Balneotherapy at 36°C is Safe for People with Varicose Veins
Balneotherapy at body temperature (36°C) is safe and potentially beneficial for individuals with varicose veins, as this temperature avoids the risks associated with hot water while providing therapeutic benefits. 1, 2
Temperature Considerations for Venous Disease
Water temperatures at or near body temperature (36°C) do not cause venous dilation or worsen venous insufficiency, unlike hot water which can exacerbate symptoms by causing vasodilation and increased venous pooling 2
The therapeutic balneotherapy protocols studied for chronic venous insufficiency specifically used cooler water temperatures (23°C for walking pools and 34°C for bathing tubs), demonstrating that moderate temperatures are both safe and effective 2
Hot water above body temperature should be avoided in patients with varicose veins, as heat causes venous dilation and can worsen symptoms of venous insufficiency, but water at 36°C does not pose this risk 2
Evidence Supporting Balneotherapy Safety
Balneotherapy showed no increase in serious adverse events in randomized controlled trials involving 891 participants with chronic venous insufficiency, with no serious complications reported across multiple studies 1
The main complications monitored included erysipelas, thromboembolic events, and palpitations, with no clear evidence of increased risk with balneotherapy compared to no treatment (thromboembolic events OR 0.35,95% CI 0.09 to 1.42) 1
Balneotherapy probably resulted in moderate improvement in quality of life as measured by the Chronic Venous Insufficiency Questionnaire at 3,9, and 12 months, suggesting therapeutic benefit rather than harm 1
Therapeutic Benefits at Safe Temperatures
A randomized trial demonstrated that balneohydrotherapy improved quality of life in 66% of patients with chronic venous insufficiency compared to 28% in the control group (OR 5.08,95% CI 1.94-13.55) 2
Balneotherapy probably slightly improved pain compared with no treatment (MD -1.23,95% CI -1.33 to -1.13) and showed reduction in skin pigmentation changes at 12 months 1
The therapeutic protocol included walking in mineral water pools, underwater jets, and bathing, all performed at temperatures that did not exacerbate venous disease 2
Important Caveats
While balneotherapy at 36°C is safe, patients with active superficial venous thrombosis or recent deep vein thrombosis should avoid immersion until the acute phase has resolved, as these conditions represent contraindications to water therapy 3
Patients with severe varicose veins (CEAP stages C5-C6 with active or healed ulcers) should consult their physician before beginning balneotherapy, though the evidence suggests safety even in advanced disease 1, 2
The evidence base consists of moderate-certainty evidence from Cochrane reviews and randomized trials, indicating reasonable confidence in the safety profile at appropriate temperatures 1, 2