CONDITIONS

What Is Varicose Veins

Varicose veins are large, swollen veins that twist up and don’t deliver blood as well as they should. Varicose veins can often be seen from outside the skin because of swelling or discoloration. Varicose veins are a very common medical problem. By some estimates as many as 3 out of 5 Americans suffer from varicose veins at some point in their lives.

Varicose veins tend to occur in the legs and the feet, but they can be anywhere on your body; while usually a minor nuisance, but they may lead to serious problems, such as pain, skin ulcers, or blood clots.

Spider veins are a condition like varicose veins, but they happen in smaller veins that are closer to the surface. Spider veins aren’t likely to cause major problems, but they can be unattractive and may appear on highly visible places such as the face.

What Causes Varicose Veins

When your circulatory system is working properly, your arteries carry blood from your heart to deliver oxygen to the muscles and organs throughout your body. The veins then deliver the usual blood back to your heart, where your heart can add more oxygen and remove carbon dioxide and then pump the blood out again.

Because the strongest pressure is on the blood flowing away from the heart, your arteries need to be flexible and strong to withstand the pressure, while your veins have a series of valves that keep the blood flowing in one direction only, so that the blood in your veins will work its way back to your heart. Unfortunately, these valves can sometimes break down, allowing the blood to back up and pool inside the vein. This is known as venous insufficiency, and it leads to the swelling that causes varicose veins. Nobody knows for sure what causes these valves to break down. Some doctors believe it may be a weakness in the walls of the veins.

Risk Factors For Varicose Veins

A number of factors can increase your risk for varicose veins. Some of these are factors you can change, but many are not. Non-controllable risk factors for varicose veins include:

  • Your age. Varicose veins are a problem that develops over time. The older you are, the more time they’ve had to develop.
  • Your sex. Varicose veins are three times more common in women than in men. Hormonal changes can cause varicose veins in girls at puberty and women at menopause. By some estimates, varicose veins affect up to 72% of women by the time they are in their 60s.
  • Your family history. You are more likely to suffer from varicose veins if someone else in your family has them as well.
  • Certain diseases, including some that cause blood to travel the wrong way between your arteries and your veins.

Risk factors you can control include:

  • Your weight. Being overweight or obese can put extra pressure on your veins, which may weaken the valves and lead to varicose veins.
  • Standing still. Moving around keeps the blood flowing in your veins. If you don’t keep your body active, you are more at risk for varicose veins—especially if you regularly stand in one place for a long time.
  • Pregnancy. Changes in your hormones while you are pregnant can cause varicose veins, especially if you gain extra weight or if you are less active while you are pregnant. Varicose veins that start during pregnancy usually go away within 3 months to a year.

Diagnosing Varicose Veins

Your doctor will start by asking you questions about your symptoms, your health, and your medical history. These questions will be followed by a physical exam. During the exam, your doctor will look at any visible varicose veins, and may touch them to check their texture as well. In some cases, your doctor may put pressure on or near the vein, or tie a tourniquet around your leg to see how it affects your blood flow.

Often, the physical exam on its own is enough to diagnose your varicose veins. However, your doctor may request other tests, such as a duplex ultrasound. During this test, a nurse or lab technician uses a handheld device to transmit high-frequency sound waves inside your veins to check for blood clots and measure how well and how quickly the blood moves through your veins. A duplex ultrasound is painless, and the sound waves are too high for the human ear to hear.

In some cases, your doctor may also request an angiogram. For this test a nurse will inject dye into your veins so they show up on an x-ray. However, most of the time, a duplex ultrasound or a physical exam alone is enough to diagnose varicose veins.

Symptoms of Varicose Veins

The primary symptom of varicose veins is the veins themselves—large, swollen, dark blue or purple veins just under your skin. They may also cause redness or discoloration in the skin around the vein, or unpleasant symptoms such as:

  • Swelling, throbbing, or cramping in your legs or near the location of your varicose veins
  • Itching near the vein, probably in your ankles or lower legs
  • Pain or aching in your legs or near the varicose vein
  • Legs that feel heavy or hard to move
  • Sores or ulcers on or near the vein

Prognosis

Varicose veins are treatable but not completely curable. A varicose vein can be removed by a surgeon, this surgery, however does not treat the overall disease, and so other varicose veins may appear over time.

Fortunately, treatment can make varicose veins less of a problem and make serious medical problems less likely. Complications of untreated varicose veins are rare, but they may include blood clots, skin ulcers, and sometimes serious or even fatal bleeding.

Living With Varicose Veins

There are many things you can do in your day-to-day life to make varicose veins more manageable. The biggest thing you can do is to stay active. Avoid standing still for too long, and get regular exercise. This keeps the blood moving and your muscles in shape. Regular exercise may also help you lose weight, which can also help with your varicose veins.

When you must sit, avoid crossing your legs if you have varicose veins there. When possible, it helps to spend time with the varicose vein raised above the level of your heart—for instance, lying on your back with your feet up, if the problem veins are in your legs.

The clothes you wear can also matter. Avoid tight jeans or other clothes that may squeeze or constrict any part of your body that is on the way from your varicose vein to your heart. Putting pressure on the veins that take blood to your heart can cause your blood flow to back up, making your varicose veins worse. Also avoid spending too much time in high heels. A lower heel helps keep your calf muscles in shape, and firmer muscles help control your varicose veins.

While tight clothes overall can worsen the problem, compression socks or stockings, which put a gentle pressure on your calves and ankles, may help keep your veins under control. These can range from ordinary support pantyhose or socks to prescription hose that need to be fitted by a trained professional.

