Compression Garments

● Background/Mechanism of Action: Compression garments (such as weight-high stockings or abdominal binders) can be extremely helpful for patients with orthostatic intolerance. Our patients usually benefit the most from lower body compression including legs and abdomen because compression in this area targets lower extremity blood pooling and reduces splanchnic venous pooling in the abdomen to move blood back up to the heart and brain. Lots of our patients find that they can function much better when wearing compression garments (i.e. reduced dizziness/lightheadedness).

● Recommended Compression Levels: When starting compression therapy, we recommend beginning with 20-30mmHg, as it provides firm compression without being too difficult to put on. If 20-30mmHg feels too firm or hard to apply, you can try 15- 20mmHg. If more compression is needed, you can move up to 30-40mmHg, which we generally prefer, though they can be challenging to put on, especially for patients with joint hypermobility. Some side effects include excess heat and reactivity to materials (ie wool allergy)

● Compression Types: For orthostatic intolerance, full lower-body compression, including the abdomen and legs, is typically recommended. This can be achieved with firm shapewear (e.g., Spanx or Skims), corsets, compression shirts, or vests. For leg compression, waist- high stockings or leggings are recommended, with thigh-high or knee-high options available depending on individual needs. The best results are usually seen when shapewear or a compression vest is worn in addition to waist-high stockings, as this helps reduce blood pooling and alleviate symptoms when upright.

● Other Suggestions: Compression garments are available online, ranging in price from $15 to $180. Higher-priced options tend to last longer, but affordable garments are also effective, though they may not be as durable. Before purchasing, check with your insurance company to see if they cover compression garments with a prescription. Insurance may have restrictions on where you can buy them, but they should work just as well as higher-end options. Make sure you buy the correct size for yourself to get the full effect of the compression. Online stores usually have a size chart you can go off of. You can even get fitted for compression stockings at some medical supply stores to ensure a perfect fit.

● List of Options: There are many places to purchase these compression garments online. Amazon, for example, has lots of inexpensive options including fun colors and patterns. Here are some websites that sell compression or shapewear products:

• Spanx.com
• Discountsurgical.com
• Shapermint.com
• Skims.com
• Ameswalker.com
• Compressionstockings.com

Citations

Bourne, K. M., Sheldon, R. S., Hall, J., Lloyd, M., Kogut, K., Sheikh, N., Jorge, J., Ng, J., Exner, D. V., Tyberg, J. V., & Raj, S. R. (2021). Compression Garment Reduces Orthostatic Tachycardia and Symptoms in Patients With Postural Orthostatic Tachycardia Syndrome. Journal of the American College of Cardiology, 77(3), 285–296. https://doi.org/10.1016/j.jacc.2020.11.040

Rowell, L. B., Detry, J. M., Blackmon, J. R., & Wyss, C. (1972). Importance of the splanchnic vascular bed in human blood pressure regulation. Journal of applied physiology, 32(2), 213–220.