Varicose veins are swollen and enlarged veins that usually occur on the legs and feet. They may be blue or dark purple, and are often lumpy, bulging or twisted in appearance.
Varicose veins are a cosmetic concern for many people, appearing as visible blue or purple veins under the skin or twisted, swollen veins that are like cords on the legs. Initially, varicose veins are usually painless, but over time they can cause symptoms and signs such as:
- aching pain or heaviness in the legs, especially when standing and walking
- cramps in the legs, most often at night;
- swelling in the feet and ankles;
- burning or throbbing in your legs;
- dry, itchy and thin skin over the affected vein
- discoloured skin in the area around the varicose veins
- an itchy rash (varicose eczema)
- burning of the skin over the veins
- restless legs.
If you have varicose veins and they don't cause you any discomfort, you may not need to visit your doctor. Varicose veins are rarely a serious condition and may not require treatment.
But speak to your doctor if:
- If the your career or social life is affected by the cosmetic appearance
- your varicose veins are causing you pain or discomfort
- the skin over your veins is sore and irritated
- the aching in your legs is causing irritation at night and disturbing your sleep
Veins have the job of taking blood back to the heart. Blood moves from the superficial veins (found just under the skin) through perforator veins to the deep veins in the leg muscles. Because the leg veins are working against gravity, they have one-way valves inside them to prevent the backflow of blood. Your leg muscles also help blood to flow the right way - when they are used, as in walking; they act as a pump, sending the blood in the veins up to the heart. If the walls of leg veins lose their elasticity and weaken, the valves can stop functioning properly. This means that blood can flow backwards and pool in the veins, causing them to swell and become varicose. Varicose veins usually affect the superficial leg veins (the veins just under the skin).
Certain things can increase your chances of developing varicose veins, such as:
- being older
- having a close family member with varicose veins
- being female
- being overweight
- having a job that involves long periods of standing
- being pregnant
- In general, varicose veins are not dangerous. However, some people experience significant discomfort associated with their varicose veins. Skin changes can also occur, including discolouration of the skin over the veins.
- Occasionally, people with varicose veins develop ulcers on the legs, usually near the ankles. These ulcers can be extremely painful and take a long time to heal. They are prone to secondary infection if untreated.
- A blood clot and inflammation in the varicose veins is another possible complication. This is known as thrombophlebitis. Bleeding from varicose veins is another possible, but rare, complication.
- Doctors can often diagnose varicose veins by simply examining the veins in the legs. Your doctor will want to look at the veins in your legs when you are standing up, and examine the skin of your legs too.
- Your doctor may recommend taking photos of the areas affected to track progress of the disease or to show improvements after treatment.
- Your doctor may recommend having an ultrasound scan to look at the veins in your legs, check for blood clots and check whether the valves in the veins are functioning properly.
- trunk varicose veins – these are near to the surface of the skin and are thick and knobbly; they're often long and can look unpleasant
- reticular varicose veins –these are red and sometimes grouped close together in a network
- telangiectasia varicose veins – also known as thread veins or spider veins, these are small clusters of blue or red veins that sometimes appear on your face or legs; they're harmless and, unlike trunk varicose veins, don't bulge underneath the surface of the skin.
Many people don’t need any specific treatment for varicose veins other than self-care measures. However, without treatment, varicose veins do tend to get worse with time. One exception to this is varicose veins that develop during pregnancy, which generally get better within several months of the birth.
The aim of treatment is to ease symptoms, improve appearance and prevent complications such as leg ulcers. Varicose veins can usually be successfully treated, but new varicose veins are still likely to develop over time.
These days there are several non-invasive or minimally-invasive treatment options for varicose veins. These can be done as outpatient procedures and don’t have a long recovery time, so are often recommended instead of surgery.
Compression stockings, taking regular exercise and elevating the affected area when resting are sole/ancillary recommended measures advised to the patients in the beginning.
The most common treatment options include:
- Surgery- ligation and stripping: the affected veins are surgically removed.
- Minimally invasive percutaneous intervention
- endothermal ablation – where heat is used to seal affected veins using a small fibre (size of a needle)
- this uses special foam agent to occlude the veins that are not amenable to ablation (due to technical reasons)
There's little evidence to suggest you can stop varicose veins getting worse or completely prevent new ones developing.
But there are ways to ease symptoms of existing varicose veins, such as:
- avoiding standing or sitting still for long periods and trying to move around every 30 minutes
- taking regular breaks throughout the day, raising the legs on pillows while resting to ease discomfort
- exercising regularly – this can improve circulation and help maintain a healthy weight
- losing weight if you are overweight
- avoiding clothes that are tight around the legs, groin and waist
- keeping your legs elevated when you are sitting
Surgery for varicose veins can be very effective and usually leaves little in the way of scars.
- Ambulatory phlebectomy : is usually used for small veins that are close to the skin surface. It involves removing varicose veins in the lower leg through a series of tiny skin punctures.
- Vein stripping and ligation: is where longer veins are tied shut and removed through small cuts in the skin. This type of surgery is usually used to treat more severe cases of varicose veins.
Laser ablation offers many advantages over surgery for most if not all patients. To enlist a few of the advantages-
- avoiding standing or sitting still for long periods and trying to move around every 30 minutes
- taking regular breaks throughout the day, raising the legs on pillows while resting to ease discomfort
- exercising regularly – this can improve circulation and help maintain a healthy weight
- losing weight if you are overweight
- avoiding clothes that are tight around the legs, groin and waist
- keeping your legs elevated when you are sitting
If you have varicose veins, ask your doctor about the most appropriate type of treatment for you. In general, it will depend on where your varicose veins are and how extensive they are. Treatments aim to either close off the varicose veins or remove them.
Also ask about the side effects of different treatments. Common short-term side effects of many treatments for varicose veins include swelling, bruising and mild pain. Infection is also a risk.