Screening

Because varicose veins are often visible, most doctors do not routinely screen for varicose veins. However, screening is available for varicose veins and other venous problems, including problems such as blood clots that may be more common if you have varicose veins. It’s a good idea to be screened for venous problems if you have:

  • Varicose veins
  • Spider veins
  • Pain or swelling in your legs

The American Venous Forum offers an online screening tool you can use to assess your own risk, and provides links to local centers where you can be screened for vein problems.

 

Prevention

There is no guaranteed way to prevent varicose veins, but taking care of your health can help reduce your risk. If you have varicose veins already, these precautions can help keep them from getting worse or leading to blood clots and other serious complications:

  • Move your body. Get regular exercise most days of the week. Avoid sitting or standing in one place too long.
  • Keep your weight under control to improve your blood flow, so your veins don’t have to work as hard.
  • Avoid high heels and tight clothes, except for support hose, with your doctors approval

Medication And Treatment

For many people, lifestyle changes can be enough to get varicose veins under control. Support hose can also put gentle pressure on the area around the vein to aid blood flow and prevent bulging and swelling. When varicose veins are too big a problem to control with lifestyle changes, there are treatments available from your doctor.

Sclerotherapy involves injecting a chemical into a varicose vein to close off the vein, so that blood can’t get through. The blood finds other veins to deliver it back to the heart, and the closed-off vein fades away over time. For larger veins, a technique known as foam sclerotherapy may be utilized. By adding a gas, such as air, to the sclerosing medication, there is more surface area for the medication to react and more efficacious scarring and eventual fading of the veins.

The same treatment, using less of the chemical and a smaller needle, is known as microsclerotherapy. Microsclerotherapy can be used to treat spider veins and smaller varicose veins.

There are also a number of surgical treatments available. These procedures are performed as outpatient surgery for the most part, meaning that you can go home after surgery without needing a hospital stay. However, some of the more complicated surgical procedures may require you to rest up at home for a few weeks. Surgical treatments for varicose veins include:

  • Laser surgery to close up smaller varicose veins without cutting
  • Endovenous ablation therapy. This treatment involves a tube inserted through a small cut in the skin near the varicose vein to close up the varicose veins using heat from lasers or radio waves.
  • Ambulatory phlebectomy uses small cuts to remove varicose veins near the surface of the skin.
  • Endoscopic vein surgery. For this technique, your doctor makes a small cut and inserts a tube through the cut, just like in endovenous ablation. However, in endoscopic surgery, the end of the tube has a small camera that the surgeon uses to find the problem vein, and tiny surgical tools to close it up. This treatment has a longer healing time than ablation or laser surgery, and is mostly reserved for varicose veins that cause sores or bleeding. The at-home recovery time is typically 1 to 2 weeks.
  • Vein stripping and ligation involves tying veins off and removing them. You can usually go home the same day that this surgery is performed, but a full recovery can take up to a month.

Complementary and Alternative Treatment

Alternative and complementary treatments such as herbs, supplements, and homeopathic medicine are not as well studied as other treatments, but complementary treatments may help keep varicose veins from worsening, when they are used together with medical treatment.

Herbal treatments are largely thought to help with venous insufficiency—that is, the vein having difficulty getting blood back to the heart. Herbal treatments that have been used for venous insufficiency include:

  • Horse chestnut (Aesculus hippocastanum)
  • Pycnogenol (Pinus pinaster), a pine bark extract
  • Gota kola (Centella asiatica)
  • Butcher’s broom (Ruscus aculeatus)

Vitamins and supplements that may help include:

  • Vitamin C
  • Vitamin E
  • Zinc
  • Rutin, a compound that helps strengthen the walls of your veins
  • Oligometric proanthocyandin complexes, derived from grape seeds and pine bark

Homeopathic treatments include:

  • Arnica montana for varicose veins that are painful when touched
  • Calcarea carbonica if you have circulation problems–for instance, if you get tired easily or your hands and your feet tend to get cold
  • Hamamelis for large purple veins or bleeding hemorrhoids
  • Pulsatilla if your varicose veins are warm and swollen, or if they get worse with heat

Cold compresses using witch hazel or yarrow tea may also help relieve pain and burning from varicose veins.

Tell your doctor about any complementary or alternative treatments before you take them. Some of these treatments may cause serious medical problems if you have other diseases or take certain medications. Knowing every medicine you take, including complementary medicine, can help your doctor manage your health and prevent serious complications.

When To Contact A Doctor

Call your doctor right away if your varicose veins cause pain or a burning feeling, or if they swell up suddenly Also talk to your doctor if they continue to worsen despite self care, or if you develop sores that do not heal on your leg or near the varicose vein.

 

Questions For Your Doctor

Depending how serious your varicose veins are, you may be able to manage them with the help of your primary care doctor, your you may need a vein specialist such as a vascular surgeon. Your doctor can refer you to a specialist, or you can find one near you through the searchable directory provided by the American Venous Forum.

Questions For A Doctor

When you go to see your doctor, it’s good to have a list of the questions you’d like to have answered. Take a moment to write down some of the things you want to know. Your questions for your doctor might include some of these:

  • What can I do in my day-to-day life to help with my varicose veins?
  • Can I adapt these lifestyle changes to accommodate the sitting and standing required by my job?
  • Do I need any additional treatment?
  • Am I at risk for blood clots or other problems?
  • Are there specific warning signs I should watch for?
  • Is there anything else I should know about my varicose veins?