Varicose veins explained including treatment and surgery

Photo credit: Paula Daniëlse - Getty Images
Photo credit: Paula Daniëlse - Getty Images

From Netdoctor

Suffering from swollen and enlarged veins on your legs? You are certainly not alone. Varicose veins are extremely common, affecting up to 30 per cent of adults in the UK, and for the most part do not lead to serious problems or require medical treatment.

For many people, varicose veins are an aesthetic concern. However, sometimes they can cause pain, swelling, heaviness, aching and discomfort around the affected veins. Thankfully, there are steps you can take to prevent varicose veins from worsening.

We spoke to Professor Mark Whiteley, venous specialist at The Whiteley Clinic, and Dr Ann Donnelly, a GP working in palliative medicine, about varicose vein causes, diagnosis and treatment options:

What are varicose veins?

Varicose veins occur when your veins become dilated and full with blood. They often appear enlarged and tend to present as a blue-purple colour, usually on the lower legs.

'Veins return blood to the heart,' says Dr Donnelly. 'Varicose veins occur when a valve in the vein becomes damaged. Normally the heart pumps bright red blood into arteries to supply the extremities. Once vital oxygen and nutrients have been delivered, the veins return the deoxygenated bluish blood to the heart and lungs to replenish.'

The valves in your legs prevent blood from staying stagnant in the feet. 'With the next pump of the heart, the blood is pushed along to the next valve,' she continues. 'When a valve is damaged, the blood accumulates and bulges the vein in the areas before the damaged valve. This can give rise to unsightly veins on the skin surface.'

Varicose veins usually come on with advancing age. They are often no great inconvenience apart from being unsightly, but can mean you are at higher risk for developing leg ulcers or clots in the superficial veins of the leg. These can then inflame the area increasing the risk of thrombophlebitis (inflammation of the superficial blood vessels) or even a deep vein thrombosis (DVT). DVT can then put you at increased risk of clots on the lungs (pulmonary embolus).

'In their simplest form, varicose veins can be identified as bulging veins which protrude from the legs,' says Professor Whiteley. 'However, half of varicose veins sufferers will show no overt signs of the condition, as many problematic veins remain hidden under the skin.'

What's the difference between veins and arteries?

The heart pumps blood through the arteries to all parts of the body, including the vital organs, plus the head, arms and legs. The blood is then spread through tiny vessels called capillaries which form a network. Later it is returned in increasingly large vessels – veins – which complete the circulation of blood back to the heart.

'Both arteries and veins transport blood,' says Professor Whiteley. 'However, the main difference between them is the specific job they carry out within the body. Arteries carry blood containing oxygen and nutrients at high pressure from the heart around the body.

'Veins bring the blood back from the body to the heart under low pressure, carrying carbon dioxide and waste products,' he continues. 'You can feel arteries as they pulsate as they have high pressure, whereas veins collapse when felt, as they have low pressure.'

Varicose veins symptoms

If you suffer from varicose veins, you may experience the following symptoms:

  • A tired, heavy or achy feeling in your legs.

  • Pain that worsens while standing or sitting for a long time, and in hot weather.

  • Burning, throbbing or cramping sensations and swelling in your lower legs.

  • Blue or purple veins most easily seen under the skin while standing.

  • Enlarged veins that appear twisted, swollen and bulging.

  • Painful lumps, which can indicate phlebitis (inflammation of a vein).

  • Night-time cramps in the legs or restless legs syndrome.

  • Spider veins in the affected leg, known as telangiectasia.

  • Skin in the affected area is red and dry, known as venous eczema.

  • Itching around one or more of your veins.

  • Skin discolouration around a varicose vein.

  • Tender or painful skin on the inner part of the lower leg.

Varicose veins risk factors

Certain factors can increase your risk of developing varicose veins, including:

• Pregnancy

When you are pregnant, the volume of blood in your body increases, which puts extra strain on your veins. Hormonal changes during pregnancy can also cause the walls of blood vessels to relax, along with the pressure that the growing pregnancy exerts from the pelvis onto the lower limb veins, increasing the likelihood of developing varicose veins.

• Family history

Genetics play a part too. Your risk of developing varicose veins increases if a close family member has the condition.

• Your occupation

If your job involves prolonged periods of standing or sitting, you may be more susceptible to varicose veins. This is because your blood does not flow as easily when you're in one position for long periods of time. The leg muscles around the veins normally act as a pump to help return the blood upwards, known as the 'venous pump mechanism'. Standing still for long periods does not give this mechanism a chance to work as effectively and the blood pools.

