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Varicose veinsPublished by Bupa's health information team, November 2006. This factsheet is for people who have varicose veins or want to learn more about them. Varicose veins are very common. They affect around three in ten women at some time in their lives and around half as many men. They are swollen veins (usually on the legs) that look lumpy and bluish through the skin. How does blood flow from your legs?Blood is pumped from your heart to your legs through arteries. Once it has supplied oxygen and nutrients to the legs, blood returns to your heart through your veins. To do this from your legs, blood in your veins must flow upwards, against gravity. The muscles in your legs help this flow. Each time your calf and thigh muscles contract when you are walking, veins deep inside your leg are squeezed. One-way valves inside your veins help prevent the blood from flowing backwards.
What causes varicose veins?The reason varicose veins develop is not fully understood. One of the basic problems is damage to the valves. This means that blood can't travel up the veins as easily, and is more likely to pool. It is possible that people inherit a tendency for weak valves. Alternatively, the vein walls may become weak, which causes bulging of the vein and so damage to the valves. There is a greater risk of getting varicose veins during pregnancy, and if you are very overweight because this increases the pressure in your abdomen and so in your veins. Many other factors have been blamed for varicose veins, such as standing for long periods, crossing your legs while sitting, smoking and poor diet. However, there isn't strong scientific evidence to support these theories. SymptomsThe symptoms from varicose veins don't necessarily match their size, and sometimes there are no symptoms at all apart from the veins being unsightly. Mild symptoms can include:
More severe symptoms are usually associated with the complications of varicose veins. These can include the following. Thrombophlebitis - veins close to the surface of the skin can become painful and reddened due to inflammation or blockage of the vein. This is different to the more dangerous blockage of the deeper veins, known as deep vein thrombosis (DVT). Bleeding - varicose veins near to the surface can bleed if the leg is cut or bumped. This bleeding might become a medical emergency if it can't be stopped. If a varicose vein in your leg is bleeding, you need to lie down, raise your leg and apply pressure directly to the bleeding area. Then seek medical help. Chronic venous insufficiency - the poor flow of blood in the veins ca interfere with the way the skin exchanges oxygen, nutrients and waste products with the blood. When this happens over a long period of time, it is called venous insufficiency, which can cause a number of problems including the following:
Having varicose veins does not mean that you will definitely get complications or chronic venous insufficiency. And although they won't usually get better without treatment, varicose veins only get worse slowly. DiagnosisVaricose veins are easily visible. To work out the position and extent of valve weakness, there are a number of tests a doctor might do.
TreatmentsCompression stockingsThese may relieve the swelling and aching of your legs but do not prevent more varicose veins from developing. They need to be worn during the day and are taken off at night. Graduated compression stockings are tightest at the ankle and get gradually looser further up the leg. These help the blood to flow up towards the heart. Compression stockings are available in various sizes and pressures and it is very important that they fit you properly. They are made to fit your calf diameter, not foot size. Your GP or pharmacist can provide advice. Some people find compression stockings difficult to put on. There are tools available to help, or you could ask for help from a partner or friend. Stockings can be uncomfortable, especially in hot weather. But there is no point in wearing them rolled down. Injection sclerotherapySmall varicose veins can be injected with a chemical that damages the vein walls. As a result, scar tissue forms which closes off the affected vein. Other stronger veins take over and the treated vein, which is no longer filled with blood, becomes less visible. For larger veins, a foam is sometimes injected instead of a liquid (this is called foam sclerotherapy), using ultrasound to guide the injection. Foam sclerotherapy is a new technique, and in a small number of people it can cause complications including blood clots in other leg veins, temporary vision problems, headaches and fainting. Your doctor will give you more information and advise whether foam sclerotherapy is a suitable treatment for you. For best results, you should wear a compression bandage for between three and six weeks after injection sclerotherapy. Injection sclerotherapy can be an alternative to surgery, but varicose veins may come back and nearby veins may become varicose. Often, several injections are needed. One possible side-effect of this treatment is skin discolouration. Your doctor will give you more information. Varicose vein surgeryThis involves removing the affected superficial veins. There are many variations of operation, depending on which veins need treatment. The most common is called ligation and stripping. For more information, please see the separate BUPA health factsheet, Varicose vein surgery. New approachesMinimally invasive techniques such as laser, microwave and radiofrequency treatments are being provided at some hospitals. One of these is endovenous ligation treatment (EVLT), where a fine laser probe is passed inside a vein. This heats the vein and causes it to close up. PreventionAnyone can develop varicose veins, so it may not always be possible to prevent them. Although there are no scientifically proven ways to prevent varicose veins, the following suggestions may be useful:
Further information
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The deep and superficial veins of the leg
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