Varicose Veins: Causes, Symptoms, Prevention, and Treatment

Varicose veins are enlarged, twisted, swollen blood vessels that lie just under the skin's surface. These vessels are found on the lower body and appear blue or purple because of poor blood flow. While this may or may not cause discomfort, it can lead to other medical problems. Varicose veins are often a source of embarrassment more than a health issue.

What causes varicose veins?

Varicose veins can develop when the veins or valves become weak or damaged. Veins have valves, or flaps that open and close, to keep blood flowing toward the heart and prevent it from backing up or flowing in the wrong direction. If the vessel becomes weak or the valves are damaged, the blood flow changes and slows, and blood collects in the veins. The veins become larger, stretching to accommodate more blood and varicose veins develop as a result.

Who’s at risk?

Anyone can develop varicose veins. Certain factors can increase the risk:

• Aging causes valves to begin to wear out and leaking can occur. Veins also do not retain shape as well and are unable to stretch and return to their previous shape.
• Gender: Females are at higher risk of developing varicose veins. Hormones related to the menstrual cycle and pregnancy cause veins to relax. Medications with hormones can raise this risk.
• Family history increases the risk.
• Obesity: Extra weight puts additional pressure on the blood vessels, making it harder for them to work correctly.
• Tobacco use causes blood vessel damage resulting in varicose veins or other vascular diseases.
• Activity levels like long periods of sitting or standing lead to decreased circulation. Movement is essential to proper blood flow.
• Wearing tight-fitting clothing (pants or belts) can decrease blood flow.
• Health conditions such as constipation can cause increased pressure on the veins and lead to varicose veins.
• Injury to the leg.

Symptoms

Symptoms of varicose veins include:

• Bulging, blue, or purple veins.
• Large, twisted, knot-like veins.
• Swelling in the legs.
• Heaviness in the legs or feet, particularly after activity.
• Itching.
• Pain or no pain: Aching or muscle cramps may be experienced, though there may be no complaint of pain.
• Skin color changes: The skin around the varicose veins may become discolored if left untreated.

Spider veins often accompany varicose veins. These vessels are smaller, with red or purple lines closer to the surface of the skin. These vessels may be in other areas of the body, such as the face.

Varicose veins develop in the lower legs; however, they can occur throughout the lower body. They may be found on the thighs, feet, ankles, testicles, vaginal, or rectal areas as well.

How are varicose veins diagnosed?

Varicose veins are easily seen. Your healthcare provider can diagnose this disorder during your physical examination. You may or may not have symptoms to report, but if you do, be sure to tell your provider of anything you notice.

Testing is unnecessary, though your provider may order an ultrasound to check blood flow. This is not necessary for diagnosis but may determine if other health conditions are also involved.

Treating varicose veins

Your healthcare provider may determine that your varicose veins may not pose a health risk and invasive treatment is not necessary. Unsightly varicose veins often require only basic management.

Management includes:

• Elevating your legs above your heart three to four times a day for 15 minutes to reduce swelling.
• Moving as much as possible if sitting or standing for long periods increases circulation.
• Wearing compression stockings daily prevents blood from pooling in the veins.

If your healthcare provider determines further treatment is necessary, you will likely be treated by a specialist or vascular surgeon. Medical treatments include:

• Sclerotherapy is a procedure in which the provider injects a solution into the vein that makes the vein walls stick together, stopping blood flow, and in time the vein closes and disappears.
• Thermal ablation uses lasers to close and cut away the damaged blood vessel.
• Vein stripping is a procedure where the provider removes the vein to prevent it from recurring.

These treatments can be invasive and risk complications or side effects. Research shows as many as half of the patients who have undergone vein stripping and thermal ablation have varicose veins return within five years. Side effects of these treatments can include:

• Scarring.
• Burns.
• Infection.
• Nerve injury.
• Blood clot.

Veins have also returned with sclerotherapy and require additional treatment. It also has side effects, including:

• Redness or bruising.
• Discolored or brown areas for several months at the procedure site.
• Hardened areas where the veins were treated.

Invasive treatments may not prove to be beneficial and are not guaranteed.

Can varicose veins be prevented?

Depending on your risk factors, you may not be able to avoid varicose veins. However, you can make lifestyle changes and reduce some of the risks. Prevent varicose veins by:

• Maintaining a healthy weight.
• Exercising regularly.
• Avoiding tight clothing or high heels.
• Elevating your feet while sitting.
• Quitting smoking.
• Using compression stockings before symptoms start will help reduce the likelihood of symptoms developing.
• Staying active often and avoid sitting or standing for long periods.
• Monitoring your blood pressure.

Complications

While varicose veins are not considered serious in most cases, some people may experience complications, including:

• Blood clots.
• Swelling or infection of the vein.
• Open wounds.
• Bleeding.

Notify your healthcare provider if any of these situations occur.

Varicose veins often look unappealing but are not generally a cause of health concerns. Minimal treatment is typically required. There is little to do to prevent varicose veins. However, lifestyle changes may help decrease the risks or severity.