Definition

Varicose veins, also known as venous varicosities, are dilated and twisted veins that commonly occur in the legs and feet. Any vein close to the skin's surface can become varicose (varicose veins).

Causes

Varicose veins arise from dysfunction in the small valves within the veins. In healthy veins, blood flows to the heart unobstructed. Venous blood from the legs must work against gravity. Muscle movement in the legs acts as a pump to assist blood flow upward. Small valves in the veins open and close to prevent blood from flowing backwards. When these valves are weakened or damaged, blood can flow backwards and pool in the veins, causing them to stretch and become twisted (varicose).

Risk factor

Your risk of developing varicose veins is increased if you:

• Elderly. Aging weakens valve function in the veins.
• Female. Hormonal changes before menstruation, during pregnancy, or menopause can increase the risk, as hormones tend to weaken vein walls. Additionally, hormonal therapies such as birth control pills can also heighten risk.
• Have a family history of varicose veins.
• Pregnant. During pregnancy, blood volume increases to support both the mother and fetus, which can lead to the expansion of veins in the legs.
• Overweight or obese. This adds pressure to the veins.
• Suffer from deep vein thrombosis (a blood clot in a vein located deeper than the skin’s surface).
• Have a history of leg injury (such as a fractured leg).
• Have a job that requires prolonged sitting or standing. Movement helps blood circulation, so standing or sitting for too long increases the risk of varicose veins.

Symptoms

Varicose veins may appear bluish or dark purple and are often lumpy or twisted.

Symptoms include:

• Pain, heaviness, and discomfort in the legs, though varicose veins can be painless.
• Swelling in the legs.
• A burning or throbbing sensation in the legs.
• Muscle cramps, particularly at night.
• Dry, itchy, and thin skin over the affected area. Symptoms typically worsen in warm weather or after standing for long periods but may improve with walking or resting with the legs elevated above the heart.

In mild cases, varicose veins may be referred to as spider veins, which are closer to the skin's surface and appear red or blue but do not protrude. These primarily cause cosmetic concerns.

Diagnosis

Varicose veins are diagnosed based on symptoms and appearance. The doctor will examine your legs while you are lying down and standing to check for swelling when upright. The diagnostic test used is duplex ultrasound. This device employs high-frequency sound waves to produce images of the veins in the legs, showing blood flow and helping the doctor locate damaged valves.

Management

Varicose veins are generally a benign condition and often do not require treatment unless they cause discomfort. Treatment typically aims to:

• Alleviate symptoms if the varicose veins cause pain or discomfort.
• Address complications such as ulcers, swelling, or skin changes in the legs.
• Address cosmetic concerns.

If treatment is needed, it often begins with at-home measures, such as wearing compression stockings. Before wearing these, the doctor will assess your blood circulation to ensure the therapy is safe. Compression stockings are designed to apply pressure to the legs, improving blood flow. The pressure is usually greatest at the ankle and decreases upward, aiding blood flow to the heart. Wearing compression stockings can reduce pain, discomfort, and swelling and is also useful for varicose veins during pregnancy. They come in various sizes, lengths, and compression levels, tailored to individual conditions. You may need to wear them for life if you have valve issues in deeper veins. It is unclear if they can prevent worsening varicose veins or the formation of new ones.

Compression stockings should be worn immediately upon waking and removed before sleeping. They may cause discomfort, especially in hot weather, but it is crucial to wear them to maximize therapeutic benefits. Ensure the stockings are worn correctly without rolling the top to maintain proper compression. If they make your skin dry, apply a moisturizer before bed to keep the skin hydrated.

Compression stockings generally need replacement every 3 to 6 months or if damaged. It is advisable to have two pairs to facilitate washing. Wash them in warm water and avoid direct sunlight for drying.

Additional at-home measures include:

• Regular exercise
• Avoiding prolonged standing
• Elevating the legs during rest

If these measures do not alleviate symptoms or complications arise, further treatment options will be based on your overall health, as well as the size, position, and severity of the varicose veins. Advanced treatment options include:

• Endovenous ablation. This method is often the first recommendation and uses high-frequency radio waves or laser energy to close varicose veins.
• Sclerotherapy. The doctor injects a solution into the varicose veins to cause scarring that can close the veins.
• Surgical removal of varicose veins.

Complications

Varicose veins can lead to complications due to impaired blood flow. Most people with varicose veins do not experience complications, but if they occur, they usually develop several years after the initial appearance of varicose veins.

Possible complications include:

• Bleeding. Varicose veins close to the skin's surface can sometimes bleed from scratches or impacts. If bleeding occurs, lie down, elevate your legs, and apply pressure to the wound.
• Blood clots. Blood clots in veins near the skin's surface can cause inflammation and swelling. If clots form in deeper veins, they can cause pain and swelling in the legs and may travel to the lungs, causing a pulmonary embolism.
• Skin ulcers. Painful sores can develop on the skin near varicose veins, especially around the ankles. These ulcers are often preceded by skin discoloration.

Prevention

To prevent varicose veins, you can:

• Avoid standing or sitting for extended periods. Aim to move or walk every 30 minutes.
• Exercise regularly. Exercise improves blood circulation and helps maintain a healthy weight.
• Avoid wearing high heels.
• Eat a high-fiber, low-sodium diet.

These measures can also help reduce symptoms of existing varicose veins.

When to see a doctor?

If you have varicose veins and they are not causing discomfort, you do not need to consult a doctor.

You should see a doctor if:

• Varicose veins cause pain, discomfort, swelling, heaviness, or itching.
• There are changes in the skin color of the legs.
• There are issues with the skin over the affected area, such as eczema.
• There are sores on the legs.
• If bleeding from varicose veins does not stop, seek immediate medical attention as this requires prompt treatment.

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