Table of Contents
How Compression Garments Help with POTS
Compression garments are commonly recommended as part of the lifestyle management plan for POTS (Postural Orthostatic Tachycardia Syndrome), vasovagal syncope, and orthostatic hypotension. They work by applying graduated pressure to the lower limbs, which helps push blood from the legs and abdominal area back into the general circulation — returning more blood to the heart.
When a person with POTS stands up, blood tends to pool in the lower body, reducing the amount returning to the heart. This triggers a rapid increase in heart rate as the body tries to compensate. Compression garments help counteract this pooling effect.
Should you compress just your legs, or your abdomen too?
A small study published in 2021 found that compressing both the legs and the abdomen was more effective at reducing symptoms than compressing the legs alone. This means that adding an abdominal binder or using waist-high compression tights may provide more benefit than knee-high stockings on their own.
Reduces heart rate rise
Helps lessen the increase in heart rate when standing upright.
Improves blood return
Pushes blood from legs back to the heart to improve circulation.
Backed by research
A 2021 study confirmed symptom reduction in POTS patients using compression clothing.
Should you compress just your legs, or your abdomen too?
A small study published in 2021 found that compressing both the legs and the abdomen was more effective at reducing symptoms than compressing the legs alone. This means that adding an abdominal binder or using waist-high compression tights may provide more benefit than knee-high stockings on their own.
Understanding Compression Strength
Compression is measured in millimetres of mercury (mmHg). Different countries use different classification systems. The table below shows the main ones relevant to POTS management:
| Standard | Class | Pressure at ankle | Notes |
|---|---|---|---|
| European (RAL) | Class 2 ✓ Recommended | 23–32 mmHg | Most widely used in the UK; the standard starting point for POTS |
| British Standard (BS) | Class 3 | 25–35 mmHg | Less common; occasionally used in POTS |
| French Standard | Class 3 | 21–36 mmHg | Rarely used; can be appropriate in some cases |
- • Compression tights for POTS should be waist-high for maximum benefit — not just knee-high.
- • If you cannot tolerate lighter support tights, you are unlikely to manage stronger medical-grade compression.
- • Consider trying lighter department store support tights before investing in stronger garments.
When and How to Wear Compression Tights
Getting the most from compression garments comes down to consistency and technique. Here are the key principles:
Tips for making application easier
Medical-grade compression tights can be quite stiff and difficult to put on. These approaches can make the process easier:
- Wear household rubber gloves — they provide grip on the fabric
- Put them on while lying on a carpeted surface
- Use a fabric foot slider or stocking-aid device (available from medical supply companies)
- Check the manufacturer’s app or instructions — many brands now offer step-by-step guides
Comfort, Skin Care, and Fit
Compression garments may feel unusual at first, but most people adjust to them over time. Here are some practical comfort tips:
Skin irritation
If the garment causes redness, petroleum jelly on the affected area can help. Check the size is correct.
Washing care
Follow washing instructions carefully. Soap residue can build up — rinse thoroughly to prevent skin irritation.
Correct sizing
Measure carefully using the manufacturer’s size guide. Many brands offer app-based measurement tools.
Knit type
Most garments are circular knit. Flat knit garments may be more comfortable if there’s fluid retention, but require specialist fitting.
Who Should Not Use Compression Garments
Important — Always consult your doctor first
Compression garments may be harmful for people with certain conditions. These include:
- • Peripheral vascular disease (reduced blood supply to the legs)
- • Diabetes (particularly with nerve or blood vessel complications)
- • Lower limb trauma or active infection
- • Very fragile skin
A Doppler ultrasound test may be needed to measure blood flow in the legs before compression garments are prescribed. This should be arranged by your doctor.
Alternatives to Medical Compression Tights
Medical-grade compression tights are not the only option. Some alternatives may suit certain individuals better:
Athletic compression garments
Sports compression garments — such as compression leggings, shorts, or upper body garments — are widely available from running and sports shops. While the compression level is generally lower and less consistent than medical-grade products, they can be a practical starting point or alternative for some people with POTS.
Lighter support tights
Lighter support tights available from department stores can be worth trying first. If these are not tolerated, it is unlikely that stronger medical compression will be comfortable either. Starting light can help you gauge your tolerance before investing in stronger garments.
Abdominal binders
Abdominal binders can be used alongside leg compression to improve the overall effect. Research suggests that abdominal compression combined with leg compression is more effective than leg compression alone for POTS symptom management.
Frequently Asked Questions
What compression strength is recommended for POTS?
European Standard (RAL) Class 2 compression tights are generally the starting recommendation for POTS, providing 23–32 mmHg at the ankle. Tights should ideally be waist-high for maximum benefit. Speak with your healthcare provider about what’s right for your specific situation.
Do compression garments really help with POTS symptoms?
A study published in 2021 found that compression clothing helped reduce POTS symptoms and lessened the increase in heart rate when patients were upright. The research also found that compressing both the legs and abdomen was more effective than leg compression alone. Individual results vary, and compression is typically part of a broader management approach.
When should I put on and remove compression tights?
Put compression tights on in the morning before getting out of bed, while still lying down. This helps prevent blood pooling as soon as you stand. Remove them at bedtime. Replace them every 3–6 months as the material loses elasticity over time.
Should I compress just my legs or my abdomen too?
Research suggests that combining abdominal and leg compression is more effective than leg compression alone for POTS. Waist-high tights, or leg compression paired with an abdominal binder, may offer greater benefit. Discuss this with your healthcare team.
Who should avoid compression garments?
Compression may not be suitable for people with peripheral vascular disease, diabetes with circulatory complications, lower limb infections or trauma, or very fragile skin. Your doctor may request a Doppler ultrasound to assess blood flow in your legs before recommending compression. Always check with a healthcare professional first.
Are there alternatives to medical-grade compression tights?
Yes. Sports compression garments (leggings, shorts) are a popular alternative and are widely available. While the compression level is generally lower and less consistent than medical products, they may be more comfortable or accessible for some people. Lighter department-store support tights are also worth trying before moving to stronger medical-grade compression.
How do I make compression tights easier to put on?
Rubber household gloves provide a firm grip on the fabric. Putting tights on while lying in bed (before standing) is also easier and recommended. A stocking aid or foot slider device can help. Many brands now offer app-based guides and downloadable instructions for application.