Varicose veins are twisted, enlarged veins near the surface of the skin. They are most common in the legs and ankles because standing and walking increases the pressure in the veins of your lower body. They usually aren’t serious, but they can sometimes lead to other problems.
Varicose veins are caused by weakened valves and veins in your legs. Normally, one-way valves in your veins keep blood flowing from your legs up toward your heart. When these valves do not work as they should, blood collects in your legs, and pressure builds up. The veins become weak, large, and twisted.
For many people varicose veins are only a cosmetic problem, for some it can cause pain and discomfort. These factors increases your risk in having varicose veins:
- Varicose veins increases with age because of wear and tear of the valves in the veins that help regulate flow of blood.
- Women are more likely to develop varicose veins because of pregnancy, premenstruation or menopause.
- Family history. If other family members had varicose veins, you may have it too.
- Added pressure to veins.
- Standing or sitting for long periods of time. Blood does not flow well.
- Because of increased blood volume and added pressure to veins.
Varicose veins can either be:
- Large varicose veins. Visible, bulging, long and dilated
- Small “spider veins”. Short, fine lines. “starbust” clusters, or a web-like maze. This type cannot be felt.
If you have symptoms of varicose veins, they tend to be mild and may include:
- Protruding or bulging veins.
- Veins that are dark purple or blue.
- A dull ache, burning, or heaviness in the legs. These symptoms may be more noticeable late in the day or after you have been sitting or standing for a long time.
- Mild swelling, usually involving the feet and ankles only.
- Itching skin over the varicose vein.
More severe symptoms or complications include:
- A buildup of fluid and swelling in the leg.
- Significant swelling and calf pain after sitting or standing for a long time.
- Skin color changes (stasis pigmentation) around the ankles and lower legs.
- Dry, stretched, swollen, itching, or scaling skin.
- Superficial thrombophlebitis (when a blood clot and inflammation develop in a small vein near the surface of the skin).
- Open sores (ulcerations).
- Bleeding and/or bruising after a minor injury.
The most important tools in diagnosing varicose veins are the physical examination and medical history. Varicose veins are typically diagnosed based on their appearance, and no other special tests are needed to confirm the diagnosis.
- The medical history will include questions about any vein problems, serious leg injuries, or leg ulcers you have had in the past, as well as any other risk factors you might have, including whether your family has a history of varicose veins. Talk to your doctor about any symptoms you are having (such as swelling, fatigue, or cramps in your legs) and what you have been doing to treat your symptoms, if anything.
- During the physical exam, the doctor will examine your legs and feet (or any other affected areas) for varicose veins. You will likely stand during this test. Varicose veins are usually easy to see. The doctor will also check your legs for tender areas, swelling, skin color changes, ulcers, and other signs of skin breakdown. To study the blood flow in your legs, the doctor may ask you to move your legs around in different positions.
- Ultrasound is done to see if the veins are functioning normally. This is only done when the doctor thinks this will be beneficial especially in severe varicose veins.
Medications are not used to treat varicose veins. Thanks to less invasive procedures, varicose veins can generally be treated on an outpatient basis.
Self-care — such as exercising, losing weight, not wearing tight clothes, elevating your legs, and avoiding long periods of standing or sitting — can ease pain and prevent varicose veins from getting worse.
Wearing compression stockings is often the first approach to try before moving on to other treatments. Compression stockings are worn all day. They steadily squeeze your legs, helping veins and leg muscles move blood more efficiently. The amount of compression varies by type and brand.
Additional treatments for more-severe varicose veins
If you don’t respond to self-care, compression stockings, or if your condition is more severe, your doctor may suggest one of these varicose vein treatments:
- Sclerotherapy. In this procedure, your doctor injects small- and medium-sized varicose veins with a solution that scars and closes those veins.
- Laser surgeries. Doctors are using new technology in laser treatments to close off smaller varicose veins and spider veins.
- Catheter-assisted procedures. This procedure is usually done for larger varicose veins.
- Vein stripping. This procedure involves removing a long vein through small incisions.
- Ambulatory phlebectomy. Your doctor removes smaller varicose veins through a series of tiny skin punctures.
- Endoscopic vein surgery. You might need this operation only in an advanced case involving leg ulcers.
Varicose veins that develop during pregnancy generally improve without medical treatment within three to 12 months after delivery.