• Sex

Women are more likely to be affected by varicose veins than men. Symptoms can worsen before and during menstruation due to changes in hormone levels. Hormone treatments, like the pill, can also increase your risk.

• Obesity

Being overweight puts extra demand on your veins. As a result, they have to work harder to transport blood back to your heart. This puts pressure on the valves that regulate blood flow, which may cause them to leak.

• Age

Ageing causes wear and tear throughout the body, including your veins. Over time, they lose their elasticity and the valves inside them stop functioning as they are supposed to.

Varicose veins diagnosis

It's easy to spot the unsightly bumps on the legs. 'These may be blue, green or even colourless depending on how deep the varicose vein is,' says Professor Whiteley.

However, up to half of all varicose veins sufferers will show no overt signs of the condition until a complication arises, he says, 'as the troublesome veins can remain hidden deeper under the skin and cannot be seen without a duplex ultrasound scan.'

If you think you have varicose veins, have them checked out by a professional who specialises in venous conditions, Professor Whiteley advises. 'They can have serious medical consequences and should not just be considered as an aesthetic problem.'

'Although many people look for a vascular specialist, vascular means arterial,' he continues. 'Therefore, it's important to speak to a venous specialist to get the best opinion.'

When to seek help for varicose veins

If you have varicose veins and they do not cause you any discomfort, you may not need to see a doctor. However, it's worth making an appointment if you experience one or more of the following:

  • Your varicose veins become painful or uncomfortable.

  • The skin over your veins is sore and irritated.

  • The aching in your legs is disturbing your sleep.

  • Fluid accumulates in your legs.

  • Standing up for long periods causes discomfort.

Your doctor will examine your legs to confirm the diagnosis and may refer you to a vascular specialist for further investigation if required. The specialist will likely arrange a duplex ultrasound scan to locate any damaged valves. This will help them to treat any complications, such as leg ulcers, swelling or skin discolouration. Ask your GP to refer you if you experience any of the following symptoms with varicose veins:

  • Bleeding from the veins - this requires immediate referral.

  • Skin changes, such as pigmentation or eczema - a brown red deposit can develop in the skin from a compound called haemosiderin that deposits due to the sluggish blood flow, and this can then encourage venous eczema.

  • Superficial vein thrombosis - the appearance of hard, painful veins.

  • Venous leg ulcer - a skin break below the knee that has not healed in two weeks.

  • A healed venous leg ulcer.

Varicose veins treatment

There are a number of cutting-edge techniques available for treating varicose veins quickly and effectively, says Professor Whiteley. 'We have come a long way since the outdated technique of stripping which was not only very painful, but it also stimulated the varicose veins to grow back,' he explains.

The most common varicose vein treatments include:

  • Endothermal ablation: heat is used to seal the affected veins.

  • Ligation and stripping: surgically removing the affected veins.

  • Sclerotherapy: using foam to close the veins.

The NHS does not provide treatment for cosmetic purposes, so if you are concerned about the way they look, you will have to pay for cosmetic treatment privately.

Varicose veins prevention

There's little evidence to suggest you can prevent varicose veins from developing, but if you do have them, the following could ease symptoms:

✔️ Avoid standing or sitting for long periods

Sitting still for long periods can make varicose veins worse, so bursts of activity interspersed with sitting is important, says Dr Donnelly. Also, avoid crossed legs while sitting – this restricts the return of blood to the heart.

✔️ Take regular breaks

Stop whatever you're doing every 30 minutes or so. While resting, keep your legs elevated as much as possible. 'Lying on your back with your legs raised against a wall can relieve any stagnant flow,' says Dr Donnelley.

✔️ Exercise regularly

Exercise gives your circulatory system a welcome boost. 'You can assist the flow of blood and decrease the bulging associated with varicose veins through regular exercise,' says Dr Donnelley. 'Contracting muscles around the veins assist the pumping action to return blood to the heart'

✔️ Wear compression stockings

Wear lightweight elastic compression stockings or support tights to promote circulation, especially if you're pregnant. 'Restrictive under garments may prevent good blood return in the groin area and worsen flow, while support tights can give a little extra surface pressure to push the blood back to the heart,' says Dr Donnelley.

✔️ Take care of your health

It's important to maintain a healthy weight – 'extra weight prevents flow back to the heart,' says Dr Donnelley – and eat a balanced diet with plenty of fresh fruits and vegetables. They're rich in rutin, a flavonoid known to lower blood pressure and strengthen blood vessels. Avoid fatty foods, excess alcohol, and 'excess salt, as this causes water retention,' she continues. 'Stay hydrated, as this will keep your circulation healthy.'

Last updated: 07-01-2021

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