When to worry about varicose veins is a question that most people never ask themselves. This is mainly because, until you have them, you will never really understand the severity of the situation. One of the first steps in understanding symptomatic varicose veins is to understand what they are and how they form.
What are varicose veins?
Varicose veins develop when valves in your veins become damaged, allowing blood to pool and flow backward through the vein rather than moving forward toward the heart. Varicose veins can be mild and barely noticeable, or they can be painful and unsightly. They most often appear in the legs and most commonly affect people who are middle-aged or older.
What causes varicose veins?
Most people don’t know what causes their varicose veins to form until they experience them. Varicose veins usually develop as you age, but there are other factors that can increase your chances of getting them:
If you have a family history of varicose veins, you are more likely to develop them yourself. If your parents or grandparents had varicose veins, there’s a 50% chance that you will too. Inherited genes can make it more likely that certain diseases will occur. This is called genetic inheritance. If one member of your family has varicose veins, the chances are higher that other members will also have them.
Obesity can cause varicose veins by putting pressure on the veins in your legs, which can cause them to swell or stretch. Over time, this can lead to weakened vein walls, which can rupture and cause bleeding or bruising.
Being overweight or obese also increases your risk of developing venous insufficiency, a condition where valves in your veins don’t close properly and blood pools in the veins. This can lead to varicose veins or spider veins (smaller varicose veins).
The main cause of varicose veins is age. As we get older, the valves in our veins can become less effective at keeping blood flowing toward the heart. This means that blood can pool in the legs and form venous insufficiency (a condition where the pressure in your veins is too low).
Pregnancy is the most common time for varicose veins to develop. The reason is that during pregnancy, there is a large amount of pressure on the veins in your legs. Pregnancy-related varicose veins are usually just small, red spider-like veins in the skin on top of the ankle. They are also called “stretch marks” because they look like red stretch marks that appear on other parts of your body during pregnancy. These spider veins can be painful and cause itching, burning, or tingling sensations in your legs and ankles.
Birth control pills and hormone therapy
Birth control pills and hormone therapy are used to treat many conditions, including abnormal uterine bleeding and endometriosis. These medications contain estrogen, which increases the blood supply to the uterus. This can cause the veins in the legs to enlarge or become more visible. Hormone therapy may also cause varicose veins if you have a family history of vein disease or if you take birth control pills before age 20.
Strenuous exercise can increase blood flow to your legs and cause them to swell temporarily. This can also make varicose veins more noticeable by making them larger and more visible through your skin’s surface. Walking uphill or jogging on a treadmill for an extended period of time increases circulation throughout your body, including in your legs, which can lead to swelling and varicose veins.
Blood clots in the legs (deep vein thrombosis)
Blood clots can form in your leg veins when they become enlarged and stretched out. This is especially common if you’re overweight or have other medical conditions that make it hard for your blood to clot normally. The risk of blood clots increases during pregnancy, as well as during and after childbirth.
When to Worry About Varicose Veins
If you have varicose veins, the most important thing is to have them evaluated by a physician. Varicose veins can be treated successfully by conservative methods, and the earlier treatment begins, the better the outcome for most patients. The following are signs that suggest that your varicose veins may need further evaluation:
- Pain or discomfort in your legs
- Swelling of your ankles or calves
- Progressive worsening of your varicose veins/li>
- Discoloration or thickening of the skin overlying a varicoid vein
- You have swollen ankles permanently
Varicose veins are usually diagnosed by a vein specialist (a vascular surgeon or a dermatologist). Diagnostic tests may include:
The doctor can determine whether there are varicose veins by examining the skin and feeling for enlarged, twisted veins in the legs. Sometimes the doctor may use an instrument called a Doppler ultrasound machine to find out how severe the varicose veins are.
To see how well your leg muscles can squeeze blood back up to your heart, you’ll be asked to stand on your feet for at least 10 minutes with your legs straight and spread apart. If you have poor muscle function, you will have difficulty standing erect with your legs wide apart for this time period. Compression tests are not very accurate in diagnosing varicosis because they only measure the ability of leg muscles to compress blood against gravity, which is only one factor involved in the circulation of blood back up into the heart.
This procedure involves injecting a special dye into an arm vein that travels through a vein in your groin area and into one or more of your legs (usually both). This allows doctors to see whether there are any problems with blood flow through any of these veins on an X-ray image.
How are varicose veins treated?
The treatment for varicose veins depends on their cause. If the veins have become damaged, they may need to be treated by a doctor. In some cases, blood-thinning medicine will be used to reduce the thickness of the blood and prevent clots from forming in the veins.
Compression stockings (also known as support hose) are used to help with symptoms caused by superficial varicose veins in the legs. The stockings are tight-fitting and feel warm when worn. They should always be worn at night and during periods of long-standing. Compression garments are available from pharmacies without prescription; however, your doctor may recommend specific brands or models which provide the best results for you.
Surgery is recommended for people with severe varicose veins or those who have already tried compression stockings and other non-surgical treatments. The procedure involves removing the damaged vein or part of the vein. In some cases, multiple veins are removed at once. Surgery has the highest success rate and is most effective when performed by an experienced vascular surgeon.
Sclerotherapy is the most common type of treatment for varicose veins. It’s a simple procedure done in your doctor’s office or clinic. Your doctor injects a chemical into the vein to make it shrink and close off. The chemical may be injected directly into the vein or sprayed onto it. The main risks of sclerotherapy include bleeding, infection, bruising, and skin discoloration (hyperpigmentation). Rarely sclerotherapy can cause scarring or ulceration of the vein.
Laser surgery is another option for treating varicose veins. It uses heat to shrink and destroy affected veins. Laser therapy is usually only used on smaller varicose veins that aren’t causing symptoms such as leg pain or swelling.
Endovascular embolization is a procedure used to treat varicose veins. It can be done in a doctor’s office or outpatient surgery centre. The procedure involves blocking the blood flow to the vein with tiny particles. These particles are injected into the vein through a thin tube called a catheter. The particles then block the vein and prevent blood from flowing through it.
Radiofrequency ablation uses a high-frequency electrical current to heat and destroy tissue. A small probe, called a catheter, is inserted into the vein through a needle in your groin or thigh and moved along it with ultrasound guidance until it reaches the bulge at the top of the vein. The probe delivers radiofrequency energy through electrode contacts on its surface that contact the wall of the vein. This causes the vein to burn and collapse, sealing off your blood from flowing back into it from behind. The burned tissue will then slough off naturally over time, leaving behind healthy veins that can carry blood down from your leg muscles without any obstruction.
Complications caused by varicose veins
Skin changes — varicose veins may appear as red or purple bulges on your skin. They may also cause discoloration and scarring if left untreated over time.
Ulcers — varicose veins are often associated with superficial venous insufficiency (SVIs), which can lead to painful ulcers on the skin surface overlying the vein. This is most common in people with diabetes but can also occur in people without diabetes who have other conditions that affect blood circulation in the legs, such as obesity and smoking.
Thrombophlebitis — inflammation of a varicose vein due to blood clotting inside it (usually along its length). Thrombophlebitis causes swelling, tenderness, and warmth around the affected vein. It’s often accompanied by redness.
Varicose veins can be treated, and there are safe minimally invasive options available. With a proper diagnosis, your consultant will have a better sense of the severity of your symptoms and can find the best course of action for you.
- What to Avoid With Varicose Veins
- Can Varicose Veins Go Away on Their Own?
- Why You Should Not Ignore Your Varicose Veins
- Understanding your Varicose Veins
- Varicose Veins Diagnosis & Management Guidelines by NICE