it's your GP, anyway). I guess the increase in intra-abdominal pressure causes it to swell momemtarily, either by pushing blood in, keeping it from flowing out, or maybe a little bit of both. But regardless, I'd still think you shouldn't worry about it any more than you should about getting a hernia. If it gets worse and becomes a problem, just get it fixed. Until then, just enjoy getting stronger.

[Ortnit]

Normally they just feel around your sack (if it's your GP, anyway). I guess the increase in intra-abdominal pressure causes it to swell momemtarily, either by pushing blood in, keeping it from flowing out, or maybe a little bit of both. But regardless, I'd still think you shouldn't worry about it any more than you should about getting a hernia. If it gets worse and becomes a problem, just get it fixed.

After I first noticed the problem I actually took a break from lifting to be on the safe side, so I probably best get back to it slowly again and see how it goes.

Until then, just enjoy getting stronger.

Thanks! Maybe I will write a follow-up post in a few weeks then with my experiences, for the sake of future concerned young people searching for these things on the internet.

[Charlie Davies]

In terms of comfort I quite notice the increasing size of my thighs, which already require a few changes in posture.

That image made me flinch. Yes, I've noticed this too. There's less room down there for the boys.

But grown men should not have a "thigh gap" like female fashion models. The thigh chafing and underwear requirements to work around big thighs are worth it.

[Ortnit]

Now its a few weeks since I started the thread and so here is the promised update. At this point I am almost at back at the weights that I was working with before the break, although the squats are taking a big longer yet and I have been going easy on the valsalva yet.

In the first few days after the diagnosis things were deteriorating a bit further and at times I actually noticed some slight discomfort, especially on hot days after sitting for longer times.

By now though it seems to have stabilized and despite high temperatures around here I didn't really notice any pain or additional swelling anymore. From time to time one can see some minor difference on the affected side, but it is quite subtle so that it doesn't bother me much.

In regards to weight lifting I don't notice any issues before or after my training. During the training I usually don't even think of it and there is no discomfort or anything unusual as compared to before either. At this point the varicocele does not seem to be affected by the training at all, and generally doesn't cause any other noticeable problems either.

There are a number of things that I tried after reading up on things online. Its hard to tell whether and which of them might have actually made a difference, and maybe some people reading this will even have opposite experiences, but I will still list up a few.


What might have been helpful:

• Cold showers (seems to work better than ice too and naturally constricts the blood vessels a bit)
• Supportive underwear (eg. comfortable, elastic boxer shorts)
• Drinking more to stay hydrated
• Consuming more flavonoids (apparently recommended for varicose veins)
• Applying gel containing aescin to the skin (an extract of horse chestnut which is also
  recommended for varicose veins by some. It was quite cheap and seemed worth a try)
• Generally giving the area some rest
• More balanced nutrition
• Changing my sleeping posture to keep more space between my thighs

What made no difference for me:

• Bodily activity and especially weight lifting
• Trying to avoid blood pooling by spending more time lying on a bed

What seemed to make things worse:

• Sitting without any break for hours
• Wearing underwear to bed (I did this for some time originally before noticing the first symptoms)
• High temperatures
• Loose or no underwear

[God of Thunder]

I've just started taking horse chestnut extract tablets, and I've noticed a real improvement in my leg veins. Downside is that my eyes (laser surgery three years ago plus dusty air at work) keep getting bloodshot.